全民医保论文：中国医保一体化研究

全民医保论文：中国医保一体化研究 【中文摘要】健康权属于每个公民,全体社会成员不应因社会地 位、经济收入、地域特征、性别和年龄等因素的不同而区别对待,每 个社会成员都有权按照自身的经济承受能力来选择自己需要的医疗 保障,这是医疗保险制度的机会均等问题。覆盖全民的医疗保险制度 是中国新医改的目标。随着城乡一体化的发展和户籍制度的改革,学 者开始从政治角度和经济角度讨论全民医保的必要性和可实现性。 我国目前医疗保险市场存在着诸多问题,比如覆盖面不广、未能涵盖 弱势群体、医疗保险筹资公平和服务利用不平衡等。其中,覆盖范围 是最为突出的问题。本文基于机会均等理论和对全面医保概念的界 定,从机会均等的角度分析我国医疗保险制度缺乏平等性的现状,用 Probit 模型分析了不同因素对我国医疗保险需求的影响并对实现全 面医保的实现途径提出政策性建议。本文介绍了中国医疗保险制度 形成的主要历程和发展趋势,通过历史分析法纵向考察了我国城乡医 疗保险体制的变迁,并通过比较分析法描述了我国城乡医疗保障服务 公平性差异的基本事实。本文从底线公平角度提出实现全民医保的 必要性,并分析了目前其他国家实现全民医保的成功典范,诠释了全 民医保的概念和目前我国实现全民医保的三种主要途径。底线公平 有三个层次的要求,其中第一个层级,即是机会公平,这是实现全民医 保的门槛和基本要求。文章实证部分以 1989 年到 2009 年至今 CHNS 所做的八次调查数据为依托,通过建立 Probit 模型,从个人特征,地 区特征,职业特征和工资收入等方面分析了影响参保行为的主要因素 和医疗保险在不同特征的群体中的分布情况。实证结果表明,我国的 医疗保险存在着明显的不公平性,参保行为主要受年龄、性别、职业 特征和教育水平的影响,参保行为受城乡这一因素影响不大。这与过 去的文献中认为城乡的医疗保险覆盖率存在着巨大差异的结论相悖, 本文认为这在很大程度上得益于新农合的实施,而且本文所选调查数 据只是关注覆盖率的状况,在城乡医保深度公平上的差异无法体现。 教育年限是对医疗保险的参与情况影响最大的因素,教育因素从直接 和间接方面制约着一个人对医疗保险的重视程度和购买能力,文章在 政策建议部分提出加强国民教育,提高医保知识宣传等建议,通过高 水平教育提高整体人口素质,并带动医疗保险市场的发展。最后,对 我国医疗保险市场的改革方向提出展望,在现行城镇职工医疗保险制 度、城镇居民基本医疗保险制度和新型农村合作医疗保险制度三网 并行的基础上,逐步通过“三网并两网”,“两网合一”等步骤,逐步 实现中国的医保一体化。本文创新之处在于：在考虑对影响医疗保 险参与情况的影响因素时,选用人口、地域、职业、收入等人口学特 征和经济特征,符合国外相关领域的研究视角,并且在前人的研究视 角上,加入了职业特性这一影响因素,具有创新性；实证分析数据来 自中国健康与营养调查(CHNS),样本量大,比国内研究学者实地调研、 统计网站数据所得数据更加详细,外国研究学者在研究中国问题时, 普遍采用这一数据库；本文选用数据更新到 2009 年,为最新数据,更 能代表目前国内的基本情况,使实证研究更有说服力。 【英文摘要】The right of health belongs to every citizen; all social members should not be discriminated because of the different factors such as social status, income, geographical features, gender and age. Every member of society is entitled to choose their own medical insurance system according to their economic capacity, which is an equal opportunity issue. Covering all people by several medical insurance systems is the goal of new health reform in China. As the trends of urban-rural integration development and household registry reform, it begins to bring up the thought of the true unified basic health insurance and discuss the necessity from the viewpoint of social politics and economics. There are many problems in Chinas current health insurance market, such as coverage is not broad, vulnerable groups are not covered by medical insurance and services and use of the health insurance is imbalance. However, the problem of coverage is the most prominent problem. Based on theory of the equality of opportunity and definition of the concept of comprehensive health care, from the perspective of equal opportunities, in my paper, I analyze the lack of equality in the health insurance system, using the Probit model to analyze the different factors on the impact of health insurance and provide some policy recommendations about the path for realize a comprehensive health insuranceIn my paper, I describe the formation of Chinas medical insurance system and the development trend of the main course, through historical analysis of the changes of urban and rural medical insurance system by longitudinal comparison; describe the basic facts of urban and rural differences in the fairness of health care services using method of comparative analysis. This article puts forward the necessity of universal health care from the point of equality of baseline, and analyzes some examples of foreign countries who have already to achieve a successful universal health care, define the concept of universal health care and three main ways to achieve universal coverage currently. There are three levels of equality of baseline, the first level, named equal opportunity, which is the threshold of universal health care and basic requirements. Empirical part of the article using date from 1989 to 2009, which made eight CHNS survey data as the basis, through the establishment of Probit model, from many factors such as the personal characteristics, regional characteristics, occupational characteristics and income, analyze the main factors which may affect the behavior of insuring medical insurance, and the distribution of the group of the medical insurance in different characteristics. The empirical results show that there is a clear unfairness in Chinas health insurance system. Participating behavior is mainly affected by age, gender, occupational characteristics and educational levels; participating behavior is not affected by the factor of urban and rural areas. There is a tremendous paradox about the conclusion compared to the past literatures which consider that the health insurance coverage in rural and urban areas exists a huge difference. To the extreme extent, this is due to the implementation of NCMS and because the survey data is only concerned about the coverage of the medical insurance, the depth difference of the urban and rural health care can not reflect in a fair way. Years of education is the most influential factors about involvement of health insurance, educational factors restrict a persons emphasis on health insurance and purchasing power from direct and indirect aspects, the article puts forwards some policy recommendations for strengthening national education and suggests that high levels of education by improving the overall quality of the population can promote the health insurance market. Finally, I put forward about the reform of the medical insurance market. Based on the three networks of the basic medical insurance system for urban employees, basic medical insurance system for urban residents and the new rural cooperative medical insurance system, we can realize the universal health care system step by step through “three nets to two nets”, and then “two nets to one net”.This innovation of my article is that:In considering the factors which impact the participation of health insurance, the choice of population, geography, occupation, income and other demographic characteristics and economic characteristics, coincide with the research field of foreign perspective, and based on the previous studies, I add the professional characteristics as the influencing factors, this is innovative; meanwhile, empirical analysis of data comes from China Health and Nutrition Survey (CHNS), sample volume is huge, and compared to data got from the domestic researchers on field research, statistical data from websites, the data from CHNS are more detailed. And foreign researchers in the study of China are widespread using this database. The selected data are from 1989, through 8 survey, the latest data update to 2009; due to updates of data 2009 was too late that domestic researchers generally select the data from CHNS to 2006. This paper using the data updated to 2009, it can be more representative of the basic situation of the domestic, and the empirical study are more conv