摘  要
　　　“健康中国”战略要求构建健全的医疗保障体系以应对老龄化和慢性病挑战，虽然基本医疗保险提供了基础保障，但是在重大疾病或者高额医疗费用面前仍并不足够。而商业医疗保险作为补充可以向居民提供更广泛、个性化的服务，同时也可以满足居民的健康需求。
　　　随着我国的生育政策从独生子女逐步放宽至全面三孩，这促使了家庭子女结构的变化，也推动了社会生育观念的深刻变革，人们的生育观念逐渐从“多子多福”转向了优生优育，少子化趋势更加明显，同时子女性别比虽有改善但仍高于正常范围。这些变化导致家庭内部子女构成多样化，从而对资源配置、抚养支出及健康规划产生了深远影响，进而会影响到商业医疗保险的参与。因此研究子女结构对商业医疗保险需求的影响有助于理解家庭结构变化对经济社会发展的影响，并为商业医疗保险市场的发展提供理论支持和实践指导，促进保险市场的健康发展。
　　　本文基于2017年、2018年和2021年的中国综合社会调查（CGSS）数据采用Probit模型进行实证分析，揭示了家庭子女结构与商业医疗保险需求之间的内在联系，同时为政府政策制定和保险公司产品创新提供科学依据。研究结果显示：子女数量的增加会显著降低家庭购买商业医疗保险的概率，主要是因为子女的增多增加了家庭经济负担；有儿子的家庭由于受“养儿防老”观念的影响购买商业医疗保险的概率也会显著降低；家庭年收入在子女数量和子女性别与商业医疗保险需求之间起到中介作用，子女数量和子女性别都会导致家庭年收入减少，进而抑制了商业医疗保险的需求；异质性分析显示东部地区影响最显著，中部地区影响比较小，而西部地区受传统观念影响较大；城市家庭比农村家庭更加受子女结构的影响，而非国有部门比国有部门影响更加显著；稳健性检验结果的一致验证了结论的可靠性。
　　　最后本文基于研究结果提出了相关的建议：强化政策支持与宣传引导、推动产品创新与服务优化、提升家庭财务规划与风险管理意识、针对行业特点制定差异化策略、加强跨部门合作与数据共享。

关键词：子女结构 商业医疗保险 生育政策 地区文化差异
Abstract
　　 The strategy of "Healthy China" requires the construction of a sound medical security system to meet the challenges of aging and chronic diseases. Although basic medical insurance provides basic security, it is still insufficient in the face of major diseases or high medical expenses. As a supplement, commercial medical insurance can provide more extensive and personalized services to residents and meet their health needs.
　　　With the gradual relaxation of China's birth policy from the only child to the all-round three-child, it not only promotes the change of the family's child structure, but also promotes the profound change of the social birth concept. People's birth concept gradually shifts from "having more children and more happiness" to prenatal and postnatal care, and the trend of fewer children is obvious. At the same time, although the sex ratio of children has improved, it is still higher than the normal range. These changes lead to the diversification of children in the family, which has a far-reaching impact on resource allocation, support expenditure and health planning, and then affects the participation of commercial medical insurance. Therefore, studying the influence of children's structure on the demand of commercial medical insurance is helpful to understand the influence of family structure changes on economic and social development, and provide theoretical support and practical guidance for the development of commercial medical insurance market and promote the healthy development of insurance market.
　　　Based on the data of China General Social Survey (CGSS) in 2017, 2018 and 2021, this paper makes an empirical analysis by using Probit model, revealing the internal relationship between the family structure and the demand for commercial medical insurance, and providing scientific basis for government policy formulation and product innovation of insurance companies. The results show that the increase in the number of children significantly reduces the probability of families buying commercial medical insurance, mainly because the increase in the number of children increases the family's economic burden; The probability of families with sons buying commercial medical insurance is also significantly reduced, reflecting the influence of the concept of "raising children to prevent old age"; The annual family income plays an intermediary role between the number and sex of children and the demand for commercial medical insurance. Both the number and sex of children lead to the decrease of annual family income, which in turn inhibits the demand for commercial medical insurance. Heterogeneity analysis shows that the eastern region has the most significant influence, the central region has less influence, and the western region is greatly influenced by traditional concepts; Urban families are more influenced by their children's structure than rural families, while non-state-owned sectors are more influential than state-owned sectors; The results of robustness test are consistent, which verifies the reliability of the conclusion.
　　　Finally, based on the research results, this paper puts forward some suggestions: strengthening policy support and publicity guidance, promoting product innovation and service optimization, raising awareness of family financial planning and risk management, formulating differentiation strategies according to industry characteristics, and strengthening cross-departmental cooperation and data sharing.
　　　
Keywords：Child structure; Commercial medical insurance; Birth policy;  Regional cultural differences