农村医疗保险便携性、就业“锁定”与福利再分配效应研究

This research tries to theoretically explore the internal linkage and mechanism among the institutional arrangements of health insurance, behavioral response of labor market and welfare redistribution from the point of view of the benefit portability of health insurance, and to depict a general mechanism of rural labor force’s decision making on the employment behavior under the condition of limited benefit portability of health insurance, which will provide a more explanatory framework for the construction of inclusive and "employment friendly" social health insurance systems. Based on the theoretical framework, this project would like to empirically examine the effect of job lock and welfare redistribution for the health insurance participants in rural China. ..This research pays considerable attention to the issues stated as follows: Does the characteristics of benefit portability of social health insurance in rural China significantly affect the free migration for the rural labor force and hence result in job lock? Does social health insurance with limited benefit portability impose restrictions on the demand and utilization of health services for rural migrant workers and induce the loss of health capital for them? How and to what extent does this public welfare program with financial subsidies have significant impact on the incidence of health-induced poverty and income gap for the households in rural China? What are the constraints and incentive mechanisms to implement the benefit portability of the social health insurance systems in rural China among different regions?..The answers to these issues mentioned above could not only have potentially far-reaching implications for further reform and improvement of social health insurance in rural China, and but also strengthen the application and explanatory capability of the mechanism design theory under the setting of China. Furthermore, our findings could provide a logically consistent and universally theoretical framework for a wide range of social security systems reform, for example, the benefit portability and top-level design of pension schemes, to evaluate the efficiency of the labor market and welfare redistribution.

本课题从便携性这一全新的视角来解析医疗保险制度安排、劳动力市场行为响应与福利再分配的连接机制，刻画农村劳动力对医保权益便携性所做出的就业行为决策的一般机理，为构建“就业友好”型的社会医疗保障制度提供一个更具解释力的分析框架。并在此基础上，实证评价农村社会医疗保险制度的就业“锁定”与福利再分配效果。.研究重点关注：农村社会医疗保险制度的便携性特征是否影响农村劳动力的自由流动而产生就业“锁定”？是否抑制农村外出务工人员的医疗服务需求、诱发健康资本损耗？既定的医保便携性安排能否降低农户“因病致贫”的风险、缩小收入差距？实现医疗保险制度可携带的条件与激励机制是什么？.研究成果不仅有助于拨开当前我国农村社会医疗保障制度体系改革的迷雾，增强机制设计理论在中国情景中的应用与解释力；还可以为更广泛意义上的社会保障制度，如养老保障制度的携带性与顶层设计，提供一个逻辑一致的、一般性的理论分析框架。

根据本项目计划书，本课题应重点回答以下研究问题：1.医保权益便携性提升能否降低农村劳动力的就业“锁定”？2.城乡居民医保整合能否提高农村居民的医疗服务利用，并降低其医疗费用负担？3.这一制度变革能否抑制农村中老年人的健康损耗？4.整合后的城乡居民医保制度能否发挥减贫功能，降低农村中老年人的贫困脆弱性？5.城乡居民医保整合能否在促进增收的同时缩小收入差距，进而推进包容性增长？.课题遵循课题设计的研究内容和研究目标展开研究，主要使用“中国健康与养老追踪调查”（CHARLS）数据以及“中国劳动力动态调查”（CLDS）数据进行实证研究。在完成主要研究内容的同时，本课题做了相应的拓展与延伸，为社会医疗保险制度的改进和完善方向提供合理的政策建议，亦为相关领域的进一步纵深研究打下坚实基础。截至2021年12月，目前已完成的成果包括公开发表14篇论文和完成3篇硕士学位论文。.本课题最重要的发现主要体现在五个方面：一、医疗保险便携程度的提升显著促进农村劳动力在本市范围内流动，降低了“就业锁定”效应。二、城乡居民医保整合有助于增加农村居民的门诊医疗服务利用，并获得更高质量的医疗资源的同时，降低农村居民就医负担。三、城乡居民医保整合有效缓解了农村中老年人的行动能力损耗，不同整合模式在抑制不同群体健康损耗方面各具优势。第四、医保整合政策有效缓解了农村中老年人的贫困脆弱性，其中，“城乡一档”整合模式的减贫效果优于“一制多档”模式。第五、医保整合有助于提高城乡劳动力的家庭收入；增收效应在不同收入水平群体间存在差异，随时间推移，整合政策对低收入群体释放出更大的增收红利。.综合以上研究成果，我国社会医疗保险制度改革切实激发了劳动力市场活力，进而发挥福利再分配功能，但是仍然需要持续动态观察医保整合对弱势群体的福利改善效果，推进社会医疗保险制度在全国范围内的统筹整合，真正实现医保权益的实质公平。