《保险研究》20230802-《逆向选择还是正向选择：健康风险与风险态度对居民商业健康保险参保的影响研究》（刘晓婷、楼心怡）

［摘   要］作为我国多层次医疗保障体系的重要组成部分，商业健康保险市场长期呈现高家庭保障需求与低市场投保率失衡发展的特点。本文基于逆向选择和正向选择理论，选取代表个体健康风险与风险态度的变量，利用2018与2020年 CFPS数据，通过Logit模型以及Bi-probit等计量方法，对商业健康保险市场进行检验。研究发现，健康风险越高越可能购买商业健康保险；风险偏好程度越高，购买健康保险的可能性越低，且拥有商业健康保险的群体多为高收入、高学历人群。面板数据回归结果表明，我国商业健康保险市场同时存在逆向选择与正向选择，异质性分析进一步证实了风险偏好程度差异对健康风险与参保间负向关系的干扰，说明正向选择的存在会缓解逆向选择效应。因此，要加强全生命周期健康信息监测体系建设，增强民众保险意识，加强商业健康保险与社会医疗保险的制度衔接，厘清基本医保与商业健康保险的互补关系。

［关键词］商业健康保险；逆向选择；正向选择；健康风险；风险态度

［基金项目］本研究是国家自然科学基金重点项目(71734005)、浙江省自然科学基金重大项目(D19G030003)的阶段性成果。

［作者简介］刘晓婷，浙江大学公共管理学院教授；楼心怡（通讯作者），浙江大学公共管理学院硕士研究生。

Adverse Selection or Positive Selection:The Impact of Health Risk and Risk Attitude on Residents′ Participation in Commercial Health Insurance

LIU Xiaoting,LOU Xinyi

Abstract：The commercial health insurance is an important part of China′s multi-level medical security system.However,the commercial health insurance market in China has long been characterized by an unbalanced development between high family demands and low rate of insurance purchase.Based on the theory of adverse selection and positive selection,this paper selectes variables representing individual health risks and risk attitudes,and empirically tests China′s commercial health insurance market by using CFPS panel data in 2018 and 2020,logit model,bi-probit and other measurement methods.The results demonstrates that the higher the health risk is,the higher the probability to buy the insurance,and the higher the risk preference is,the lower the probability to participate in the insurance,and the group having commercial health insurance is mostly those with high income and high education.Panel data regression results show that both adverse selection and positive selection exist in China′s commercial health insurance market,and heterogeneity analysis further confirms the interference of risk preference degree differences on the negative relationship between health risk and insurance participation,indicating that the existence of positive selection can dissolve the adverse selection effect.Therefore,we should strengthen full life-cycle health monitoring,enhance the insurance awareness of the public,strengthen the cooperation between commercial health insurance and the social medical insurance system,and properly define the complementary relationship between them.

Key words：commercial health insurance;adverse selection;positive selection;health risks;risk attitude