《保险研究》20220508-《职工基本医疗保险的收入再分配效应》（于新亮、伊扬、张文瑞、韩琳琳）

［摘   要］本文运用2018年山东省城镇职工基本医疗保险采集数据，将医疗保险缴费和补偿的不同环节作为研究对象，通过计算基尼系数与MT指数，从全覆盖、多层次和碎片化的视角研究职工基本医疗保险的收入再分配效应。结果发现:剥离医疗资源分布不均衡带来的健康不平等因素后，职工基本医疗保险能够显著降低收入分配的不公平性；职工基本医疗保险体系的多重保障层次具有不同的收入再分配效应，其中统筹基金的收入再分配效应为正且影响程度较大，医疗补助、企业补充保险和个人账户的再分配效应为负；职工基本医疗保险的碎片化特征使其收入再分配效应存在异质性；个人账户余额会诱导参保职工更倾向于选择住院的就诊方式，极大地阻碍了职工基本医疗保险正向收入再分配效应的发挥。本文据此提出完善多层次补偿机制、提升行政管理统筹层次和加快推进门诊共济保障机制等政策建议，从而有助于推进我国医疗保障改革进程，实现共同富裕。

［关键词］基本医疗保险；收入再分配；多层次；碎片化；个人账户

［基金项目］国家自然科学基金青年科学基金项目“灾难性卫生支出风险识别、致贫路径与精准保障研究”(批准号:71804090)；山东省泰山学者工程专项经费“保险风险优化控制策略研究”(批准号:tsqn20161041)；山东省艺术科学重点课题“省会都市圈消费文化发展研究”(批准号:L2021Q07080121)。

［作者简介］于新亮(通讯作者),山东财经大学保险学院副院长、副教授、博士生导师,研究方向:卫生经济与医疗保障；伊扬,山东财经大学保险学院硕士研究生,研究方向:卫生经济与医疗保障；张文瑞,中国海洋大学管理学院博士研究生,研究方向:非正式制度与公司治理；韩琳琳,山东师范大学经济学院博士研究生,研究方向:消费与消费不平等。

A Research on the Income Redistribution Effect of Employee Basic Medical Insurance

YU Xin-liang,YI Yang,ZHANG Wen-rui,HAN Lin-lin

Abstract：Using the collected data of employee basic medical insurance in Shandong Province in 2018,this paper took different segments of medical insurance contributions and compensation as the research objects,and studied the income redistribution effect of employee basic medical insurance from the perspective of full coverage,multi-level and fragmentation by calculating the Gini coefficient and MT index.The results find that:after stripping the health inequality factors caused by the uneven distribution of medical resources,employee basic medical insurance can significantly reduce the inequality of income distribution;the multiple levels of coverage in the employee basic medical insurance have different income redistribution effects,among which the income redistribution effect of the integrated fund is positive and has a greater degree of influence,while the redistribution effect of medical assistance,enterprise supplementary insurance and individual accounts is negative;the fragmentation of employee basic medical insurance makes its income redistribution effect heterogeneous;the personal account balance induces employees to prefer hospitalization,which greatly hinders the positive income redistribution effect of employee basic medical insurance.Accordingly,this paper put forward policy suggestions such as improving the multi-level compensation mechanism,upgrading the administrative coordination level and accelerating the outpatient co-payment guarantee mechanism,thus helping to advance the process of China′s medical insurance reform and achieve common prosperity.

Key words：basic medical insurance;income redistribution;multilevel;fragmentation;individual accounts