农村居民健康人力资本的收入效应与影响因素研究
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摘要
居民的健康问题关系着生产和生活,良好的健康水平既是经济发展的必要条件,也是人类发展的终极目标之一。我国农村居民的健康状况与城市居民存在很大差距,健康的人力资本角色一直未得到重视。对于如何改善健康,相关研究主要集中在医疗保健因素,而对收入、教育等其他社会经济因素的影响未有充分讨论；对正在广泛实施的新型农村合作医疗制度的作用也众说纷纭。
本文基于人力资本理论和Grossman健康需求理论等,采用2000年至2006年中国健康与营养调查在全国9省中收集的跟踪调查数据,通过实证分析回答了相关的三个核心问题：(1)作为人力资本形式之一的健康对农村居民的劳动参与行为和收入有怎样的影响?(2)除医疗因素之外,收入、教育等社会经济因素对农村居民的健康产生了怎样的影响?(3)正在实施的新型农村合作医疗制度(NCMS)是否增加了医疗服务的可获得性并改善了农村居民的健康?
基于实证分析回答上述三个问题是本文的主要内容,具体研究内容和结论如下：
(1)研究发现,当期和滞后期健康良好能显著增加农村居民参与劳动的概率。并且,滞后期健康良好能使农村男性参与非农劳动的概率增加11%。对于收入,健康良好能使个人的农业收入、商业收入、工资收入和总收入都得到显著的增加,如当期健康良好能使总收入增加14.4%,滞后期健康良好能使总收入增加7%,而教育人力资本没有对农村居民收入发生显著影响。相比之下,城市居民的收入受健康人力资本的影响小于农村,主要受到教育人力资本的影响。因此,对于农村居民,健康人力资本在劳动参与和收入增加方面的作用都非常重要。
(2)模型检验发现农村居民的健康容易受到多种社会经济因素的影响。除了年龄造成的健康折旧之外,长期收入和医疗价格都对农村居民健康产生了显著作用；在教育方面,初中及以上的教育水平能对健康发挥积极作用；处于不同地区也使农村居民健康存在很大的差异；最后,上述影响都存在着性别差异。模型中对健康的动态性也进行了控制,发现初期健康良好和滞后期健康良好都能显著增加农村居民当期健康良好的概率。相比之下,城市居民的健康主要受到年龄和初期健康的影响,而收入、医疗价格和教育都没有产生显著影响。以上存在的城乡差异表明,在城乡二元结构下,农村居民的健康更为脆弱。
(3)为了更有效的控制不可观测因素造成的估计偏差,采用了准实验设计方法,应用三倍差模型来进一步研究了社会经济因素中的NCMS的影响。研究发现,NCMS增加了就医的便捷性,但未增加人们对基层医疗服务设施的使用,反而增加了到省市级医院的就医,表明基层医疗服务质量上还有待改进。而且NCMS导致医疗价格显著增加,对于总体人群的医疗支出没有影响；不过,分收入组后发现参加NCMS能减少中低收入组的医疗支出。在对健康的影响方面,参加NCMS减少了人们的患病情况,但农村居民的自我健康评价还没有得到改善。因此,NCMS在继续推广的过程中,需要针对这些方面的不足加以完善。
总体而言,本文在理论上检验了人力资本理论和Grossman的健康需求理论对于研究我国农村居民健康问题的适用性；在实践上能为政府制定农村居民的健康保障政策提供参考。文章从人力资本视角重新认识了农村居民健康人力资本对于劳动参与和收入的作用；对收入、教育等社会经济因素的综合考察弥补了健康影响因素研究中偏重医疗的缺陷；对非线性动态随机效应模型、三倍差模型等模型的应用在国内研究中属于首次,拓展了计量方法的适用性,而且对不可观测变量的有效控制使得结论对政策制定更具有参考价值。
Health, a necessary and sufficient condition of economic development and the ultimate goal of human developing. There is big disparity between the health statuses of rural residents and urban residents. Nevertheless, the problem of the role of health human capital has not yet been given enough importance. Researches on health improvement have attached much value to medical care, but little to income, education and other social economic factors. There are also alternative opinions on the new rural cooperative medical system which is being extensively enforced currently.
This paper, based on human capital theory and Grossman theory, and applying frontier measurement method, answers three core questions:(1) What are the influences of health, as a part of human capital, on labor participation and income of rural residents? (2) In addition to medical care factors, how do social economic factors, like income and education, etc, affect health of rural residents? (3) If the New Cooperative Medical scheme (NCMS) being carried out in rural areas increases the accessibility of medical care service and improves health conditions of rural residents?
Content of empirical studies and answers to the three questions are:
(1) The empirical study shows that good current and lag health statuses can obviously increase the probabilities of labor participation. Besides, lag health status adds a bigger marginal participation rate of male people to the non-farm work. Good health status improves all kinds of incomes, such as farm income, business income, wage income, and general income. Good current health status improves general income by a rate of 14.4%, compared to a rate of 7% by good lag health status, whereas education human capital has on significant effect on income. The influence of health human capital on incomes of urban residents is lighter than that on incomes of rural residents, due to the effect of education human capital. Therefore, as to rural residents, health human capital plays an important role for both labor participation and income improvement.
(2) The health of rural residents is prone to be affected by various social economic factors. Empirical studies state that long term incomes and prices of medical care have significant influences on health of rural residents, taking into consideration of health depreciation by age. Higher education levels above junior high school have a positive effect on health. There are remarkable differences between health statuses of people living in different areas. Generally, these factors have alternative influences on male and female. By controlling for the dynamics of health in the formal model, we find that either good initial health or good lag health helps to increase the probability of good current health. By contract, health of urban residents is mainly affected by age and initial health, rather than income, medical care prices or education. The different situations between urban and rural residents demonstrate that, under the dual economic structure of urban and rural areas, health of rural residents is more fragile than that of urban residents.
(3) The carryover effect of NCMS is estimated using triple difference model with a treatment group and two control groups by controlling the random of medical insurance participation. The empirical work argues that NCMS increases the convenience of medical treatment and brings about more people taking medical treatment in provincial and city-level hospitals rather than increases use of rural level medical services. This point implies that medical services of rural level are waited for improvement. Besides, NCMS leads to much higher prices of medical treatment. Yet there is no increase in general medical care expense of the whole population. However, NCMS helps to save the medical care expense of people of low-middle level incomes, which is found by applying the model with specific groups of alternative income level. Moreover, NCMS tends to, decrease sickness, whereas there's no improvement in self assessed health of rural residents. Therefore, measurements in the promotion of NCMS in future should be taken by directing at these above mentioned limitations.
In general, the applicability of using human capital theory and Grossman demand theory in studies on health of rural residents is tested theoretically and some references are drawn for policies regard health security of rural residents practically. The paper reacquaints the effects of health of rural residents on labor participation and income, makes up for the imperfection in researches in factors influencing health by incorporating social economic factors such as income and education, and applies Dynamic Panel Probit model and triple difference model for the first time in researches nationally, which expands the feasibility of econometric methods and makes the conclusions more indicative for policies by effectively controlling for unobservable variables.
本文基于人力资本理论和Grossman健康需求理论等,采用2000年至2006年中国健康与营养调查在全国9省中收集的跟踪调查数据,通过实证分析回答了相关的三个核心问题：(1)作为人力资本形式之一的健康对农村居民的劳动参与行为和收入有怎样的影响?(2)除医疗因素之外,收入、教育等社会经济因素对农村居民的健康产生了怎样的影响?(3)正在实施的新型农村合作医疗制度(NCMS)是否增加了医疗服务的可获得性并改善了农村居民的健康?
基于实证分析回答上述三个问题是本文的主要内容,具体研究内容和结论如下：
(1)研究发现,当期和滞后期健康良好能显著增加农村居民参与劳动的概率。并且,滞后期健康良好能使农村男性参与非农劳动的概率增加11%。对于收入,健康良好能使个人的农业收入、商业收入、工资收入和总收入都得到显著的增加,如当期健康良好能使总收入增加14.4%,滞后期健康良好能使总收入增加7%,而教育人力资本没有对农村居民收入发生显著影响。相比之下,城市居民的收入受健康人力资本的影响小于农村,主要受到教育人力资本的影响。因此,对于农村居民,健康人力资本在劳动参与和收入增加方面的作用都非常重要。
(2)模型检验发现农村居民的健康容易受到多种社会经济因素的影响。除了年龄造成的健康折旧之外,长期收入和医疗价格都对农村居民健康产生了显著作用；在教育方面,初中及以上的教育水平能对健康发挥积极作用；处于不同地区也使农村居民健康存在很大的差异；最后,上述影响都存在着性别差异。模型中对健康的动态性也进行了控制,发现初期健康良好和滞后期健康良好都能显著增加农村居民当期健康良好的概率。相比之下,城市居民的健康主要受到年龄和初期健康的影响,而收入、医疗价格和教育都没有产生显著影响。以上存在的城乡差异表明,在城乡二元结构下,农村居民的健康更为脆弱。
(3)为了更有效的控制不可观测因素造成的估计偏差,采用了准实验设计方法,应用三倍差模型来进一步研究了社会经济因素中的NCMS的影响。研究发现,NCMS增加了就医的便捷性,但未增加人们对基层医疗服务设施的使用,反而增加了到省市级医院的就医,表明基层医疗服务质量上还有待改进。而且NCMS导致医疗价格显著增加,对于总体人群的医疗支出没有影响；不过,分收入组后发现参加NCMS能减少中低收入组的医疗支出。在对健康的影响方面,参加NCMS减少了人们的患病情况,但农村居民的自我健康评价还没有得到改善。因此,NCMS在继续推广的过程中,需要针对这些方面的不足加以完善。
总体而言,本文在理论上检验了人力资本理论和Grossman的健康需求理论对于研究我国农村居民健康问题的适用性；在实践上能为政府制定农村居民的健康保障政策提供参考。文章从人力资本视角重新认识了农村居民健康人力资本对于劳动参与和收入的作用；对收入、教育等社会经济因素的综合考察弥补了健康影响因素研究中偏重医疗的缺陷；对非线性动态随机效应模型、三倍差模型等模型的应用在国内研究中属于首次,拓展了计量方法的适用性,而且对不可观测变量的有效控制使得结论对政策制定更具有参考价值。
Health, a necessary and sufficient condition of economic development and the ultimate goal of human developing. There is big disparity between the health statuses of rural residents and urban residents. Nevertheless, the problem of the role of health human capital has not yet been given enough importance. Researches on health improvement have attached much value to medical care, but little to income, education and other social economic factors. There are also alternative opinions on the new rural cooperative medical system which is being extensively enforced currently.
This paper, based on human capital theory and Grossman theory, and applying frontier measurement method, answers three core questions:(1) What are the influences of health, as a part of human capital, on labor participation and income of rural residents? (2) In addition to medical care factors, how do social economic factors, like income and education, etc, affect health of rural residents? (3) If the New Cooperative Medical scheme (NCMS) being carried out in rural areas increases the accessibility of medical care service and improves health conditions of rural residents?
Content of empirical studies and answers to the three questions are:
(1) The empirical study shows that good current and lag health statuses can obviously increase the probabilities of labor participation. Besides, lag health status adds a bigger marginal participation rate of male people to the non-farm work. Good health status improves all kinds of incomes, such as farm income, business income, wage income, and general income. Good current health status improves general income by a rate of 14.4%, compared to a rate of 7% by good lag health status, whereas education human capital has on significant effect on income. The influence of health human capital on incomes of urban residents is lighter than that on incomes of rural residents, due to the effect of education human capital. Therefore, as to rural residents, health human capital plays an important role for both labor participation and income improvement.
(2) The health of rural residents is prone to be affected by various social economic factors. Empirical studies state that long term incomes and prices of medical care have significant influences on health of rural residents, taking into consideration of health depreciation by age. Higher education levels above junior high school have a positive effect on health. There are remarkable differences between health statuses of people living in different areas. Generally, these factors have alternative influences on male and female. By controlling for the dynamics of health in the formal model, we find that either good initial health or good lag health helps to increase the probability of good current health. By contract, health of urban residents is mainly affected by age and initial health, rather than income, medical care prices or education. The different situations between urban and rural residents demonstrate that, under the dual economic structure of urban and rural areas, health of rural residents is more fragile than that of urban residents.
(3) The carryover effect of NCMS is estimated using triple difference model with a treatment group and two control groups by controlling the random of medical insurance participation. The empirical work argues that NCMS increases the convenience of medical treatment and brings about more people taking medical treatment in provincial and city-level hospitals rather than increases use of rural level medical services. This point implies that medical services of rural level are waited for improvement. Besides, NCMS leads to much higher prices of medical treatment. Yet there is no increase in general medical care expense of the whole population. However, NCMS helps to save the medical care expense of people of low-middle level incomes, which is found by applying the model with specific groups of alternative income level. Moreover, NCMS tends to, decrease sickness, whereas there's no improvement in self assessed health of rural residents. Therefore, measurements in the promotion of NCMS in future should be taken by directing at these above mentioned limitations.
In general, the applicability of using human capital theory and Grossman demand theory in studies on health of rural residents is tested theoretically and some references are drawn for policies regard health security of rural residents practically. The paper reacquaints the effects of health of rural residents on labor participation and income, makes up for the imperfection in researches in factors influencing health by incorporating social economic factors such as income and education, and applies Dynamic Panel Probit model and triple difference model for the first time in researches nationally, which expands the feasibility of econometric methods and makes the conclusions more indicative for policies by effectively controlling for unobservable variables.
引文
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