摘要
在一份最新的研究中,有学者发现相比于没有医保,参合城镇居民医疗保险能显著提高个体的健康水平。在我国医疗保险已基本做到全覆盖的背景下,研究居民自由选择参合不同类型的基本医疗保险是否能促进其健康水平,将更具有现实意义。因此,本文借助太仓市和宜兴市医保统筹进程中的一次自然实验,利用微观调研数据对该问题进行了实证研究,结果如下:局部平均处理效应显示,依从者由居民医保(低档次医保)转为参合职工医保(高档次医保)显著提高了居民的健康水平;进一步,工具变量分位数处理效应显示,参合更高档次医保对健康的促进效应随着健康分位点的提高而提高。该结论表明参保自选政策具有正健康效应。由此,本文提出在城乡医保统筹进程中,应给予居民更多自由选择空间。不过,在本文识别过程中,工具变量的排他性可能并不是完美满足的。
This paper tries to get the evidence about whether higher grade of medical insurance can lead to better health as Pan et al.(2013) had got the evidence that Urban Basic Medical Insurance leads to better health recently. We choose two pilot areas with homogeneity,Taicang and Yixing, which had slight differ-ences in their functional integrations in the past during the proceeding of the Urban-Rural Integrated Medical Insurance System(IMIS),which lead to different policies about whether citizens can participate different medical insurances freely. These different policies provide a good nature experiment to employ the IV estimation approach to identify the causal effect of higher grade of medical insurances on health. Results from the survey data show that participating higher grade of medical insurances leads to better health significantly by estimating the LATE. Furthermore,the results from IVQTE show that the treatment grade of medical insurances on health care is more significant than on health. But the exclusion assumption may not well satisfy during our identification strategy. This paper suggests that the policy of IMIS should be more flexible for residents to choose their medical insurance freely based on the results. The causal effect of higher medical insurance on health which this paper captures is rare in Chinese academic study. The value is more prominent especially in the background of a nearly full coverage of medical insurance. Meanwhile,the identification strategy this research used can also be referred by similar research.
出处
《公共管理学报》
CSSCI
北大核心
2015年第2期106-118 157-15,157-158,共15页
Journal of Public Management
基金
国家自然科学基金项目(71373120)
全国高校科研启动项目(3225005203)
关键词
医疗保险
工具变量
局部平均处理效应
分位数处理效应
Medical insurance,Instrument Variable,Local Average Treatment Effect,Quantile Treatment Effect
