共济何以共健?职工医保门诊共济与健康不平等

江西财经大学学报 ›› 2025, Vol. 0 ›› Issue (5): 61-75.

共济何以共健?职工医保门诊共济与健康不平等

陈薇¹, 张心洁^2,3

1.复旦大学社会发展与公共政策学院, 上海 200433;
2.南京大学政府管理学院, 江苏南京 210023;
3.江苏大学管理学院, 江苏镇江 212013

收稿日期:2025-04-29 出版日期:2025-09-25 发布日期:2025-11-04
通讯作者: 张心洁,江苏大学副教授,博士生导师,南京大学博士后,主要从事社会保障与健康治理研究,联系方式zhangxinjie1218@126.com。
作者简介:陈薇,复旦大学博士研究生,主要从事社会保障与健康经济研究。
基金资助:
国家自然科学基金面上项目“基于激励相容的城乡居民门诊大病保障支付模式研究”（72174078）; 国家自然科学基金青年项目“健康治理视域下社会、心理资本对农村重大疾病患者健康的影响研究”（71804061）

How Can Mutual-Aid Promote Common Health? Outpatient Cost-Sharing of Basic Medical Insurance for Employees and Health Inequality

Chen Wei¹, Zhang Xin-jie^2,3

1. Fudan University, Shanghai 200433;
2. Nanjing University, Nanjing 210023;
3. Jiangsu University, Zhenjiang 212013, China

Received:2025-04-29 Online:2025-09-25 Published:2025-11-04

摘要/Abstract

摘要： 职工医保门诊共济是实现全民健康的内在要求。基于2011—2020年中国健康与养老追踪调查数据,利用交错双重差分模型等方法,实证检验了职工医保门诊共济对中老年人健康不平等的影响,并进一步探究其作用机制及调节效应。研究发现,职工医保门诊共济显著缓解了中老年人的健康不平等,但该缓解作用仅体现在政策实施后的第一年,中老年人未能持续受益。机制分析表明,职工医保门诊共济通过发挥医疗支出补偿效应和健康行为激励效应,进一步缓解健康不平等。调节效应分析发现,结构型社会资本削弱了职工医保门诊共济对健康不平等的缓解作用。异质性分析表明,职工医保门诊共济对健康不平等的缓解作用在女性群体、老年人群体和低学历群体中更为明显。因此,有必要建立门诊待遇动态调整机制、发挥门诊“健康守门人”作用、培育中老年弱势群体的社会资本,并构建门诊共济精准识别机制,从而助推职工医保门诊共济改革释放共健红利。

关键词: 职工医保门诊共济, 健康不平等, 医疗支出补偿效应, 健康行为激励效应

Abstract: Outpatient cost-sharing of basic medical insurance for employees is an inherent requirement for achieving national health. Based on the data from the China Health and Retirement Longitudinal Study from 2011 to 2020, this study empirically examines the impact of employee medical insurance outpatient mutual assistance on health inequality among middle-aged and elderly people by using methods such as the staggered double difference model, and further explores its mechanism and moderating effect. The findings show that employee medical insurance outpatient mutual assistance significantly alleviates health inequality among middle-aged and elderly people, but this alleviation effect is only reflected in the first year after policy implementation, and middle-aged and elderly people have not been able to continue to benefit. The mechanism analysis shows that employee medical insurance outpatient mutual assistance can further alleviate health inequality by leveraging the compensation effect of medical expenses and the incentive effect of health behavior. The moderation effect analysis reveals that the structural social capital will weaken the alleviating effect of employee medical insurance outpatient mutual assistance on health inequality. The heterogeneity analysis shows that the alleviation effect of outpatient cost-sharing of basic medical insurance for employees on health inequality is more pronounced in the female, elderly, and low education groups. Therefore, it is necessary to establish a dynamic adjustment mechanism for outpatient treatment, play the role of outpatient “health gatekeepers”, cultivate social capital of vulnerable groups in the middle-aged and elderly, and build a precise identification mechanism for outpatient mutual assistance, so as to promote the reform of employee medical insurance outpatient mutual assistance and release the dividends of common health.

Key words: outpatient cost-sharing of basic medical insurance for employees, health inequality, compensatory effects of medical expenditure, incentive effects of health behavior

中图分类号:

F842
R197

陈薇, 张心洁. 共济何以共健?职工医保门诊共济与健康不平等[J]. 江西财经大学学报, 2025, 0(5): 61-75.

Chen Wei, Zhang Xin-jie. How Can Mutual-Aid Promote Common Health? Outpatient Cost-Sharing of Basic Medical Insurance for Employees and Health Inequality[J]. Journal of Jiangxi University of Finance and Economics, 2025, 0(5): 61-75.

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