《保险研究》20211207-《城乡居民医保整合对农村居民城市定居意愿的影响——来自中国劳动力动态追踪调查的证据》（赵紫荆、王天宇）

［摘   要］长期以来,基于户籍身份的公共福利权利差异使农村外出务工群体处于“流而不迁”的状态,无法真正融入城市。2016年开始实施的新型农村合作医疗和城镇居民基本医疗保险整合打破了医疗保障的户籍壁垒,使农村居民在迁移到城镇地区后能够享受和城镇居民同样的定点范围、医保目录和报销待遇。本文使用中国劳动力动态调查2014和2016的数据,利用各地区城乡医保整合时间差异作为外生冲击,使用双重差分法评估城乡居民医保整合对农村居民迁居城市意愿和购房意愿的影响,提出“福利导向定居”和“工作导向定居”两种机制并进行验证。研究发现,城乡医保整合显著提高了农村居民定居城镇和在城镇购房的意愿。机制检验表明,“工作导向定居”的影响占主导,即医保整合提高了农村居民在城市务工的便捷性,从而提高了其定居意愿。本文证实现阶段缩小城乡公共服务差异、打破公共服务壁垒有助于就近城镇化,并且这种作用主要是通过减轻劳动力流动阻力实现的,并不会出现福利磁铁效应,对以公共服务改革推进“以人为核心”的城镇化和共同富裕具有参考意义。

［关键词］城乡居民医保整合；基本公共服务均等化；定居意愿；双重差分

［基金项目］本文受到北京市社会科学基金项目“北京市新医改对居民就医行为的影响”(项目号:18YJC024)和教育部人文社科基金项目“基于医保行政数据的医院竞争与医疗费用关系研究”(项目号:17YJC790155)资助。

［作者简介］赵紫荆,清华大学社会科学学院政治学系博士研究生,研究方向:医疗保险、社会心态、政治传播；王天宇,中国人民大学劳动人事学院社会保障系副教授,研究方向:养老保险,医疗保险。

The Impact of the Urban and Rural Residents′ Social Medical Insurance on the Rural Residents′ Willingness to Settle in Cities:Evidences from the China Labor Dynamics Survey

ZHAO Zi-jing,WANG Tian-yu

Abstract：For a long time,differences in public welfare rights based on hukou status have left rural migrant workers in a state of“transient migration without integration” into cities. The integration of the New Rural Cooperative Medical Scheme and the Urban Residents′ Basic Medical Insurance since 2016 has broken the hukou status barriers to the medical insurance,enabling rural residents settled in cities to enjoy the same medical insurance catalog and reimbursement benefits as urban residents. With data from the China Labor Dynamics Survey in 2014 and 2016,this study used regional variation in the integration time as exogenous shocks and applied difference-in-difference estimations to evaluate the impact of this integration on rural residents′ willingness to settle in cities and to buy houses. We proposed and examined two mechanisms:the work-oriented settlement and the welfare-oriented settlement. This paper finds that this integration has significantly increased the willingness of rural residents to settle and buy houses in urban areas. The mechanism test shows that the work-oriented settlement mechanism plays a dominant role,namely this integration improves the convenience of rural residents to work in cities,thereby increases their willingness to settle down. This article proves that at the current stage,the equalization of public services between urban and rural areas is conducive to nearby urbanization,and this effect is mainly achieved by reducing the resistance to labor mobility,while the welfare magnet effect is not evident. This article can endorse the promotion of people-centered urbanization and “common prosperity” through the reform on basic public services.

Key words：the integration of urban and rural residents′ social medical insurance;equalization of basic public services;willingness to settle;difference-in-difference