《保险研究》20190608-《从税收竞争视角看居民医疗保险筹资与商业健康保险发展》（李涛、朱铭来）

［摘   要］本文从地方政府税收竞争视角,探讨居民医疗保险筹资与商业健康保险发展的关系。在动态经济模型基础上,构建税收竞争下居民医疗保险筹资与商业健康保险发展的理论框架。利用空间计量模型和合成控制法对理论模型进行系统的实证分析。研究结果表明:在财政下行压力和资本边际收益递减的宏观背景下,地方政府在民生领域的高支出竞争偏好,倒逼地方政府展开新一轮税收竞争,容易导致地方政府财政收入减少和财政困难,从而增加居民医疗保险财政筹资压力。在这个过程中居民医疗保险筹资水平提高,能够凸显商业健康保险在医疗保障筹资体系中的补充地位。

［关键词］地方政府税收竞争；居民医疗保险筹资；商业健康保险发展

［基金项目］国家社科基金一般项目“职工基本医疗保险个人账户改革研究”(18BGL199)。

［作者简介］李涛,青岛大学经济学院讲师、南开大学卫生经济与医疗保障研究中心特约研究员，E-mail:huodelinghun@163.com；朱铭来,南开大学金融学院教授、博士生导师。

Tax Competition Perspective:Individual Medical Insurance Funding and Commercial Health Insurance Development

LI Tao,ZHU Ming-lai

Abstract：This paper explored the relationship between individual medical insurance funding and commercial health insurance from the perspective of local government tax competition.Based on the dynamic economic model,the theoretical framework of individual medical insurance financing and commercial health insurance under tax competition was constructed.The theoretical model was systematically and empirically analyzed using the spatial econometric model and the synthetic control method.The results show that under the macro background of fiscal income downward pressure and diminishing marginal return of capital,the local government′s high expenditure competition preferences for people′s livelihood forces a new round of local government tax competition,which easily leads to local government revenue reduction and financial difficulties,and increases the financing pressure for individual medical insurance.In this process,the increase in the level of financing for medical insurance can highlight the complementary status of commercial health insurance in the medical insurance funding system.

Key words：local government tax competition;individual medical insurance funding;commercial health insurance development