《保险研究》20240406-《因病返贫、债务负担与大病保险补偿》（陈晓宇、锁凌燕、吕欣怡）

［摘   要］防范化解因病致贫、因病返贫风险，是提升低收入群体内生发展动力和能力、实现共同富裕的基础性工作。本文基于中国家庭金融调查数据，运用双重差分法估计了罹患重大疾病对个体医疗及债务负担的影响，并探讨了城乡居民大病保险对缓解个体医疗及债务负担的作用。研究表明，罹患重大疾病会导致个体医疗开支平均增加119%，相应的债务负担增长98%。这一结论在考虑了处理效应异质性、自然灾害与人为灾害的安慰剂检验和一系列其他稳健性检验后均成立。进一步研究发现，农业户籍居民、家庭资产规模较小者及经济、医疗欠发达地区的居民在罹患重大疾病时更易增加债务负担；参与城乡居民大病保险和商业健康保险能够在一定程度上减轻其医疗费用和债务负担。本研究强调了多层次医疗保障体系的重要性，为减轻居民医疗负担提供了政策启示。

［关键词］因病返贫；大病保险；社会保障

［基金项目］本文为教育部人文社会科学重点研究基地重大项目“中国特色多层次养老保障体系研究”(22JJD790091)的阶段性成果，文责自负。

［作者简介］陈晓宇，清华大学五道口金融学院博士研究生；锁凌燕（通讯作者），北京大学经济学院副院长、风险管理与保险学系教授；吕欣怡，北京大学经济学院本科生。

Back to Poverty Due to Illness,Debt Burden,and Major Disease Insurance Compensation

CHEN Xiao-yu,SUO Ling-yan,LV Xin-yi

Abstract：Preventing the risks of illness-induced poverty or relapse to poverty is a fundamental work to enhance the endogenous development drive and abilities of low-income groups and achieve common prosperity.This article,based on data from the Chinese Household Finance Survey,employs the difference in differences method to estimate the impact of critical diseases on individual healthcare expense and debt burden.It also explores the role of urban and rural residents′ major medical expenses insurance in alleviating individual healthcare and debt burden.The results of this article indicate that individual medical expenses would increase 119% on average due to critical diseases,and the corresponding debt burden increases by 98%.This conclusion is valid after considering the placebo test for natural and man-made disasters,the heterogeneity of treatment effects and a series of robustness tests.Further research has found that residents with agricultural HUKOU,those with lower household assets,and those in economically underdeveloped areas are more likely to increase their debt burden while facing critical diseases.Individuals participating in major medical expenses insurance for urban and rural residents and commercial health insurance can to some extent reduce their medical expenses and debt burden.This study emphasizes the importance of a multi-level medical security system and provides important policy insights for reducing the medical burden on residents.

Key words：relapse to poverty due to illness;major medical expenses insurance;social security