《保险研究》20251107-《城乡居民大病保险对向下代际支持的影响——基于经济支持和服务支持的研究》（杜霞、王治）

［摘   要］在人口老龄化与家庭结构小型化的背景下，完善社会正式风险分担和家庭非正式风险分担机制是缓解家庭医疗经济负担的重要途径。本文利用中国健康与养老追踪调查数据，运用交错差分法研究城乡居民大病保险对家庭向下代际经济支持和服务支持的影响，并进一步探究完善多层次医疗保障体系，优化家庭代际资源配置的渠道。研究结果表明，城乡居民大病保险显著提高家庭向下代际经济支持和服务支持，并且该影响会因父母或子女年龄、婚姻状况和居住地区而存在异质性。机制分析表明，城乡居民大病保险主要通过改善居民健康状况，促进代际向下经济支持，增强老年人隔代照料动机。因此,有必要重点完善特定老年群体的风险分担机制，在人口流动背景下促进异地医保的衔接，畅通大病保险优化家庭资源配置的路径。

［关键词］城乡居民大病保险；代际经济支持；代际服务支持；健康机制

［基金项目］国家自然科学基金青年项目(72504151)和教育部人文社科研究一般项目青年基金项目(24YJC790036)。

［作者简介］杜霞，南开大学金融学院风险管理与保险学系讲师；王治，北京大学经济学院风险管理与保险系。

The Impact of Urban and Rural Residents’ Critical Illness Insurance on Downward Intergenerational Support—A Study Based on Economic Support and Service Support

DU Xia,WANG Zhi

Abstract：Against the backdrop of population aging and shrinking family structures,improving both formal social risk-sharing mechanisms and informal family risk-sharing mechanisms serves as a crucial approach to alleviating households’ financial burdens.Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) and employing a staggered difference-in-differences approach,this paper examines the impact of the Urban and Rural Resident Critical Illness Insurance (URRCI) on downward intergenerational economic and service support within families.It further explores pathways to optimize the multi-tiered healthcare security system and improve intergenerational resource allocation within families.The findings demonstrate that URRCI significantly enhances downward intergenerational economic and service support.Moreover,this effect exhibits heterogeneity depending on the age of parents or children,marital status,and residential location.Mechanism analysis reveals that URRCI primarily improves residents’ health conditions,thereby promoting downward intergenerational economic support and strengthening elderly individuals’ motivation to provide grandchild care.Consequently,it is imperative to prioritize the refinement of risk-sharing mechanisms for specific elderly subgroups,facilitate the portability of health insurance across regions in the context of population mobility,and streamline the pathways through which critical illness insurance optimizes intra-family resource allocation.

Key words：Urban and Rural Resident Critical Illness Insurance (URRCI);intergenerational economic support;intergenerational service support;health mechanism