公私合营健康计划对私人保险的影响

Journal of Development Economics · 2026 · [{"name": "Hui Ding", "affiliation": ["Shanghai University of Finance and Economics", "Fudan University", "Shanghai University of International Business and Economics"]}, {"name": "Xintong Wang", "affiliation": ["Fudan University"]}, {"name": "Xian Xu", "affiliation": ["Fudan University"]}]

中文摘要

公私合作（PPP）健康保险计划一直被视为在维持财政可持续性的同时扩大覆盖面的有前景工具。然而，在中国这类拥有全民基本公共保险、但私人保险市场仍在发展中的环境下，人们对其影响知之甚少，尤其是它究竟提高了总体覆盖率，还是挤出了现有的私人保险。为考察这一问题，我们利用中国城市定制型补充医疗保险（CCSMI）在各城市的交错引入，以及一套新颖的交易层面私人健康保险数据集。结果显示，CCSMI 在广延边际和集约边际上均产生显著的溢出效应：它大幅挤出私人保险购买，并降低了平均保障金额。平均支付保费同样下降，其中三分之二的降幅由消费者转向更窄的保障范围所驱动，其余部分则可能源于保险公司的定价调整。一个粗略估算表明，私人保险购买的下降至少抵消了 CCSMI 参保增量的 25%。这些发现为全面评估 PPP 保险项目提供了重要启示。（JEL I13, H42, G22, G41）

Abstract

Public-private partnership (PPP) health insurance plans have been viewed as a promising tool to expand coverage while maintaining fiscal sustainability. However, in settings like China, with universal basic public insurance but still-emerging private insurance markets, little is known about their impact, particularly whether they increase overall coverage or displace existing private insurance. To examine this, we leverage the staggered introduction of China's City-Customized Supplemental Medical Insurance (CCSMI) across cities and a novel transaction-level dataset of private health insurance. Results reveal significant spillover effects on both the extensive and intensive margins: CCSMI substantially crowds out private insurance purchases and reduces average coverage amounts. Average premiums paid also decline, with two-thirds of the reduction driven by consumers opting for narrower coverage and the remainder likely due to insurers' pricing adjustments. A back-of-the-envelope calculation suggests that the decline in private insurance purchases offsets at least 25% of CCSMI enrollment gains. These findings provide important insights for comprehensively evaluating PPP insurance programs. (JEL I13, H42, G22, G41)