《保险研究》20260107-《大病冲击、医疗保险和中国城镇家庭贫困脆弱性——基于微观模拟方法的研究》（张浩田、祝伟）

［摘   要］本文建立贫困脆弱性分析框架，运用微观模拟方法评估大病风险冲击下医疗保险保障降低中国城镇居民家庭贫困脆弱性的作用。研究发现，城镇居民家庭因病致贫的风险脆弱性问题不容忽视，大病冲击下陷贫概率超过50%的家庭占全部样本家庭的16%，低收入家庭中该比例则高达73%;社会医疗保险总体上有效地降低了城镇居民家庭的贫困脆弱性，但面临更高因病致贫风险的家庭却并未充分持有社会医保，且从当前持有的社会医保中获得的脆弱性改善效果相对有限，表明社会医疗保险在覆盖对象和效果方面的精准度有待提高；补充医疗保险对于我国城镇家庭的覆盖范围很有限，降低贫困脆弱性的总体作用微弱，且在覆盖对象和效果方面均缺乏精准度。有必要推动社会医疗保险实现全民覆盖，并从提高对象精准度和效果精准度的视角引导补充医疗保险的发展，从而有效减少大病风险冲击导致的贫困。

［关键词］重大疾病；社会医疗保险；补充医疗保险；贫困脆弱性

［基金项目］外经济贸易大学中央高校基本科研业务费专项资金资助（ZD6-02）。

［作者简介］张浩田，北京大学经济学院博士研究生；祝伟（通讯作者），对外经济贸易大学保险学院教授。

Major Disease Shock，Medical Insurance，and Poverty Vulnerability of Urban Households in China

ZHANG Hao-tian，ZHU Wei

Abstract：This paper constructs an analytical framework for poverty vulnerability and employs a micro-simulation approach to assess the extent to which medical insurance mitigates the poverty vulnerability of urban households in China in the face of major disease shocks.The results show that the poverty vulnerability induced by health shocks is a pressing concern：over 16% of households in the sample exhibit a probability of impoverishment exceeding 50% following a major disease shock，with this proportion rising to 73% among low-income households.Overall，social medical insurance plays an effective role in reducing poverty vulnerability among urban households.However，households facing higher risks of illness-induced poverty are not adequately covered by social medical insurance and experience only limited improvements in vulnerability from their current coverage，highlighting the need to improve the precision of targeting and effectiveness of the social medical insurance program.Supplementary medical insurance plans provide limited coverage for urban households and exhibits only marginal effects in reducing poverty vulnerability，with even less precision in both targeting and effectiveness.It is necessary to promote universal coverage of social medical insurance and guide the development of supplementary medical insurance from the perspective of improving target precision and effect precision，so as to effectively reduce the poverty vulnerability caused by major disease shocks.

Key words：major disease;social medical insurance;supplementary medical insurance;poverty vulnerability