《保险研究》20230805-《医疗保险、家庭可持续生计资本与财务脆弱性研究》（杨亮、王亚茹、丁少群）

［摘   要］后扶贫时代，如何巩固脱贫成果，推进共同富裕，成为新的研究问题。医疗保险作为分散疾病风险的重要工具，对于稳定和提升家庭可持续生计资本，降低家庭财务脆弱风险，防止因病致贫返贫具有积极意义。本文基于中国家庭金融调查数据，构建家庭财务脆弱性和脆弱程度指标，并进一步细分财务困境家庭和边缘脆弱家庭，从家庭可持续生计资本视角，探究医疗保险对家庭财务脆弱风险的影响。研究结果表明：医疗保险通过改变家庭的金融资本和人力资本存量实现对家庭财务脆弱的影响。其中，作为多层次医疗保障体系的主体，居民医保能够显著降低所有家庭陷入财务脆弱状态的概率和程度，尤其对边缘脆弱家庭的效果更显著；商业医保作为基本医疗保险的重要补充，能够进一步降低家庭陷入财务脆弱状态的概率及程度，对财务困境家庭的改善效果更明显。建议从政府、社会和家庭三个层面完善多层次医疗保障体系，通过不同渠道增加家庭的可持续生计资本，缩小医疗保障需求缺口，减轻居民的医疗负担，改善家庭财务状态。

［关键词］医疗保险；家庭可持续生计资本；财务脆弱性；脆弱程度

［基金项目］本文获得研究阐释党的二十大精神国家社会科学基金重大项目基于系统观念的多层次社会保障制度创新与政策协同研究(23ZDA099)的资助。

［作者简介］杨亮，西南财经大学金融学院副教授、硕士生导师；王亚茹，西南财经大学公共管理学院博士研究生；丁少群（通讯作者），西南财经大学公共管理学院教授、博士生导师。

A Research  on Medical insurance,Sustainable Household Livelihood Capital and Financial Vulnerability

YANG Liang,WANG Ya-ru,DING Shao-qun

Abstract：In the post-poverty alleviation era,how to consolidate the achievements of poverty alleviation and promote common prosperity has become a new research question.As an important tool to spread disease risk,medical insurance has a positive significance on stabilizing and improving the sustainable household livelihood capital,reducing the risk of household financial vulnerability,and preventing illness-led poverty or relapse into poverty due to illness.Based on the data of Chinese Household Finance Survey,this paper constructs the indicators of household financial vulnerability and degree of vulnerability,and further distinguishes the financially distressed households and marginalized vulnerable households.From the perspective of sustainable livelihood capital,it explores the impact of medical insurance on household financial vulnerability.The results show that medical insurance has an impact on the financial fragility of households by changing their financial and human capital stock.Among them,as the mainstay of the multi-level medical security system,the social medical insurance for residents can significantly reduce the probability and degree of financial vulnerability of all households,especially for marginalized vulnerable families.As an important supplement,commercial medical insurance can further reduce the probability and degree of financial vulnerability,especially for financially distressed families .It is suggested to improve the multi-level medical security system from the three levels of government,society and family,increase the sustainable livelihood capital of families through different channels,narrow the gap of medical security demands,reduce the medical burden of households,and improve their financial situation.

Key words：medical insurance;sustainable livelihood capital;financial vulnerability;degree of vulnerability