《保险研究》20260306-《城乡居民基本医疗保险省级统筹与居民健康——基于机器学习方法的预测分析》（鲁一鸣）

［摘   要］本文基于中国家庭收入调查数据与手动收集的我国地级及以上城市城乡居民基本医疗保险报销政策，运用机器学习方法，模拟预测城乡居民基本医疗保险省级统筹对居民健康的影响。研究发现，预算刚性假设下，城乡居民医保省级统筹可以在不损害居民整体健康水平的基础上大幅缩小健康差距。进一步地，特征重要性分析显示，城乡居民医保保障水平与地区生产总值增速影响力相当，对居民健康具有不容忽视的重要作用；依赖图分析发现，城乡居民医保保障水平与居民健康具有非线性关系。异质性分析结果显示，城乡居民医保省级统筹对健康差距的缩小作用在经济发达省份更加明显。本文的研究量化评估了城乡居民医保省级统筹对居民健康的影响，为推动城乡居民基本医疗保险朝着更加公平、统一的方向发展提供实证依据与政策建议。

［关键词］城乡居民基本医疗保险；保险保障；居民健康；机器学习

［基金项目］本文受到国家社会科学基金一般项目“延迟退休背景下中国特色代际支持模式及影响研究”（23BRK015）、河北省社会科学发展研究青年课题“河北省基本医保统筹层次提升对健康公平的影响效应与政策优化研究”（HBSKFZ25QN217）、中央高校基本科研业务费“居民基本医疗保险制度建设对居民健康差距的影响与对策研究”（N2523022）的支持。

［作者简介］鲁一鸣，东北大学工商管理学院讲师、东北大学秦皇岛分校经济学院讲师、南开大学卫生经济与医疗保障研究中心研究员，研究方向：风险管理与保险学、社会保障。

The Provincial-level Coordination of Urban and Rural Residents′ Basic Medical Insurance and Residents′ Health—A Predictive Analysis Based on Machine Learning Methods

LU Yi-ming

Abstract：Drawing upon data from the China Household Income Survey and manually compiled information regarding the reimbursement policies for urban and rural residents′ basic medical insurance in cities at or above the prefecture level across China，this study employs machine learning methods to simulate and predict the influence of provincial-level coordination of urban and rural residents′ basic medical insurance on residents′ health.The findings reveal that，assuming budget rigidity，such coordination can considerably reduce health disparities without diminishing the overall health standards of the population.Additionally，the feature importance analysis underscores that the level of coverage in urban and rural residents′ basic medical insurance is on par with the impact of the growth rate of regional GDP，wielding considerable influence over residents′ health that should not be overlooked.Dependence graph analysis reveals that there is a non-linear relationship between the level of urban and rural residents′ medical insurance coverage and residents′ health.Heterogeneity analysis further indicates that the impact of provincial-level coordination in narrowing health disparities is more pronounced in economically advanced provinces.This study offers a quantitative assessment of the impact of provincial-level coordination on the health of residents and provides empirical insights and policy recommendations aimed at fostering a more equitable and unified development of urban and rural residents′ basic medical insurance.

Key words：urban and rural residents′ basic medical insurance;insurance protection;residents′ health;machine learning methods