医疗保险对长期贫困的影响：作用机制与动态模拟

《财经研究》 2022年48卷第8期 页码：33 - 47  online：2022年8月3日

医疗保险对长期贫困的影响：作用机制与动态模拟

The Impact of Health Insurance on Long-term Poverty: Mechanism and Dynamic Simulation

作者（中）：赵桂芹1 , 孔祥钊1 , 陈莹1

作者（英）：Zhao Guiqin1, Kong Xiangzhao1, Chen Ying1

作者单位：1.上海财经大学 金融学院，上海 200433

摘要：发展是解决贫困问题的“总钥匙”，要从根源上解决贫困问题，关键还是要提升贫困家庭和脱贫家庭的自主发展能力，而医疗保险是解决此问题的重要政策工具。现有研究忽视了医疗保险对家庭投资决策的作用及其长期影响，而文章将医疗保险机制纳入包含消费和投资的家庭资产随机增长模型，在无医疗保险、有医疗保险无保费补贴和有医疗保险有保费补贴三种情形下，对比分析了不同资产水平家庭的贫困脆弱性及其投资决策变化，并分析三种情形下的长期贫困率、贫困深度以及长期减贫成本的变动趋势。研究发现，医疗保险不仅通过事后的损失补偿效应降低家庭贫困脆弱性，还通过事前的投资激励效应促进脱贫后的家庭主动增加生产投资，加速家庭资产累积，巩固既有扶贫成果。医疗保险和政府现金补助政策的结合在显著降低长期贫困率和贫困深度的同时，大幅降低了减贫和抑制返贫所需的长期成本。因此，相较于单一的现金补助，政策政府应采用“现金补助+保费补贴”的扶贫政策，提升贫困家庭的主观能动性，从而降低其长期贫困的可能性。文章的研究对于减少长期贫困和防止返贫等具有一定的参考价值。

关键词：医疗保险；贫困脆弱性；投资激励；长期减贫

Summary: Under the current standards, China has eliminated absolute poverty and has achieved decisive progress and staged victory in poverty alleviation. After 2020, consolidating the achievements of poverty alleviation and reducing long-term poverty will be the focus of anti-poverty. Therefore, it is necessary to analyze the impact of different poverty reduction policies on the long-term poverty rate, depth of poverty and costs of long-term poverty reduction. This will help to optimize existing poverty reduction policies and allocate resources for poverty alleviation efficiently. This paper develops a dynamic theoretical model to compare vulnerability to poverty and investment decisions of households with different asset levels in the three cases of government cash subsidy, health insurance and health insurance with premium subsidy. On this basis, this paper further analyzes the changing trend of long-term poverty rate, depth of poverty and costs of long-term poverty reduction in the three cases. It is found that: First, health insurance has an ex-post vulnerability reduction effect, especially for families who are non-poor vulnerable. Second, for families who are poor and non-poor vulnerable, health insurance can increase productive investment through the ex-ante investment incentive effect. Third, compared with government cash subsidy, “government cash subsidy + premium subsidy” significantly lowers the long-term poverty rate, depth of poverty and costs of long-term poverty reduction. This paper contributes to the existing literature in three ways: First, this paper develops a dynamic theoretical model to compare vulnerability to poverty and investment decisions of households. Further, it analyzes the ex-ante incentive effect of health insurance on the production investment of poor and non-poor vulnerable families, enriching the theoretical research on the mechanism of health insurance in poverty reduction and prevention of returning to poverty. Second, from the perspective of long-term poverty reduction, this paper discusses the mechanism of health insurance on the poverty dynamics of different groups, especially the impact of health insurance on the inter-temporal capital dynamics of non-poor vulnerable families, and deepens the understanding of the function of health insurance to restrain the return to poverty. Third, on the basis of government cash subsidy, this paper introduces health insurance and further explores the synergistic effect of the two on long-term poverty reduction.

Key words: health insurance; vulnerability to poverty; investment incentive; long-term poverty reduction

DOI：10.16538/j.cnki.jfe.20220414.401

收稿日期：2021-11-08

基金项目： 国家自然科学基金面上项目（71973089）；上海财经大学研究生创新基金项目（CXJJ-2019-311，CXJJ-2020-352）

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