精准扶贫、人情支出与农村家庭医疗负担
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摘要
文章在揭示家庭医疗负担与人情支出关系的基础上,评价了精准扶贫政策对农村大病家庭医疗负担的影响。使用Tobit模型和处理效应模型分析表明,农村家庭人情支出指标可以作为监测大病家庭医疗负担是否沉重的"风向标",大病冲击会减少家庭的人情支出;目前精准扶贫政策对建档立卡家庭(贫困户)的大病医疗负担缓解效果显著,并且有效遏制了"因病致贫";非建档立卡大病家庭(非贫困户)更易遭受沉重的医疗负担,并在大病冲击下呈现出一定的脆弱性;对于非贫困户来说,当期患有大病对家庭医疗负担影响较大,随着时间推移,大病对家庭负担的影响逐渐减弱。因此,在贫困户识别方面,除了从家庭人均收入和财产状况进行识别外,将人情支出的变动作为识别维度有利于实现更为精准的贫困户识别。文章建议采用人情支出的变动来监测建档立卡贫困户医疗负担是否沉重,以及是否属于"因病致贫"。
This paper evaluates the influence of targeted poverty reduction policy on the medical burden of rural families with major illnesses in perspective of correlation between family medical burden and gift expenses. Employing Tobit Model and Treatment Effect Model, we find that the occurrence of serious illnesses reduces gift expenses of rural families, which acts like a"wind indicator"in monitoring the medical burden of family with serious illnesses. The targeted poverty alleviation policy has a very significant effect in alleviating the medical burden for families with major illnesses, and it effectively curbs the"disease-led poverty". The families with serious illnesses which have not entered the list of established state cards(non-impoverished households) are still more vulnerable to heavy medical burdens, and they show some vulnerability to major illnesses. For non-impoverished households, the current illness has a great impact on the family's medical burden, although it declines gradually over time. Therefore, in addition to household income per capita and property status, it is important to take into consideration of changes in gift expenditure in order to identify and targetpoverty more accurately. It is also possible to monitor changes in gift expenditures and judge whether the poor households are heavily burdened with medical treatment and whether they are"disease-led poverty".
This paper evaluates the influence of targeted poverty reduction policy on the medical burden of rural families with major illnesses in perspective of correlation between family medical burden and gift expenses. Employing Tobit Model and Treatment Effect Model, we find that the occurrence of serious illnesses reduces gift expenses of rural families, which acts like a"wind indicator"in monitoring the medical burden of family with serious illnesses. The targeted poverty alleviation policy has a very significant effect in alleviating the medical burden for families with major illnesses, and it effectively curbs the"disease-led poverty". The families with serious illnesses which have not entered the list of established state cards(non-impoverished households) are still more vulnerable to heavy medical burdens, and they show some vulnerability to major illnesses. For non-impoverished households, the current illness has a great impact on the family's medical burden, although it declines gradually over time. Therefore, in addition to household income per capita and property status, it is important to take into consideration of changes in gift expenditure in order to identify and targetpoverty more accurately. It is also possible to monitor changes in gift expenditures and judge whether the poor households are heavily burdened with medical treatment and whether they are"disease-led poverty".
引文
1.白重恩等(2012):《医疗保险与消费:来自新型农村合作医疗的证据》,《经济研究》,第2期。
2 .程令国、张晔(2012):《“新农合”:经济绩效还是健康绩效?》,《经济研究》,第1期。
3 .丁锦希等(2012):《新型农村合作医疗制度对农户医疗负担的影响——基于江苏、安徽、陕西的调研数据》,《农业经济问题》,第11期。
4 .方黎明(2013):《新型农村合作医疗和农村医疗救助制度对农村贫困居民就医经济负担的影响》,《中国农村观察》,第2期。
5 .封进等(2010):《新型农村合作医疗对县村两级医疗价格的影响》,《经济研究》,第11期。
6 .黄晓宁、李勇(2016):《新农合对农民医疗负担和健康水平影响的实证分析》,《农业技术经济》,第4期。
7 .李华等(2009):《完善我国农村医疗救助制度的思考》,《人口学刊》,第1期。
8 .罗楚亮(2007):《健康风险、医疗保障与农村家庭内部资源配置》,《中国人口科学》,第2期。
9 .宁满秀、刘进(2014):《新型农村合作医疗制度对农户医疗负担的影响——基于供给者诱导需求视角的实证分析》,《公共管理学报》,第3期。
10 .田学斌、闫真(2011):《农村人情消费中的非正式制度:一个交易费用理论框架》,《消费经济》,第3期。
11 .王翌秋、吕美晔(2013):《农村老年人的疾病经济负担及影响因素——基于江苏省26个县老年人调查的实证分析》,《中国农村观察》,第6期。
12 .闫新华等(2016):《中国农户的人情支出行为——基于地位寻求模型的实证分析》,《消费经济》,第1期。
13 .周广肃、马光荣(2015):《人情支出挤出了正常消费吗?——来自中国家户数据的证据》,《浙江社会科学》,第3期。
14 .周钦、刘国恩(2014):《健康冲击:现行医疗保险制度究竟发挥了什么作用?》,《经济评论》,第6期。
15 .朱铭来等(2017):《中国家庭灾难性医疗支出与大病保险补偿模式评价研究》,《经济研究》,第9期。
16 .Cameron,C.,&Trivedi,P.(2005),Microeconometrics:Methods and Applications.New York:Cambridge University Press.
17 .Finkelstein,A.,Taubman,S.,Wright,B.,et al.(2012),The Oregon Health Insurance Experiment:Evidence from the First Year.The Quartely Journal of Economics.127(3),1057-1106.
18 .Heckman,J.J.(1976),The Common Structure of Statistical Models of Truncation,Sample Selection and Limited Dependent Variables and a Simple Estimator for Such Models.Annals of Economic and Social Measurement.5(4),475-492.
19 .Heckman,J.J.(1977),Dummy Endogenous Variables in a Simultaneous Equation System.Nber Working Papers.46(4),931-959.
20 .Liu,Y.,Rao,K.,Wu,J.,&Gakidou,E.(2008),China's Health System Performance.The Lancet.372(9653),1914-1923.
21 .Sun,X.,Jackson,S.,Carmichael,G.,&Sleigh,A.C.(2009),Catastrophic Medical Payment and Financial Protection in Rural China:Evidence from the New Cooperative Medical Scheme in Shandong Province.Health Economics.18(1),103-119.
22 .Wagstaff,A.,&Lindelow,M.(2008),Can Insurance Increase Financial Risk?:The Curious Case of Health Insurance in China.Journal of Health Economics.27(4),990-1005.
23 .Wang,J.,Chen,L.,Ye,T.,Zhang,Z.,&Ma,J.(2014),Financial Protection Effects of Modification of China's New Cooperative Medical Scheme on Rural Households with Chronic Diseases.BMC Health Services Research.14(1),305-313.
24 .Wooldridge,J.M.(2010),Econometric Analysis of Vross-section and Panel Data.The MIT Press.
25 .Xu,K.,Evans,D.B.,Kawabata,K.,Zeramdini,R.,Klavus,J.,&Marray C.J.(2013),Housedold Catastrophic Health Expenditure:A Multicantry Analysis.Lancet.362(9378):111-117.
(1)中国网:中共中央国务院印发《中国农村扶贫开发纲要(2011~2020年)》(http://www.china.com.cn/lianghui/fangtan/2016-02/16/content_37872114.htm)。
(1)数据来源于《人民日报》,2017年3月21日。
(1)广义上看贫困县、贫困村的所有农民都是精准扶贫政策的参与者和受益者,狭义上看建档立卡贫困户才是精准扶贫政策的参与者。
(1)官方文件将这种封顶线称之为“政策兜底”,但政策兜底在现实中很难做到,各区县不具备财力进行兜底,政策执行尺度具有弹性,扶贫部门只能尽量保证。
2 .程令国、张晔(2012):《“新农合”:经济绩效还是健康绩效?》,《经济研究》,第1期。
3 .丁锦希等(2012):《新型农村合作医疗制度对农户医疗负担的影响——基于江苏、安徽、陕西的调研数据》,《农业经济问题》,第11期。
4 .方黎明(2013):《新型农村合作医疗和农村医疗救助制度对农村贫困居民就医经济负担的影响》,《中国农村观察》,第2期。
5 .封进等(2010):《新型农村合作医疗对县村两级医疗价格的影响》,《经济研究》,第11期。
6 .黄晓宁、李勇(2016):《新农合对农民医疗负担和健康水平影响的实证分析》,《农业技术经济》,第4期。
7 .李华等(2009):《完善我国农村医疗救助制度的思考》,《人口学刊》,第1期。
8 .罗楚亮(2007):《健康风险、医疗保障与农村家庭内部资源配置》,《中国人口科学》,第2期。
9 .宁满秀、刘进(2014):《新型农村合作医疗制度对农户医疗负担的影响——基于供给者诱导需求视角的实证分析》,《公共管理学报》,第3期。
10 .田学斌、闫真(2011):《农村人情消费中的非正式制度:一个交易费用理论框架》,《消费经济》,第3期。
11 .王翌秋、吕美晔(2013):《农村老年人的疾病经济负担及影响因素——基于江苏省26个县老年人调查的实证分析》,《中国农村观察》,第6期。
12 .闫新华等(2016):《中国农户的人情支出行为——基于地位寻求模型的实证分析》,《消费经济》,第1期。
13 .周广肃、马光荣(2015):《人情支出挤出了正常消费吗?——来自中国家户数据的证据》,《浙江社会科学》,第3期。
14 .周钦、刘国恩(2014):《健康冲击:现行医疗保险制度究竟发挥了什么作用?》,《经济评论》,第6期。
15 .朱铭来等(2017):《中国家庭灾难性医疗支出与大病保险补偿模式评价研究》,《经济研究》,第9期。
16 .Cameron,C.,&Trivedi,P.(2005),Microeconometrics:Methods and Applications.New York:Cambridge University Press.
17 .Finkelstein,A.,Taubman,S.,Wright,B.,et al.(2012),The Oregon Health Insurance Experiment:Evidence from the First Year.The Quartely Journal of Economics.127(3),1057-1106.
18 .Heckman,J.J.(1976),The Common Structure of Statistical Models of Truncation,Sample Selection and Limited Dependent Variables and a Simple Estimator for Such Models.Annals of Economic and Social Measurement.5(4),475-492.
19 .Heckman,J.J.(1977),Dummy Endogenous Variables in a Simultaneous Equation System.Nber Working Papers.46(4),931-959.
20 .Liu,Y.,Rao,K.,Wu,J.,&Gakidou,E.(2008),China's Health System Performance.The Lancet.372(9653),1914-1923.
21 .Sun,X.,Jackson,S.,Carmichael,G.,&Sleigh,A.C.(2009),Catastrophic Medical Payment and Financial Protection in Rural China:Evidence from the New Cooperative Medical Scheme in Shandong Province.Health Economics.18(1),103-119.
22 .Wagstaff,A.,&Lindelow,M.(2008),Can Insurance Increase Financial Risk?:The Curious Case of Health Insurance in China.Journal of Health Economics.27(4),990-1005.
23 .Wang,J.,Chen,L.,Ye,T.,Zhang,Z.,&Ma,J.(2014),Financial Protection Effects of Modification of China's New Cooperative Medical Scheme on Rural Households with Chronic Diseases.BMC Health Services Research.14(1),305-313.
24 .Wooldridge,J.M.(2010),Econometric Analysis of Vross-section and Panel Data.The MIT Press.
25 .Xu,K.,Evans,D.B.,Kawabata,K.,Zeramdini,R.,Klavus,J.,&Marray C.J.(2013),Housedold Catastrophic Health Expenditure:A Multicantry Analysis.Lancet.362(9378):111-117.
(1)中国网:中共中央国务院印发《中国农村扶贫开发纲要(2011~2020年)》(http://www.china.com.cn/lianghui/fangtan/2016-02/16/content_37872114.htm)。
(1)数据来源于《人民日报》,2017年3月21日。
(1)广义上看贫困县、贫困村的所有农民都是精准扶贫政策的参与者和受益者,狭义上看建档立卡贫困户才是精准扶贫政策的参与者。
(1)官方文件将这种封顶线称之为“政策兜底”,但政策兜底在现实中很难做到,各区县不具备财力进行兜底,政策执行尺度具有弹性,扶贫部门只能尽量保证。