我国城镇医疗保险制度改革的实证研究
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摘要
如何建立完善的医疗保险制度是公认的世界性难题。德国早在1883年就通过立法在世界上首先实行了社会医疗保险制度,迄今,全世界已有160多个国家和地区实施了医疗保险制度。100多年来,对于医疗保险制度理论和实践方面的研究和探索一直都没有停止过,但目前尚无一个国家能够给出一个可资他国“套用”的医疗保险“标准模式”,几乎每个国家的医疗保险制度都存在不尽完善的地方。
我国医疗保险制度改革从上世纪90年代初开始,经过了十多年的不懈努力与探索,先后建立了城镇职工基本医疗保险(1998)、新型农村合作医疗(2003)和城镇居民基本医疗保险(2007),初步建立起一个有中国特色的基本医疗保险制度,取得了医疗体制改革的阶段性胜利。
目前,“全民医保”在制度层面已经实现,所有的中国公民均可通过参加相应的医疗保险获得基本的医疗保障。具体来说,城镇用人单位及其职工应强制参加城镇职工基本医疗保险,医疗保险费由城镇用人单位和职工共同缴纳；无雇工的个体工商户、未在用人单位参加社会保险的非全日制从业人员以及其他灵活就业人员可以选择参加城镇职工基本医疗保险；城镇未就业的居民可以参加城镇居民基本医疗保险；农村居民可以参加新型农村合作医疗；进城务工的农村居民可根据自身情况选择参保,可以参加户口所在地的新农合,部分地区已经可以选择参加城镇居民基本医疗保险或城镇职工基本医疗保险；国家及事业单位的工作人员和离退休人员有公费医疗；所有公民还可以购买商业医疗保险获得补充保险。截止2010年末,全国参加城镇基本医疗保险人数为4.32亿人,其中参加城镇职工基本医疗保险、城镇居民基本医疗保险的人数分别达到了2.37亿人、1.95亿人①；同期全国城镇人口为6.66亿,城镇人口享有基本医疗保险的比率达到了64.9%②。医疗改革在医疗保险的覆盖层面取得了骄人的成绩。
与此同时,医疗保险制度完善过程中也暴露出不少的问题。本文的研究是在肯定我国过去医疗保险制度改革取得的成就基础上,以医疗保障制度相关的经济理论为指导,利用微观调查数据,运用实证分析的方法,对我国城镇医疗保险体系进行评估,指出其需要进一步完善之处,为进一步完善我国医疗保障制度提供建议。
本文的第一章,在概括性的描述我国城镇医疗保险制度现状的基础上,提出本文所要研究的问题及采用的研究方法,对与本文的研究相关的基本概念做了界定；第二章简要回顾了我国医疗保障制度体系改革的主要历程,重点介绍了城镇居民基本医保政策的实施和特点,并对本文采用的数据——城镇居民基本医疗保险试点评估调查数据进行了简要描述；第三章至第六章是本文的核心部分,主要由四篇论文构成,从不同的角度评估我国城镇医疗保险制度：
其中第三章实证检验我国城镇医疗保险中的逆向选择问题。逆向选择是指在自愿参加原则下,由于参保者拥有自由选择权,个人可以根据自身的家庭经济条件或者健康状况选择是否加入医疗保险计划,并且由于不同人群的疾病风险不同,最终可能导致在统一的缴费条件下,高健康风险者选择加入医疗保险计划,低健康风险者选择不加入医疗保险计划,导致被保险群体的整体风险较高。本文的实证结果证实了城镇居民医保中逆向选择的存在：无论是主观健康风险(自我报告的健康状况较差)相对较高的群体还是客观健康风险(门诊与住院医疗服务利用率更高)都更容易选择参加城镇居民医保。较高的疾病风险会带来更高的保险赔付,高风险人群向城镇居民医保集中,必然造成保险基金的亏损和透支,从而最终导致巨大的医疗费用支出,增加政府的财政负担,影响公共医疗保险计划的可持续性。同时也会使医疗保险难以实现普遍覆盖,共担风险的能力减弱。文章最后对如何解决逆向选择问题也提出了建议。
本文接下来的第四章通过考察一类特殊的未参保人群——“医保夹心层”来研究医疗保险对健康及医疗服务利用的影响。医保夹心层是指由于其就业单位不缴或欠缴医疗保险费而被迫无法纳入医疗保险体系的城镇职工。这样一部分职工,因为其就业的企业没有支付医保费而没有被城镇职工基本医疗保险覆盖,但他们又不能加入农村合作医疗(因为是城镇户口),也不属于公费医疗制度范围(因为不是国家工作人员),也不能加入城镇居民基本医疗保险(因为他们有工作或者有就业单位)；他们一般也没有购买商业保险(因为商业保险保费太高)。
国内外大量健康经济学文献表明,没有医疗保险或者失去医疗保险会对无保险者的健康产生各种负面影响,包括医疗服务利用率降低、健康保健意识更差、保健预防性行为更少、死亡率提高等。本文利用国务院关于城镇居民基本医疗保险试点评估调查2007—2009年的跟踪调查微观数据,研究了医保夹心层的健康状况及其医疗服务利用情况。我们发现,在控制了个人特征、就业状况、保险状态以及家庭经济状况后,医保夹心层职工自我报告的健康状况较差,在了解医疗保健知识及主动进行身体检查方面缺乏积极性,但更经常参加锻炼活动；医保夹心层更少接受住院服务,在门诊服务方面没有差别。此外,医保夹心层的医疗费用显著增加,感受的医疗负担更重。
与医保夹心层形成鲜明对比的是,一般的无保险人群自我报告的健康状况要明显好于保险人群。这一发现与医疗保险“逆向选择”理论吻合,同时这一发现也从另一方面印证了“医保夹心层”人群的劣势地位。与一般的无保险人群不同,此类职工处于无保险状态通常是因为企业没有缴纳或者拖欠医保费,而非“自愿”无保险。不过,无保险人群的医疗服务利用普遍较低。因此,总体而言,无保险人群在医疗服务的利用上处于劣势,夹心层人群尤其如此,这种劣势会进一步影响该类人群的健康。
医疗保险不仅可以直接影响对医疗服务的使用,进而影响到个人的健康状况,与此同时,医疗保险可能对家庭的经济资源分配也会产生重大影响,比如家庭的消费、收入能力等。本文接下来的两章则主要从家庭消费保险和收入分布的角度分析公共医疗保险对家庭消费以及收入能力的影响。
其中第五章研究我国城镇家庭面临大病冲击时的消费保险能力。消费保险是指家庭在面临突如其来的外生冲击时(如家庭成员失业、生病等)保持消费水平稳定或者不变的能力。本文主要考察我国城镇家庭在面临大病冲击时的消费保险能力。大病冲击在我国具有普遍性和严重性两个特点：对于我国的城镇居民而言,大病冲击是仅次于失业最可能致贫的事件；其次,伴随大病冲击而来的高额医疗费用增加了家庭的经济负担,严重影响了家庭生活水平的提高。对于遭受大病冲击的家庭,他们能够在多大程度上消化大病冲击的影响,这是本章主要关心的问题。此问题的回答对于我国进一步深化医疗体制改革有一定的政策借鉴意义。
本章的实证分析结论显示,大病冲击显著降低了家庭收入,增加了医疗负担,同时也显著降低了家庭的消费水平,因此拒绝了完全保险假设,但基于不同收入组的检验显示,高收入家庭能对大病冲击进行完全消费保险,中低收入家庭不能对大病冲击进行完全消费保险。而基于不同医疗保险组别的进一步的实证研究表明,各种医疗保险释放了医疗消费需求,但在家庭面临大病冲击时的消费保险过程中起到的作用有限。
与发达国家相比,发展中国家的社会保障制度比较落后,家庭主要依靠非正式的保险机制应对大病冲击。目前我国城镇虽然已经建立起比较完善的医疗保障制度,但是本文的实证表明,我国城镇家庭不仅不能对大病冲击进行完全的消费保险,还主要依赖非正式的保险机制来抵御大病冲击的负面影响。伴随医疗保障的逐步完善,居民的医疗需求因此得到了一定的释放,但是家庭的医疗负担并不会因此就减轻(Wagstaff,2008)。造成这一结果的主要原因可能是：如果在医疗需求的急剧增加的同时,医疗供给却没有相应跟上,医疗服务的价格不仅不会下降,可能还会因此而上升,这样居民的医疗负担可能也会随之增加。由此可见,建立完善的社会保险体系还不能从根本上减轻家庭的医疗负担。要从根本上解决“看病难看病贵”问题,医疗改革还需要从如何增强医疗供给能力入手。
本文的最后一章对比研究了城镇居民基本医疗保险和新型农村合作医疗在缩小收入差距方面的作用。采用面板数据的固定效应模型,该章的实证分析结果表明,以自愿参保和广覆盖为特征的公共医疗保险计划有利于降低了收入不平等程度,但是相比较而言,由于存在较大的地区差别,新农合对农村地区的收入差距的影响总体效果并不明显,而城镇居民医保则显著降低了城镇地区家庭之间的收入差距。相比较而言城镇居民医保对降低收入差距起到显著的作用可能与城镇居民医保降低医疗负担有关,而新农合被证明在初期并没有降低参保者医疗负担的作用。
本文最后对以上的研究做出了总结,从各方面对我国城镇医疗保障制度的进一步完善提出了看法与建议,展望了本文未来研究的方向。
Health insurance is recognized as a worldwide problem. So far, more than 160 countries or regions around the world have established their own medical insurance system, but no one country can provide a "standard model", and almost every country's health insurance system has many difficulties to solve.
From the early 1990s China launched the medical insurance system reform, and after twenty years of effort, has established the urban basic employee medical insurance(UBEMI) for urban workers (1998), the new rural cooperative medical care insurance (NRCMI) for rural people (2003) and urban basic resident medical insurance (UBRMI) for urban non-employed (2007).
In this dissertation, I try to use a unique data set to answer several important questions that are related to the social health insurance in China. The dissertation is structured into seven chapters.
In chapter one, I give a brief introduction to the questions this dissertation focus on and my research framework.
In chapter two, I briefly describe the Chinese medical insurance reforms in the last ten years, especially the URBMI which was just launched in 2007, but now has covered 195 million urban residents.
In chapter three, I examine the problem of adverse selection in URBMI. The results show that adverse selection exists.In particular, individuals with worse health status or higher health risk are more likely to enroll in URBMI than individuals with better health status, and individuals who enroll in URBMI will use more medical services than the uninsured. I also find that employees who already covered by the UEBMI with worst self-reported health status are less likely to buy commercial health insurance than other individuals, and they use more medical services than others who are not covered by commercial health insurance.
In Chapter 4,I focus on health status and the utilization of medical services of the'sandwich'group. Some employees are not covered by any health insurance because their employers do not pay their portion of the insurance premium. And at the same time, those employees are not eligible to join NRCMC (because they are urban residents), the free public health insurance (because they are not government employees), URBMI (because they are employed or had been employed before retirement), and finally they generally cannot afford the private commercial insurance. We call these employees "sandwich" group. Compared with the general uninsured, the sandwich is uninsured mostly because of poor performance of their employers, rather than "voluntary" uninsured. The results show that the'sandwich' group suffers from worse self-reported health status, utilizes less medical services, and have less incentive to get health information and medical examination than others.
In chapter 5, I study whether and how much urban households can insure against a negative health shock, which is very common in underdeveloped countries and is considered one of the most important causes of poverty in China. A serious illness will not only lead to the loss of work ability thus income of a family, but also very likely resulted in a considerable amount of medical expenses during the treatment of the disease. However, the rise of health care costs and the loss of income do not mean that the family's consumption behavior has to be adjusted accordingly because it can usually protect itself from the negative health shock via a variety of formal as well as informal insurance mechanisms, such purchasing health insurance, reducing savings, selling assets, or borrowing from relatives and friends or getting loans from credit institutions. However, since the majority of serious illness is difficult to predict and the loss of family income may be very large, we assume that most families are unlikely to carry out full consumption insurance meaning that they would adjust their consumption behavior whenever there is a negative health shock. Our empirical results show that (1) consumption insurance is not complete, especially for low and mid income families; (2) the health insurance have no significant welfare effects but increase the medical expenditures.
Chapter 6 tries to compare the income redistribution effect of NRCMC and URBMI. The Difference in difference model and fixed effect model estimation results show that the URBMI has reduced the income inequality significantly while the NRCMI has a non-significant effect on income inequality.
The last chapter makes some conclusions and proposes some further improvements.
我国医疗保险制度改革从上世纪90年代初开始,经过了十多年的不懈努力与探索,先后建立了城镇职工基本医疗保险(1998)、新型农村合作医疗(2003)和城镇居民基本医疗保险(2007),初步建立起一个有中国特色的基本医疗保险制度,取得了医疗体制改革的阶段性胜利。
目前,“全民医保”在制度层面已经实现,所有的中国公民均可通过参加相应的医疗保险获得基本的医疗保障。具体来说,城镇用人单位及其职工应强制参加城镇职工基本医疗保险,医疗保险费由城镇用人单位和职工共同缴纳；无雇工的个体工商户、未在用人单位参加社会保险的非全日制从业人员以及其他灵活就业人员可以选择参加城镇职工基本医疗保险；城镇未就业的居民可以参加城镇居民基本医疗保险；农村居民可以参加新型农村合作医疗；进城务工的农村居民可根据自身情况选择参保,可以参加户口所在地的新农合,部分地区已经可以选择参加城镇居民基本医疗保险或城镇职工基本医疗保险；国家及事业单位的工作人员和离退休人员有公费医疗；所有公民还可以购买商业医疗保险获得补充保险。截止2010年末,全国参加城镇基本医疗保险人数为4.32亿人,其中参加城镇职工基本医疗保险、城镇居民基本医疗保险的人数分别达到了2.37亿人、1.95亿人①；同期全国城镇人口为6.66亿,城镇人口享有基本医疗保险的比率达到了64.9%②。医疗改革在医疗保险的覆盖层面取得了骄人的成绩。
与此同时,医疗保险制度完善过程中也暴露出不少的问题。本文的研究是在肯定我国过去医疗保险制度改革取得的成就基础上,以医疗保障制度相关的经济理论为指导,利用微观调查数据,运用实证分析的方法,对我国城镇医疗保险体系进行评估,指出其需要进一步完善之处,为进一步完善我国医疗保障制度提供建议。
本文的第一章,在概括性的描述我国城镇医疗保险制度现状的基础上,提出本文所要研究的问题及采用的研究方法,对与本文的研究相关的基本概念做了界定；第二章简要回顾了我国医疗保障制度体系改革的主要历程,重点介绍了城镇居民基本医保政策的实施和特点,并对本文采用的数据——城镇居民基本医疗保险试点评估调查数据进行了简要描述；第三章至第六章是本文的核心部分,主要由四篇论文构成,从不同的角度评估我国城镇医疗保险制度：
其中第三章实证检验我国城镇医疗保险中的逆向选择问题。逆向选择是指在自愿参加原则下,由于参保者拥有自由选择权,个人可以根据自身的家庭经济条件或者健康状况选择是否加入医疗保险计划,并且由于不同人群的疾病风险不同,最终可能导致在统一的缴费条件下,高健康风险者选择加入医疗保险计划,低健康风险者选择不加入医疗保险计划,导致被保险群体的整体风险较高。本文的实证结果证实了城镇居民医保中逆向选择的存在：无论是主观健康风险(自我报告的健康状况较差)相对较高的群体还是客观健康风险(门诊与住院医疗服务利用率更高)都更容易选择参加城镇居民医保。较高的疾病风险会带来更高的保险赔付,高风险人群向城镇居民医保集中,必然造成保险基金的亏损和透支,从而最终导致巨大的医疗费用支出,增加政府的财政负担,影响公共医疗保险计划的可持续性。同时也会使医疗保险难以实现普遍覆盖,共担风险的能力减弱。文章最后对如何解决逆向选择问题也提出了建议。
本文接下来的第四章通过考察一类特殊的未参保人群——“医保夹心层”来研究医疗保险对健康及医疗服务利用的影响。医保夹心层是指由于其就业单位不缴或欠缴医疗保险费而被迫无法纳入医疗保险体系的城镇职工。这样一部分职工,因为其就业的企业没有支付医保费而没有被城镇职工基本医疗保险覆盖,但他们又不能加入农村合作医疗(因为是城镇户口),也不属于公费医疗制度范围(因为不是国家工作人员),也不能加入城镇居民基本医疗保险(因为他们有工作或者有就业单位)；他们一般也没有购买商业保险(因为商业保险保费太高)。
国内外大量健康经济学文献表明,没有医疗保险或者失去医疗保险会对无保险者的健康产生各种负面影响,包括医疗服务利用率降低、健康保健意识更差、保健预防性行为更少、死亡率提高等。本文利用国务院关于城镇居民基本医疗保险试点评估调查2007—2009年的跟踪调查微观数据,研究了医保夹心层的健康状况及其医疗服务利用情况。我们发现,在控制了个人特征、就业状况、保险状态以及家庭经济状况后,医保夹心层职工自我报告的健康状况较差,在了解医疗保健知识及主动进行身体检查方面缺乏积极性,但更经常参加锻炼活动；医保夹心层更少接受住院服务,在门诊服务方面没有差别。此外,医保夹心层的医疗费用显著增加,感受的医疗负担更重。
与医保夹心层形成鲜明对比的是,一般的无保险人群自我报告的健康状况要明显好于保险人群。这一发现与医疗保险“逆向选择”理论吻合,同时这一发现也从另一方面印证了“医保夹心层”人群的劣势地位。与一般的无保险人群不同,此类职工处于无保险状态通常是因为企业没有缴纳或者拖欠医保费,而非“自愿”无保险。不过,无保险人群的医疗服务利用普遍较低。因此,总体而言,无保险人群在医疗服务的利用上处于劣势,夹心层人群尤其如此,这种劣势会进一步影响该类人群的健康。
医疗保险不仅可以直接影响对医疗服务的使用,进而影响到个人的健康状况,与此同时,医疗保险可能对家庭的经济资源分配也会产生重大影响,比如家庭的消费、收入能力等。本文接下来的两章则主要从家庭消费保险和收入分布的角度分析公共医疗保险对家庭消费以及收入能力的影响。
其中第五章研究我国城镇家庭面临大病冲击时的消费保险能力。消费保险是指家庭在面临突如其来的外生冲击时(如家庭成员失业、生病等)保持消费水平稳定或者不变的能力。本文主要考察我国城镇家庭在面临大病冲击时的消费保险能力。大病冲击在我国具有普遍性和严重性两个特点：对于我国的城镇居民而言,大病冲击是仅次于失业最可能致贫的事件；其次,伴随大病冲击而来的高额医疗费用增加了家庭的经济负担,严重影响了家庭生活水平的提高。对于遭受大病冲击的家庭,他们能够在多大程度上消化大病冲击的影响,这是本章主要关心的问题。此问题的回答对于我国进一步深化医疗体制改革有一定的政策借鉴意义。
本章的实证分析结论显示,大病冲击显著降低了家庭收入,增加了医疗负担,同时也显著降低了家庭的消费水平,因此拒绝了完全保险假设,但基于不同收入组的检验显示,高收入家庭能对大病冲击进行完全消费保险,中低收入家庭不能对大病冲击进行完全消费保险。而基于不同医疗保险组别的进一步的实证研究表明,各种医疗保险释放了医疗消费需求,但在家庭面临大病冲击时的消费保险过程中起到的作用有限。
与发达国家相比,发展中国家的社会保障制度比较落后,家庭主要依靠非正式的保险机制应对大病冲击。目前我国城镇虽然已经建立起比较完善的医疗保障制度,但是本文的实证表明,我国城镇家庭不仅不能对大病冲击进行完全的消费保险,还主要依赖非正式的保险机制来抵御大病冲击的负面影响。伴随医疗保障的逐步完善,居民的医疗需求因此得到了一定的释放,但是家庭的医疗负担并不会因此就减轻(Wagstaff,2008)。造成这一结果的主要原因可能是：如果在医疗需求的急剧增加的同时,医疗供给却没有相应跟上,医疗服务的价格不仅不会下降,可能还会因此而上升,这样居民的医疗负担可能也会随之增加。由此可见,建立完善的社会保险体系还不能从根本上减轻家庭的医疗负担。要从根本上解决“看病难看病贵”问题,医疗改革还需要从如何增强医疗供给能力入手。
本文的最后一章对比研究了城镇居民基本医疗保险和新型农村合作医疗在缩小收入差距方面的作用。采用面板数据的固定效应模型,该章的实证分析结果表明,以自愿参保和广覆盖为特征的公共医疗保险计划有利于降低了收入不平等程度,但是相比较而言,由于存在较大的地区差别,新农合对农村地区的收入差距的影响总体效果并不明显,而城镇居民医保则显著降低了城镇地区家庭之间的收入差距。相比较而言城镇居民医保对降低收入差距起到显著的作用可能与城镇居民医保降低医疗负担有关,而新农合被证明在初期并没有降低参保者医疗负担的作用。
本文最后对以上的研究做出了总结,从各方面对我国城镇医疗保障制度的进一步完善提出了看法与建议,展望了本文未来研究的方向。
Health insurance is recognized as a worldwide problem. So far, more than 160 countries or regions around the world have established their own medical insurance system, but no one country can provide a "standard model", and almost every country's health insurance system has many difficulties to solve.
From the early 1990s China launched the medical insurance system reform, and after twenty years of effort, has established the urban basic employee medical insurance(UBEMI) for urban workers (1998), the new rural cooperative medical care insurance (NRCMI) for rural people (2003) and urban basic resident medical insurance (UBRMI) for urban non-employed (2007).
In this dissertation, I try to use a unique data set to answer several important questions that are related to the social health insurance in China. The dissertation is structured into seven chapters.
In chapter one, I give a brief introduction to the questions this dissertation focus on and my research framework.
In chapter two, I briefly describe the Chinese medical insurance reforms in the last ten years, especially the URBMI which was just launched in 2007, but now has covered 195 million urban residents.
In chapter three, I examine the problem of adverse selection in URBMI. The results show that adverse selection exists.In particular, individuals with worse health status or higher health risk are more likely to enroll in URBMI than individuals with better health status, and individuals who enroll in URBMI will use more medical services than the uninsured. I also find that employees who already covered by the UEBMI with worst self-reported health status are less likely to buy commercial health insurance than other individuals, and they use more medical services than others who are not covered by commercial health insurance.
In Chapter 4,I focus on health status and the utilization of medical services of the'sandwich'group. Some employees are not covered by any health insurance because their employers do not pay their portion of the insurance premium. And at the same time, those employees are not eligible to join NRCMC (because they are urban residents), the free public health insurance (because they are not government employees), URBMI (because they are employed or had been employed before retirement), and finally they generally cannot afford the private commercial insurance. We call these employees "sandwich" group. Compared with the general uninsured, the sandwich is uninsured mostly because of poor performance of their employers, rather than "voluntary" uninsured. The results show that the'sandwich' group suffers from worse self-reported health status, utilizes less medical services, and have less incentive to get health information and medical examination than others.
In chapter 5, I study whether and how much urban households can insure against a negative health shock, which is very common in underdeveloped countries and is considered one of the most important causes of poverty in China. A serious illness will not only lead to the loss of work ability thus income of a family, but also very likely resulted in a considerable amount of medical expenses during the treatment of the disease. However, the rise of health care costs and the loss of income do not mean that the family's consumption behavior has to be adjusted accordingly because it can usually protect itself from the negative health shock via a variety of formal as well as informal insurance mechanisms, such purchasing health insurance, reducing savings, selling assets, or borrowing from relatives and friends or getting loans from credit institutions. However, since the majority of serious illness is difficult to predict and the loss of family income may be very large, we assume that most families are unlikely to carry out full consumption insurance meaning that they would adjust their consumption behavior whenever there is a negative health shock. Our empirical results show that (1) consumption insurance is not complete, especially for low and mid income families; (2) the health insurance have no significant welfare effects but increase the medical expenditures.
Chapter 6 tries to compare the income redistribution effect of NRCMC and URBMI. The Difference in difference model and fixed effect model estimation results show that the URBMI has reduced the income inequality significantly while the NRCMI has a non-significant effect on income inequality.
The last chapter makes some conclusions and proposes some further improvements.
引文
①王东进.回顾与前瞻——中国医疗保险制度改革[M].北京：中国社会科学出版社,2008.
①资料来源：2010年国民经济和社会发展统计公报。
②与此同时,截止2010年,2678个县(市、区)开展了新型农村合作医疗工作,新型农村合作医参合率96.3%(2010年国民经济和社会发展统计公报)。
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[52]Hanratty, Maria,1996, "Canadian national health insurance and infant health"[J], American Economic Review 86,276-84.
[53]Harrison, G. W., J. A. List, et al.,2007, "Naturally Occurring Preferences and Exogenous Laboratory Experiments:A Case Study of Risk Aversion" [J]. Econometrica 75(2):433-458.
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[55]Ho, Lok Sang,1995, Market reforms and China's health care system. Social Science & Medicine 41,1065-1072.
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[59]Jutting, J. P.,2004, "Do Community-based Health Insurance Schemes Improve Poor People's Access to Health Care? Evidence From Rural Senegal"[J], World Development 32(2):273-288.
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①资料来源：2010年国民经济和社会发展统计公报。
②与此同时,截止2010年,2678个县(市、区)开展了新型农村合作医疗工作,新型农村合作医参合率96.3%(2010年国民经济和社会发展统计公报)。
[1]陈玉宇、行伟波,2006：《消费平滑、风险分担与完全保险—基于城镇家庭收支调查的实证研究》,《经济学季刊》,第6卷第1期。
[2]方黎明、顾昕：《突破自愿性的困局：新型农村合作医疗中参合的激励机制与可持续性发展》,《中国农村观察》2006年第4期。
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[7]顾听：《通向全民医保的渐进主义之路》,《东岳论丛》2008年第1期。
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[9]何立新：《中国城镇养老保险制度改革的收入分配效应》,《经济研究》2007年03期
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[12]黄枫、吴纯杰：《中国医疗保险对城镇老年人死亡率的影响》,《南开经济研究》2009年第6期。
[13]林莞娟、刘国恩、熊先军、陈钢：《中国城镇居民基本医疗保险初期评价—谁参保、谁受益、谁满意》,即将发表于《经济学报》
[14]罗楚亮：《城镇居民健康差异与医疗支出行为》,《财经研究》2008年第10期。
[15]刘国恩、臧文斌、徐菲、熊先军,2010,《中国城镇居民基本医疗保险对家庭消费的影响》,工作论文。
[16]马双、臧文斌等：《合作医疗与食物消费》,《经济学季刊》2010年第1期
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[18]王珺、高峰,《我国汽车保险市场逆向选择实证研究》《金融研究》2007年第12期
[19]王珺、高峰：《逆向选择现象实证研究评述》,《经济学动态》2008年第8期。
[20]王东进：《回顾与前瞻——中国医疗保险制度改革》,北京：中国社会科学出版社,2008。
[21]王震：《新农村建设的收入再分配效应》,《经济研究》2010年第6期
[22]谢垩：《与收入相关的健康及医疗服务利用不平等研究》,《经济研究》2009年第2期。
[23]周桦、曾辉,《中国车损险市场不对称信息存在性的实证分析》《金融研究》2008年第4期
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[26]赵忠,侯振刚：《我国城镇居民的健康需求与Grossman模型》,《经济研究》2005年第10期。
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