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城乡医保统筹背景下流动人口医疗保健的机会不平等——事前补偿原则与事后补偿原则的悖论 被引量:3

Inequality of Opportunity of Floating Population's Health Care under the Integrated Medical Insurance System --Paradox of the Ex-ante or Ex-post Compensation Principle
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摘要 本文借鉴机会平等理论构建了一个可用于分析城乡医保统筹问题的理论框架,从理论上和实证上阐述了事前补偿原则与事后补偿原则的联系和冲突.并对现有文献进行了评述和归纳:随后,利用2014年全国流动人口动态监测数据.分析了农业户籍流动人口在医疗保健方面面临的机会不平等。结果显示:在事前补偿原则下,参加新农合的农业户籍流动人口面临显著的由户籍造成的机会不平等,而参加统筹医保的则不显著:在事后补偿原则下,无论参加新农合还是统筹医保.农业户籍流动人口面临的机会不平等均显著,且公正缺口数值很大。这体现了事前补偿原则与事后补偿原则的冲突。在此基础上,本文采用匹配双差分的方法进一步考察城乡医保统筹政策是否有效缓解了由户籍造成的机会不平等。结果显示:从事前角度看,医保统筹政策对缓解机会不平等有显著作用.而从事后角度则没有发现显著的效果。这从政策效果角度反映了事前事后原则的冲突。考虑到中国现行医保统筹政策导向更多是基于事前补偿思想.而事后补偿思想反映了更为本质的机会平等,因此.本研究对医保统筹的顶层设计具有借鉴意义。 Based on theory of Equality of Opportunity,this paper constructs a framework to analyze the Integrated Medical Insurance System(IMIS). Under the theory framework, This paper employs survey of the floating population wave 2014 to measure the inequality of opportunity between rural and urban floating population. The results show that the rural floating population who participate in the New Cooperative Medical Scheme(NCMS) face significant inequality of opportunity of health care under Ex-ante compensation principle, while the person who participates in the ISIM will not. Correspondingly, under Ex-post compensation principle, no matter what kind of medical insurance the rural floating population participate in, they all face significant inequality of opportunity, and the fairness gap is much bigger. Moreover, PSMDD result shows that there is a conflict between Ex-ante and Ex- post compensation principle. Considering that the IMIS is based on the Ex-ante concept in practice, while Ex-post concept reflects the essential equality of opportunity. Therefore, the findings are relevant to the top-level design for the IMIS.
作者 马超 曲兆鹏 宋泽 MA Chao1,2, QU Zhao-peng3, SONG Ze4(1. School of Public Health, Southeast University, Nanjing 210009, China;2. School of Public Health, Yale University, New Haven 06510, U.S.;3. School of Business, Nanjing University, Nanjing 210093, China;4. National School of Development, Peking University, Beijing 100571, China)
出处 《中国工业经济》 CSSCI 北大核心 2018年第2期100-117,共18页 China Industrial Economy
基金 国家自然科学基金青年项目“‘二保合一’背景下城乡医保一体化理论构建、制度评估及对策研究--基于选择性平等框架下的分析”(批准号71603046) 国家社会科学基金青年项目“新世纪我国农民工消费研究”(批准号13CJY091) 江苏省自然科学基金青年项目“城乡医保统筹对农村老年居民医疗服务利用公平性的影响”(批准号BK20150646).
关键词 机会平等 医疗保健 公平 城乡医保统筹 流动人口 equality of opportunity health care equity Urban-Rural Integrated Medical Insurance System floating population
作者简介 马超,东南大学公共卫生学院讲师,耶鲁大学公共卫生学院博士后,管理学博士;通讯作者:马超,电子邮箱:machao@seu.edu.cn。;曲兆鹏,南京大学商学院副教授,经济学博士;;宋泽,北京大学国家发展研究院博士后,经济学博士。
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