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作为一项制度创新,新型农村合作医疗要求农民以家庭为单位集体参保。此举目的是为了规避个人参保背景下家庭中年迈体弱者参保、而青壮年身体健康者不参保的“逆向选择”。在“集体参合、自愿选择”的制度框架下,农户参合行为客观上受到家庭基本特征的影响。本文基于CGSS(2013)的实证分析发现,当家庭成员中老人占比增加、家庭代际关系紧张以及人户分离时,农户家庭倾向于放弃参加新农合,进而导致老年农民参合行为受到影响,医疗保障可及性受到限制。
As a system innovation, the new type of rural cooperative medical system requires farmers to take collective insurance with their families as their unit. The purpose of this move is to avoid the “adverse selection” of the elderly and the infirm in the family in the context of the personal insurance, while the young and the healthy are not insured. Under the institutional framework of “collective participation and voluntary choice”, the peasant household participation behavior is objectively influenced by the basic characteristics of the family. Based on the empirical analysis of CGSS (2013), this paper finds that when the proportion of elderly people in family members increases, family intergenerational tensions and the separation of people and households, families tend to abandon their participation in NRCMS, which in turn leads to the participation of older peasants being affected. Access to health care is limited.