【摘要】 新时代健康中国战略的根本目标是实现全民健康，而政府配置公共医疗卫生资源的方式对实现健康中国战略目标具有重大影响。本文基于两部门世代交叠模型，研究政府预防性支出占比和医疗保险报销比例对个人健康投资、居民健康和福利的经济影响及其作用机制，并通过数值模拟分析医疗卫生政策调整对卫生总费用、个人卫生支出、社会总消费及医保基金财政依赖程度的定量影响。研究发现，适度提高政府预防性支出占比不仅改善居民健康并提升福利，还能降低卫生总费用占GDP比重和医保基金财政依赖程度，增加社会总消费。在现有预算体制下，提高医疗保险报销比例能够降低个人自付医疗负担，但会对个人健康投资产生两种相反的激励效应，且负向激励占主导，导致个人健康投资水平随报销比例上升而下降。上述发现对持续优化政府卫生支出结构、有效实施健康中国战略提供了定量政策参考。更多还原

【Abstract】 Along with rapid economic growth in past decades, China’s spending on health and medical services has also been increasing dramatically, as a share of GDP, has stayed 6.7% in 2021 compared to only 3.1% in 1979. Out of the total spending on healthcare, the government’s increasing share plays an important role, and the effects of the government’s health expenditure and its composition on individual health and welfare have attracted many discussions in recent literature. In this paper, we focus on the government’s health service expenditure and medical insurance subsidies, which account for more than 90 percent of government health expenditure in China, and analyze how the allocation of government spending on preventive care and subsidies to medical insurance affects individual health and welfare.Within the dynamic general equilibrium framework, we establish a two-period overlapping generations model with both non-medical and medical sectors to analyze the relationship between government health expenditure and individual health, consumption, and welfare. Medical demand is assumed to depend on individual health status, which is jointly determined by private and government preventive efforts. Two competing mechanisms, the health effect and the price effect, are found and decomposed to explain the nonlinear policy effects. We then examine how two major health policy adjustments change individual consumption, health, and welfare through numerical simulations, i.e., increasing the proportion of government preventive spending and raising the reimbursement rate of medical insurance. Our numerical simulations show that households’ medical expenditure, personal health investment, and saving rate all respond similarly in a U-shape to an increase in the proportion of government preventive spending. A positive price effect and a negative health effect explain the nonlinear change in individual medical expenditure, while a negative substitution effect and a positive incentive effect explain the change in personal health investment. As for the saving rate, declining personal health investment and medical expenditure relax the budget constraint in old age and cause a decrease in the saving rate in youth, but further increase in government preventive spending share may lead to a significant rise in the price of medical services and therefore medical expenditure, causing the saving rate to rise again for precautionary concern. Moderate increase in the proportion of government preventive spending can also improve total consumption of non-medical goods, and lower the ratio of total health spending to GDP and the degree of financial dependence of medical insurance funds on government subsidies. On the other hand, raising the medical reimbursement rate can reduce individual out-of-pocket medical spending and improve their non-medical consumption, but lead to a decline in individual preventive efforts due to a negative incentive effect. However, under China’s current budget system, it also crowds out government expenditure on public preventive care, and motivates people to invest more in preventive efforts. The overall effect of the two incentive effects is still negative, and welfare change is dominated by insufficient personal health investment rather than increased consumption, so the overall effect is negative.Compared with the existing research, this study makes contributions in the following ways. First, we distinguish the different mechanisms of government preventive and curative expenditures affecting individuals’ decisions and analyze the economic effects of major health policy adjustments. Second, we determine the demand and price of medical care by introducing a medical sector, which allows us to analyze the health effect and the price effect of adjusting the government health expenditure structure. Third, we characterize the relationship between medical insurance and government health expenditure in the Chinese context and analyze the crowing-out effect and the incentive effect of raising the medical reimbursement rate on personal health investment.Two more questions deserve further investigation. First, to be more in line with China’s economic reality, government’s productive expenditure should be considered to explore the optimal budget structure. Second, the risk-sharing function of the medical insurance system should be characterized by introducing heterogeneity, which may enable us to discuss the effects of public policies on health and income inequalities.更多还原