摘要
我国自2019年全面建成城乡统一的居民基本医保制度后,医保服务“城乡二元”割裂问题得到了制度性解决,缩小地区间医保权益差异则成为新的关注热点与改革命题,也成为实现“共同富裕”的必由民生道路。准确理解城乡居民基本医保服务的经济约束性和评估其地区间均等性,将为全民医保体系优化完善提供参考。本研究首先基于准公共产品视角,核心围绕“逆向选择”和“道德风险”概念,对医保服务全生命周期过程进行理论阐释,在此基础上界定了一种基于医保服务全生命周期过程且在经济约束下的均等性。而后,基于此种均等性界定,本研究搜集全国31个省份公开数据,通过基尼系数(Gini Index)和泰尔指数(Theil Index)两类均等性评价指数,对医保服务地区间均等性展开实证评价。发现医保服务在筹资、实施效果方面具有较好的地区间均等性,其中中部、东北部区域的地区间均等性优于西部、东部,区域间均等性优于区域内均等性。最后从医保服务有效提供、医保服务合理使用以及医保服务地区间均等性提升三方面提出政策建议。
China has fully established a unified basic medical insurance scheme for both urban and rural residents in 2019,since when the imbalance of medical insurance between urban and rural has been systematically solved,and narrowing the gaps between regions has become the next reform direction,and a must-go way to realize common prosperity.Understanding the economic constraint and interregional equality of the new-established national medical insurance services for for urban and rural residents accurately is necessary for the optimization of the universal medical insurance system.From the perspective of the quasi-public goods,this study firstly analyzes the whole lifecycle process of medical insurance services around two key concepts of"adverse selection"and"moral hazard",based on which"equality"is defined.Then,under the definition,this study collects empirical data of 31 provinces in China and evaluates the interregional equality of medical insurance services currently,by constructing two types of indicators,i.e.Gini Index and Theil Index.Results show that medical insurance services has achieved great interregional equality in the aspects of financing and implementation.The interregional equality in central and northeast China is better than that in west and east regions,and the equality between four regions(i.e.,east,central,west and northeast China)is better than the intraregional equality.Based on findings above,this study put forward policy considerations in three aspects,i.e.reaching the optimal supply of medical insurance services,the rational use of medical insurance services and the improvement of the interregional equality.
作者
周若婧
黄璜
江滨
ZHOU Ruojing;HUANG Huang;JIANG Bin
出处
《社会政策研究》
CSSCI
2022年第2期53-66,共14页
Social Policy Research
关键词
城乡居民基本医保
准公共产品
逆向选择
道德风险
均等性
Basic medical insurance for urban and rural residents
Quasi-public goods
Adverse selection
Moral hazard
Equality
