2024-07-15
来源：Health Policy and Planning, 2024, 39(6), 564-582
作者：周钦 、Karen Eggleston、刘国恩
全文链接：https://doi.org/10.1093/heapol/czae031
周钦 | 中国人民大学公共管理学院副教授
Abstract
Health insurance coverage and the risk protection it provides may improve enrollees’ subjective well-being, as demonstrated for example by Oregon Medicaid’s randomized expansion significantly improving enrollees’ mental health and happiness. Yet little evidence from low- and middle-incomen countries documents the link between insurance coverage and subjective well-being. We analyze individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programs. This reform, expanded nationally since 2016, is recognized as a vital step toward attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban-rural health insurance integration on the subjective well-being of the Chinese population. Analyzing 2011-2018 data from the China Health and Retirement Longitudinal Study in a difference-in-difference (DID) framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on subjective well-being appears to stem from the improvement of rural residents’ mental health (decrease in depressive symptoms) and associated increases in some health behaviors, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on subjective well-being among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts.
医疗保障及其提供的风险防范有益于提升参保者的主观幸福感，例如美国俄勒冈州的医疗补助计划（Medicaid）的扩增显著地提升了参保者的心理健康水平和幸福感。然而，在中低收入国家中关于医疗保险覆盖和主观幸福感关系的研究相对缺乏。居民在享受到城乡居民医保新政后，是否提高了其主观福利感受，对生活是否更加满意，这是评估政策实施效果的重要内容之一，但是目前尚无相关研究证据。本文利用中国健康与养老追踪调查2011-2018年数据，运用异时性双重差分模型估计方法考察城乡居民医疗保险整合改革对我国城乡中老年人群主观幸福感的影响，以揭示医疗保险政策变动与参保居民主观福利感受的关系，为评估我国医保统筹改革成效提供新的研究证据。我们发现，城乡居民医保整合改革显著提高了农村居民的生活满意度，尤其是低收入和老年人。医保整合对主观幸福感的积极影响主要源于农村居民心理健康的改善和相关健康行为的增加，以及门诊服务利用和财务风险保护水平在一定程度上的提升。医保整合对城市居民的主观幸福感没有显著影响，表明医保整合改革在降低城乡居民医疗服务利用和健康不平等的同时，并没有对城市居民产生明显的负面溢出效应。
