金融学院知识库

十八大以来，党中央高度重视贫困人群的医疗保障工作，不断推进医疗保障制度改 革，致力于构建覆盖全民、公平可及、全面均衡的多层次医疗保障体系，医疗保障脱贫 攻坚也取得了决定性成就。然而，目前我国居民的灾难性医疗支出发生率尚处于较高水 平，由重大疾病导致的返贫问题是巩固脱贫攻坚成果的一大制约因素，为了避免城乡居 民看病发生就医“贵”甚至“负担不起”的情况，我国在 2022 年提出要构建一个以“1” 为基础，“3+N”协同发力的多层次医疗保障体系，保障人民权益，增强民生福祉。二 十届三中全会中，党中央强调要加快完善大病保险和医疗救助制度，促进多层次医疗保 障体系的有效衔接，从而有效缓解城乡居民的医疗经济压力。但灾难性医疗支出仍不时 发生。

本文基于中国家庭追踪调查（China Family Panel Studies，简称 CFPS）的五期微观 面板数据，运用渐进双重差分模型探究大病保险对城镇居民灾难性医疗支出的影响，并 进行稳健性检验以确保结果的可靠性，此外，考虑到不同性别、不同收入水平群体以及 不同区域之间可能存在差异性，本文从性别、收入和地区三个维度出发，就大病保险对 城镇居民灾难性医疗支出影响的异质性进行了分析。

研究结论表明：第一，城镇居民灾难性医疗支出的发生率在大病保险政策实施后显 著降低；第二，异质性分析表明，大病保险的实施对低收入群体影响效果明显；发现对 东部地区而言，大病保险带来的负向影响更为显著；相对于男性群体而言，大病保险的 实施对女性群体的影响更为显著。根据以上结论，文章从筹资方式、筹资渠道和保险待 遇等方面提出相应的对策建议。旨在通过大病保险对城镇居民灾难性医疗支出的影响研 究，为大病保险制度的优化以及进一步推动健康中国战略的实施，确保广大人民群众能 够享受到更加公平、高效、可持续的医疗服务提供实证分析的参考依据。

Since the 18th National Congress of the Communist Party of China, the CPC Central Committee has attached great importance to the medical security of the poor, continuously promoted the reform of the medical security system, and committed to building a multi-level medical security system that covers the whole people, is fair and accessible, and is comprehensive and balanced. In order to avoid the situation that urban and rural residents are "expensive" or even "unaffordable" to seek medical treatment, China proposed in 2022 to build a multi-level medical security system based on "1" and "3+N" to protect people's rights and interests and enhance people's livelihood and well-being. At the Third Plenary Session of the 20th CPC Central Committee, the CPC Central Committee emphasized the need to speed up the improvement of the serious illness insurance and medical assistance system, and promote the effective connection of the multilevel medical security system, so as to effectively alleviate the medical economic pressure of urban and rural residents, but catastrophic medical expenditures still occur from time to time. Based on the five-phase micro-panel data of the China Family Panel Studies (CFPS), this paper uses a progressive difference-in-difference model to explore the impact of critical illness insurance on the catastrophic medical expenditure of urban residents, and conducts a robustness test to ensure the reliability of the results. This paper analyzes the heterogeneity of the impact of critical illness insurance on the catastrophic medical expenditure of urban residents. The conclusions of the study show that: first, the incidence of catastrophic medical expenditure of urban residents is significantly reduced after the implementation of the critical illness insurance policy; Second, heterogeneity analysis shows that the implementation of critical illness insurance has a significant impact on low-income groups. It is found that for the eastern region, the negative impact of critical illness insurance is more significant. Compared with the male group, the implementation of critical illness insurance has a more significant impact on the female group. Based on the above conclusions, this paper puts forward corresponding countermeasures and suggestions from the aspects of financing methods, financing channels and insurance benefits. The aim of this study is to provide an empirical basis for the optimization of the critical illness insurance system, the further promotion of the implementation of the Healthy China strategy, and the need to ensure that the general public can enjoy more equitable, efficient and sustainable medical services through the study of the impact of critical illness insurance on the catastrophic medical expenditure of urban residents.