《保险研究》20250507-《基本医疗保险效率、中老年健康与劳动供给决策：基于DEA方法的实证分析》（朱铭来、孙赫阳、解莹）

［摘   要］本文采取数据包络分析方法（DEA）全面评估2016~2020年中国30个省市区的基本医疗保险制度效率，对基本医疗保险效率影响中老年劳动供应决策的路径进行理论与实证分析。结果显示，医保效率的提升与中老年劳动参与度的增长存在显著关联，且自评健康状况在这一关联中发挥中介作用，这种关系并非线性，存在效应转换的劳动供给临界点，对于文内样本而言该点为25.92小时/周的工作时长，超越此点，医保效率进一步提高可能导致劳动供应减少。有鉴于此，为确保中老年劳动力持续供给，需改善医保效率和资金管理，增强医疗保障功能，使医保从单纯的“事后补偿”逐步转为包含疾病预防的“全面健康保障”，并鼓励商业健康保险发展，优化多层次医保体系，促进劳动力市场健康增长。

［关键词］基本医疗保险；劳动力供给；效率；DEA分析；中介效应

［作者简介］朱铭来，南开大学卫生经济与医疗保障研究中心主任，金融学院教授、博士生导师，研究方向：卫生经济与医疗保障；孙赫阳（通讯作者），南开大学金融学院博士研究生；解莹，泰康集团财务精算企划部价值管理精算主任。

The Efficiency of Basic Medical Insurance，Health of Middle-aged and Elderly People，and Labor Supply Decisions：An Empirical Analysis Based on DEA Method

ZHU Ming-lai，SUN He-yang，XIE Ying

Abstract：Utilizing Data Envelopment Analysis （DEA），we comprehensively evaluate the efficiency of the basic medical insurance system across 30 provinces，municipalities，and autonomous regions in China for the period 2016-2020，and conducts a theoretical and empirical analysis of the pathways through which the efficiency of basic medical insurance influences the labor supply decisions of middle-aged and elderly people.Our findings indicate a significant positive association between enhanced basic medical insurance efficiency and increased labor participation among middle-aged and elderly people.Furthermore，self-rated health status is identified as a significant mediator in this relationship.The analysis also reveals that this association is non-linear，characterized by a critical threshold in labor supply.For the sample under investigation，this threshold is determined to be 25.92 weekly working hours.Beyond this point，further improvements in basic medical insurance efficiency may potentially lead to a reduction in labor supply.In light of these results，policy recommendations emphasize the need to improve basic medical insurance efficiency and fund management to ensure a sustainable labor supply from the middle-aged and older population.This involves strengthening the medical protection function，transitioning the basic medical insurance system from focusing solely on ‘ex-post compensation’ towards a ‘comprehensive health security’ framework that integrates disease prevention.Additionally，fostering the development of commercial health insurance and optimizing the multi-tiered social medical insurance system are crucial for promoting healthy growth in the labor force market.

Key words：basic medical insurance;labor supply;efficiency;DEA analysis;mediating effect