中国医疗保险的地区差异及其对就医行为的影响
Regional Disparity in China's Medical Insurance System and Its Implication on Health Service Use

中国社会医疗保险在经历快速扩张后，于2010年左右实现了对全国城乡各地区的制度性全面覆盖。在这一背景下，各地居民实际拥有的医疗保险资源是否还存在突出差异？医疗保险资源是否会影响各地居民的医疗服务利用行为以及有病不医现象的严重程度？围绕这些问题，文章以中老年人群为例，利用全国性抽样调查数据进行了实证分析。研究发现，2011年，全国约有7%的中老年人没有任何医疗保险。未参保人群既包括社会经济资源相对匮乏者，也包括健康状况较好、预期医疗需求较低的个人。总体而言，医疗保险提高了参保人利用医疗服务的可能性；但不同医保项目的效应强度存在显著差异。新农合与城镇居民医保项目的促进作用相对较小，城镇职工医疗保险的效应明显更大，与商业医保的效应强度接近。值得一提的是，各地居民有病不医的现象主要取决于个人健康状况，医疗保险资源对有病不医现象的直接影响相当有限。研究认为，现阶段社会医疗保险项目的统筹层次较低，这在各地医疗卫生资源分布不均衡的现实背景下，极有可能制约医疗保险资源对于缓减看病贵、有病不医问题的实际效应，并在客观上增加保险的运行和管理成本。鉴于此，进一步改革医疗保险应当提高保险统筹层次，正视医疗卫生资源的分布差异，促进医有所保目标的真正实现。
：China's medical insurance system has achieved an institutional full coverage nationwide by 2010. Whether this milestone achievement has eliminated the imbalance in medical insurance resource distribution among regions and individuals? Does medical insurance make a difference in individuals' health service use and unmet medical needs? To address these questions, we conduct a multilevel analysis to investigate the regional and individual differences in the healthcare practices with data collected from the national sample survey of CHARLS2011. We find that, in spite of the institutional full coverage, around seven percent individuals remain uninsured in 2011 when the population aged 45 and above is concerned. The uninsured individuals either have limited socioeconomic resources, or are healthy at the moment and thus have lower expected medical needs. Medical insurance resources promote individuals' health service use significantly, but they do not make a big difference in individuals' unmet medical needs. The promotion effects on health service use also differ across the insurance programs, with the New Rural Cooperative Medical Scheme and the Urban Resident Medical Insurance showing comparable but lower impacts as compared with the Urban Employee Medical Insurance. This study concludes that it is vital to level up the pooling and administrative level of the present social medical insurance programs in order to achieve actual full insurance coverage and better protection for its targeted population