社会杂志 ›› 2019, Vol. 39 ›› Issue (2): 58-84.

• 专题一：国家治理研究 • 上一篇    下一篇

新农合“病有所医”有无增进农村居民健康？——对住院患者医疗服务利用、健康和收入影响的再审视

章丹1, 徐志刚1, 陈品2   

  1. 1. 南京农业大学经济管理学院;
    2. 常州工学院经济与管理学院
  • 出版日期:2019-03-20 发布日期:2019-03-20
  • 作者简介:徐志刚,E-mail:zgxu@njau.edu.cn

Does “Basic Health Protection for All” Improve Farmers'Health? Reassessing the Effect of CNCMS on Medical Service Utilization, Health and Income of Inpatients

ZHANG Dan1, XU Zhigang1, CHEN Pin2   

  1. 1. College of Economics and Management, Nanjing Agricultural University;
    2. School of Economics and Management, Changzhou Institute of Technology
  • Online:2019-03-20 Published:2019-03-20

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摘要：

中国新型农村合作医疗制度已基本实现农村居民“病有所医”，但其有无明显增进农村居民健康一直存在争议。以往研究多基于2009年之前的数据，忽视不同群体受益程度异质性，本文研究发现，新农合实施有改善农村居民身体健康的作用，但难说能全面增进农村居民健康。即便对健康状况较差、医疗需求较大的住院或被建议住院的人，新农合的影响也比较有限。其中，患病重、年龄大和收入较低的人受益稍大，新农合能显著增进其健康还不增加住院自付支出，且参合时间越长，作用越明显，但健康增进只是缓解病痛。对患病轻和年龄较小者，新农合仅有助于其增加医疗服务的利用。

关键词: 新农合, 医疗支出, 倾向得分匹配, 健康收入

Abstract:

China's New Cooperative Medical Scheme (CNCMS) has basically achieved “Basic Health Protection for All”, but there is still no consensus whether the program has really improved the farmers' health. There are two main reasons: one is that the effect of CNCMS maybe is limited because of the principle of “wide coverage and low copayment” followed before the New Medical Reform in 2009, but its effect has strengthened after that and the data previous research used is before 2009 mostly, therefore it cannot estimate the effect brought by the New Medical Reform accurately; the other reason is that the previous research ignores the heterogeneity of people with different age, health and wealth. Based on the data of 2011 and 2013 CHARLS(China Health and Retirement Longitudinal Study) national survey, this study explores the effect of CNCMS on farmers' medical expenditure, health status and income systematically by using propensity score matching (PSM). We mainly focus on people who have higher demand for medical care such as inpatients or people who should have been, and all samples are divided into different groups by age, health and wealth. The result shows that, although CNCMS has an effect on farmers' health status, it is limited and hard to say CNCMS can fully improve farmers' health, even for those who have poorer health, demanding more medical care or are referred to hospital. However, those who are older, poorer or have poorer health have huge benefit. For them, CNCMS has a positive and strong effect and it can improve their health significantly without increasing out-of-pocket expenditure. Besides, the longer time they enroll in it the greater the effect. For those who are younger and have better health, participating in CNCMS will let them have more access to medical service.

Key words: CNCMS, PSM, health status, medical expenditure, income