我国中老年人群商业健康保险的健康绩效分析——基于中国健康与养老追踪调查(CHARLS)的经验证据
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摘要
本文通过利用中国健康与养老追踪调查(CHARLS) 2013、2015年两年的基线调查数据,运用双重差分倾向得分匹配(PSMDID)方法,对我国中老年人群商业健康保险的健康绩效进行了实证分析。研究表明,商业健康保险总体上改善了参保人群的健康水平。此外,区分农村样本和城镇样本来看,农村和城镇参保人群的健康水平总体上得到提升,但是农村居民和城镇居民在评价健康水平的不同维度方面具有不同表现。本文不仅实证检验了商业健康保险的健康绩效,同时也为我国医疗保险制度改革以及促进商业健康保险发展重点提供了经验证据。
Based on the survey data of three consecutive phases of the China Health and Retirement Longitudinal Study( CHARLS) in 2013 and 2015,this paper uses the dual differential propensity score matching( PSMDID) method to empirically analyze the health performance of commercial health insurance for middle-aged and elderly people. This paper has shown that commercial health insurance has effectively improved the health status of the insured population. In addition,judging from the rural and urban samples,the health level of the rural and urban insured population has improved significantly,but rural residents and urban residents have different performances in evaluating different dimensions of health. This paper not only empirically tests the health performance of commercial health insurance,but also provides empirical evidence for the reform of China's medical insurance system and the development of commercial health insurance.
Based on the survey data of three consecutive phases of the China Health and Retirement Longitudinal Study( CHARLS) in 2013 and 2015,this paper uses the dual differential propensity score matching( PSMDID) method to empirically analyze the health performance of commercial health insurance for middle-aged and elderly people. This paper has shown that commercial health insurance has effectively improved the health status of the insured population. In addition,judging from the rural and urban samples,the health level of the rural and urban insured population has improved significantly,but rural residents and urban residents have different performances in evaluating different dimensions of health. This paper not only empirically tests the health performance of commercial health insurance,but also provides empirical evidence for the reform of China's medical insurance system and the development of commercial health insurance.
引文
[1]国务院.健康中国“20230规划纲要”[EB/OL].http://www.gov.cn/zhengce/2016-10/25/content_5124174.htm.
[2]国务院.关于建立城镇职工基本医疗保险制度的决定[EB/OL].http://www.360doc.com/content/17/0529/22/43649671_658319979.shtml.
[3]国务院.关于建立新型农村合作医疗制度的意见[EB/OL].http://www.gov.cn/zwgk/2005-08/12/content_21850.htm.
[4]国务院.关于开展城镇居民基本医疗保险试点的指导意见[EB/OL].http://www.gov.cn/zwgk/2007-07/24/content_695118.htm.
[5]国务院.关于整合城乡居民基本医疗保险制度的意见[EB/OL].http://www.xinhuanet.com/finance/2016-01/12/c_1117747677.htm.
[6]申曙光.新时期我国社会医疗保险体系的改革与发展[J].社会保障评论,2017(2):40-53.
[7]陈秋霖.我国基本医疗保险制度的发展与主要成就[M]//中国人口与劳动问题报告No.16.北京:社会科学文献出版社,2015:316-357.
[8]Li H,Jiang L.Catastrophic medical insurance in China[J].Lancet,2017,390:1724.
[9]陈信勇,王运福.建立农村医疗保障体系的路径选择---一个需求演化的视角[J].浙江社会科学,2004(1):146-149.
[10]张仲芳.制度定位、税收激励与商业健康保险发展:国际经验及启示[J].江西财经大学学报,2012(1):52-59.
[11]杨乔.社会医疗保险与商业健康保险关系的探讨---基于“湛江模式”的实践[J].吉林广播电视大学学报,2014(8):11-12.
[12]曾卓,李良军.商业健康保险的定义及分类研究[J].保险研究,2003(4):20-22.
[13]中国保险行业协会.2017中国商业健康保险发展指数研究报告[EB/OL].http://www.iachina.cn/art/2017/6/23/art_424_44812.html.
[14]陈华,邓佩云.城镇职工基本医疗保险的健康绩效研究---基于CHNS数据[J].社会保障研究,2016(4):44-52.
[15]Freeman J D,Kadiyala S,Bell J F,et al.The causal effect of health insurance on utilization and outcomes in adults:A systematic review of US studies[J].Medical Care,2008,46(10):1023-1032.
[16]罗楚亮.城镇居民健康差异与医疗支出行为[J].财经研究,2008,34(10):63-75.
[17]程令国,张晔.“新农合”:经济绩效还是健康绩效?[J].经济研究,2012(1):120-133.
[14]陈华,邓佩云.城镇职工基本医疗保险的健康绩效研究---基于CHNS数据[J].社会保障研究,2016(4):44-52.
[18]Lei X,Lin W.The new cooperative medical scheme in rural China:Does more coverage mean more service and better health?[J].Health Economics,2009,18(Supplement):S25-S46.
[19]Sun X,Jackson S,Carmichael G,et al.Catastrophic medical payment and financial protection in rural China:Evidence from the new cooperative medical scheme in Shandong Province[J].Health Economics,2009,18(1):103-119.
[20]官海静,刘国恩,熊先军.我国城镇居民的健康公平和健康绩效[J].中国卫生经济,2013,32(9):33-37.
[21]黄枫,甘犁.过度需求还是有效需求?---城镇老人健康与医疗保险的实证分析[J].经济研究,2010(6):105-119.
[22]Li X,Zhang W.The impacts of health insurance on health care utilization among the older people in China[J].Social Science&Medicine,2013,85(4):59-65.
[23]World Health Organization.The world health report2000:Health systems:improving performance[EB/OL].http://www.who.int/whr/2000/en/whi00_en.pdf.
[24]胡宏伟,刘国恩.城镇居民医疗保险对国民健康的影响效应与机制[J].南方经济,2012,30(10):186-199.
[25]李湘君,王中华,林振平.新型农村合作医疗对农民就医行为及健康的影响---基于不同收入层次的分析[J].世界经济文汇,2012(3):58-75.
[26]Chen Y,Jin G Z.Does health insurance coverage lead to better health and educational outcomes?Evidence from rural China[J].Journal of Health Economics,2012,31(1):1-14.
[27]吴联灿,申曙光.新型农村合作医疗制度对农民健康影响的实证研究[J].保险研究,2010(6):60-68.
[28]于大川,丁建定.社会医疗保险对老年人健康的影响---基于倾向得分匹配方法的反事实评估[J].华中科技大学学报(社会科学版),2016,30(2):107-115.
[29]Froelich J M,Beck R,Novicoff W M,et al.Effect of health insurance type on access to care[J].Orthopedics,2013,36(10):1272-6.
[30]Thornton J A,Rice J L.Does extending health insurance coverage to the uninsured improve population health outcomes?[J].Applied Health Economics and Health Policy,2008,6(4):217-230.
[31]Kang S,You C H,Kwon Y D,et al.Effects of supplementary private health insurance on physician visits in Korea[J].Journal of the Formosan Medical Association,2009,108(12):912.
[32]Nyman J A,Barleen N A.The effect of supplemental private health insurance on health care use,health and welfare in Brazil[J].Social Science Electronic Publishing,2007.
[33]田玲,姚鹏.健康保险能有效促进健康状况吗?---来自CHARLS的经验证据[C]//2014中国保险与风险管理国际年会,2014.
[34]刘宏,王俊.中国居民医疗保险行为研究---基于商业健康保险的角度[C]]//“中国医疗改革与老年健康、福利跨学科研究”学术研讨会,2011.
[35]Rosenbaum P R,Rubin D B.The central role of the propensity score in observational studies for causal effects[J].Biometrika,1983,70(1):41-55.
[36]Rosenbaum P,Rubin D.Constructing a control group using multivariate matched sampling methods that incorporate the propensity score[J].American Statistician,1985,39(1):33-38.
[37]Heckman J J,Ichimura H,Todd P E.Matching as an econometric estimator evaluation[J].Review of Economic Studies,1998,65(223):261-294.
[38]陈强.高级计量经济学及Stata应用[M].北京:高等教育出版社,2017:545.
[39]人力资源和社会保障部.2017年度人力资源和社会保障事业发展统计公报[Z].2017:6.
[40]国务院.关于加快发展商业健康保险的若干意见[EB/OL].http://www.gov.cn/zhengce/content/2014-11/17/content_9210.htm.
[41]财政部.关于将商业健康保险个人所得税试点政策推广到全国范围实施的通知[EB/OL].http://szs.mof.gov.cn/zhengwuxinxi/zhengcefabu/201705/t20170502_2591715.html.
[42]中国保险行业协会.2018中国商业健康保险发展指数报告[EB/OL].http://www.iachina.cn/art/2018/6/7/art_22_102589.html.
[2]国务院.关于建立城镇职工基本医疗保险制度的决定[EB/OL].http://www.360doc.com/content/17/0529/22/43649671_658319979.shtml.
[3]国务院.关于建立新型农村合作医疗制度的意见[EB/OL].http://www.gov.cn/zwgk/2005-08/12/content_21850.htm.
[4]国务院.关于开展城镇居民基本医疗保险试点的指导意见[EB/OL].http://www.gov.cn/zwgk/2007-07/24/content_695118.htm.
[5]国务院.关于整合城乡居民基本医疗保险制度的意见[EB/OL].http://www.xinhuanet.com/finance/2016-01/12/c_1117747677.htm.
[6]申曙光.新时期我国社会医疗保险体系的改革与发展[J].社会保障评论,2017(2):40-53.
[7]陈秋霖.我国基本医疗保险制度的发展与主要成就[M]//中国人口与劳动问题报告No.16.北京:社会科学文献出版社,2015:316-357.
[8]Li H,Jiang L.Catastrophic medical insurance in China[J].Lancet,2017,390:1724.
[9]陈信勇,王运福.建立农村医疗保障体系的路径选择---一个需求演化的视角[J].浙江社会科学,2004(1):146-149.
[10]张仲芳.制度定位、税收激励与商业健康保险发展:国际经验及启示[J].江西财经大学学报,2012(1):52-59.
[11]杨乔.社会医疗保险与商业健康保险关系的探讨---基于“湛江模式”的实践[J].吉林广播电视大学学报,2014(8):11-12.
[12]曾卓,李良军.商业健康保险的定义及分类研究[J].保险研究,2003(4):20-22.
[13]中国保险行业协会.2017中国商业健康保险发展指数研究报告[EB/OL].http://www.iachina.cn/art/2017/6/23/art_424_44812.html.
[14]陈华,邓佩云.城镇职工基本医疗保险的健康绩效研究---基于CHNS数据[J].社会保障研究,2016(4):44-52.
[15]Freeman J D,Kadiyala S,Bell J F,et al.The causal effect of health insurance on utilization and outcomes in adults:A systematic review of US studies[J].Medical Care,2008,46(10):1023-1032.
[16]罗楚亮.城镇居民健康差异与医疗支出行为[J].财经研究,2008,34(10):63-75.
[17]程令国,张晔.“新农合”:经济绩效还是健康绩效?[J].经济研究,2012(1):120-133.
[14]陈华,邓佩云.城镇职工基本医疗保险的健康绩效研究---基于CHNS数据[J].社会保障研究,2016(4):44-52.
[18]Lei X,Lin W.The new cooperative medical scheme in rural China:Does more coverage mean more service and better health?[J].Health Economics,2009,18(Supplement):S25-S46.
[19]Sun X,Jackson S,Carmichael G,et al.Catastrophic medical payment and financial protection in rural China:Evidence from the new cooperative medical scheme in Shandong Province[J].Health Economics,2009,18(1):103-119.
[20]官海静,刘国恩,熊先军.我国城镇居民的健康公平和健康绩效[J].中国卫生经济,2013,32(9):33-37.
[21]黄枫,甘犁.过度需求还是有效需求?---城镇老人健康与医疗保险的实证分析[J].经济研究,2010(6):105-119.
[22]Li X,Zhang W.The impacts of health insurance on health care utilization among the older people in China[J].Social Science&Medicine,2013,85(4):59-65.
[23]World Health Organization.The world health report2000:Health systems:improving performance[EB/OL].http://www.who.int/whr/2000/en/whi00_en.pdf.
[24]胡宏伟,刘国恩.城镇居民医疗保险对国民健康的影响效应与机制[J].南方经济,2012,30(10):186-199.
[25]李湘君,王中华,林振平.新型农村合作医疗对农民就医行为及健康的影响---基于不同收入层次的分析[J].世界经济文汇,2012(3):58-75.
[26]Chen Y,Jin G Z.Does health insurance coverage lead to better health and educational outcomes?Evidence from rural China[J].Journal of Health Economics,2012,31(1):1-14.
[27]吴联灿,申曙光.新型农村合作医疗制度对农民健康影响的实证研究[J].保险研究,2010(6):60-68.
[28]于大川,丁建定.社会医疗保险对老年人健康的影响---基于倾向得分匹配方法的反事实评估[J].华中科技大学学报(社会科学版),2016,30(2):107-115.
[29]Froelich J M,Beck R,Novicoff W M,et al.Effect of health insurance type on access to care[J].Orthopedics,2013,36(10):1272-6.
[30]Thornton J A,Rice J L.Does extending health insurance coverage to the uninsured improve population health outcomes?[J].Applied Health Economics and Health Policy,2008,6(4):217-230.
[31]Kang S,You C H,Kwon Y D,et al.Effects of supplementary private health insurance on physician visits in Korea[J].Journal of the Formosan Medical Association,2009,108(12):912.
[32]Nyman J A,Barleen N A.The effect of supplemental private health insurance on health care use,health and welfare in Brazil[J].Social Science Electronic Publishing,2007.
[33]田玲,姚鹏.健康保险能有效促进健康状况吗?---来自CHARLS的经验证据[C]//2014中国保险与风险管理国际年会,2014.
[34]刘宏,王俊.中国居民医疗保险行为研究---基于商业健康保险的角度[C]]//“中国医疗改革与老年健康、福利跨学科研究”学术研讨会,2011.
[35]Rosenbaum P R,Rubin D B.The central role of the propensity score in observational studies for causal effects[J].Biometrika,1983,70(1):41-55.
[36]Rosenbaum P,Rubin D.Constructing a control group using multivariate matched sampling methods that incorporate the propensity score[J].American Statistician,1985,39(1):33-38.
[37]Heckman J J,Ichimura H,Todd P E.Matching as an econometric estimator evaluation[J].Review of Economic Studies,1998,65(223):261-294.
[38]陈强.高级计量经济学及Stata应用[M].北京:高等教育出版社,2017:545.
[39]人力资源和社会保障部.2017年度人力资源和社会保障事业发展统计公报[Z].2017:6.
[40]国务院.关于加快发展商业健康保险的若干意见[EB/OL].http://www.gov.cn/zhengce/content/2014-11/17/content_9210.htm.
[41]财政部.关于将商业健康保险个人所得税试点政策推广到全国范围实施的通知[EB/OL].http://szs.mof.gov.cn/zhengwuxinxi/zhengcefabu/201705/t20170502_2591715.html.
[42]中国保险行业协会.2018中国商业健康保险发展指数报告[EB/OL].http://www.iachina.cn/art/2018/6/7/art_22_102589.html.