《保险研究》20230205-《中国医疗保障体系的收入再分配效应：“劫贫”还是“济贫”？》（李亚青、罗耀）

［摘   要］医疗保障能否有效发挥“济贫”的正向再分配作用,是实现“实质公平”和共同富裕的关键环节。本文基于广东地区的医疗保险数据库,并从基本医保进一步扩展到补充医保,通过引入MT指数、基尼系数路径曲线等工具进行了较系统的研究,还考察了制度变量调整对再分配效应可能造成的动态影响。研究发现,医疗保障在筹资和补偿环节都是“济贫”的,其中补偿环节的作用更突出,但医疗保障的“济贫”效应源自基本医保的贡献而非补充医保。边际效应分析结果表明,若总体补偿水平继续提高将进一步强化这种“济贫”效应。医保补偿还未达到使基尼系数降至最低点的水平。未来有必要在精准识别困难群体的基础上完善筹资和补偿机制,适度加大对弱势者的政策倾斜。

［关键词］医疗保障；收入再分配；MT指数；基尼系数路径曲线；弱势群体

［基金项目］国家社科基金年度项目“医疗保障制度对健康平等的精准化改进研究”（18BJY215）。

［作者简介］李亚青，广东财经大学金融学院副院长、副教授，硕士生导师，研究方向:健康经济和社会保障；罗耀，广东机电职业技术学院人工智能学院讲师，研究方向:大数据分析。

Redistribution Effects of China′s Health Insurance System:“Assiting the Poor” or “Robbing the Poor”?

LI Ya-qing,LUO Yao

Abstract：Whether China′s Health Insurance System (CHIS) is efficient on income redistribution for “assisting the poor” is key for achieving “substantive fairness” and highquality.Based on the data of Guangdong province,and broadening the research scope from basic health insurance to supplementary medical insurance,the paper introduces the MT index and the path curve of the Gini coefficient to conduct a systematic study on this question.It also studies the dynamic impacts of policy variable adjustment on the redistribution effects.The results show that China′s social health insurance as a whole has the effect of “assisting the poor” not only in the phase of fund-raising but also compensation,with the effect more pronounced in the phase of compensation.However,it is the basic health insurance rather than supplementary medical insurance that has played the primary role of “assisting the poor”.The marginal effect analysis reveals that the “assisting the poor” effect will be strengthened if the compensation level continues to be adjusted up.The compensation of social medical insurance hasn′t yet reached the level that helps to achieve the minimum Gini coefficient.The paper concludes that it′s necessary to adopt favorable policy for the poor through improvements on the fund-raising and compensation mechanisms on the premise of accurate identification of vulnerable groups.

Key words：health insurance protection;income redistribution;MT index;the path curve of the Gini coefficient;the vulnerable groups