通讯作者: 吴宇涵, 2017200043@ruc.edu.cn

DOI：10.12201/bmr.202501.00036

The Effect of Chinas Basic Medical Insurance System on the Income Distribution

• 摘要：目的：从制度设计视角深入探讨我国基本医疗保险的问题，为未来以实现公平社会分配为目标的医保改革提供实证依据。方法：利用中国居民收入分配项目（CHIP）数据，采用RE指数分解方法，评估了我国基本医疗保险制度在收入分配方面的作用，并通过政策模拟方法，测算了七种缴费与报销政策对医保收入分配效应的影响。结果：当前医保缴费具有较强的累退性，导致参保人员缴费后收入差距扩大，而医疗报销环节对此的改善作用有限。实行居民医保定比缴费（尤其是累进费率）、居民医保与职工医保并轨等政策，能够显著增强医保收入分配效应；相比之下，退休职工缴费和基金池省级统筹政策对医保公平性的提升效果有限。结论与建议：针对居民医保优先采用低费率的累进性缴费方案，同时积极尝试推进居民医保与职工医保基金池统筹，以缩小不同医保制度间的待遇差距，缓解低收入城乡居民的就医负担，进一步提高医保统筹基金的使用效率，最终实现更公平的收入分配。

  关键词： 医疗保障; 公平性; 收入分配; 政策模拟

   

  Abstract: Objective: By deeply exploring the issues of Chinas basic medical insurance system from the perspective of system design, this study provides empirical evidence for future medical insurance reforms aimed at achieving fair social distribution. Methods: Based on the data of China Household Income Project (CHIP), this paper evaluates the effect of Chinas basic medical insurance system on income distribution by using the RE index decomposition method, and calculates the impact of seven kinds of contribution and reimbursement policies on income distribution effect through policy simulation. Results: The current medical insurance payment exhibits a strong regressive character, which leads to the widening of the income gap after the payment of the insured, and the improvement brought by the medical reimbursement mechanism is limited. The implementation of fixed-proportion contribution (especially progressive rate), the integration of resident insurance and employee insurance policies can significantly enhance the income distribution effect of medical insurance; In contrast, the contribution of retired employees and the provincial pooling policy of fund pool have limited effect on improving the equity of medical insurance. Conclusion: Adopt a low rate progressive payment scheme for residents medical insurance, and actively try to promote the pooling of residents medical insurance and employees medical insurance fund, so as to narrow the treatment gap between different medical insurance systems, alleviate the medical burden of low-income residents, further improve the efficiency of the use of medical insurance pooling fund,and ultimately achieve more equitable income distribution.

  Key words: Basic Medical Insurance; Equity; Income Distribution; Policy Simulation

  提交时间：2025-01-14

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2024-10-22	10.12201/bmr.202501.00036V1	下载

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