摘  要
随着中国经济快速发展，居民健康水平显著提升，但区域与收入阶层间的健康差距依然存在。基本医疗保险虽有效改善居民健康，但其保障水平有限，尤其在重大疾病中受限于报销范围、支付限额及比例，可能加剧健康不平等。商业健康保险作为补充机制，通过降低医疗自付成本与提升健康风险意识，成为缓解不平等的重要路径。本文综合理论、现状与实证分析，系统探究商业健康保险对健康不平等的影响。  
本文首先界定了相关概念和理论基础，分别分析商业健康保险和健康不平等各自的发展现状；进一步基于中国家庭追踪调查（CFPS）2016、2018、2020和2022年的面板数据，以“商业健康保险参与”和“商业健康保险保费”作为解释变量，通过量化个人自评健康测度的相对剥夺指数来衡量健康不平等，构建固定效应模型来分析商业健康保险与健康不平等之间的关系。为增强结论稳健性，采用筛选样本、替换变量和新增固定效应的方式进行检验；针对内生性问题，引入工具变量法进行修正；最后通过中介效应模型揭示传导机制，并从地区差异和收入差异的角度进行了异质性分析。
研究结果发现：第一，商业健康保险发展趋势良好，但仍然具有较大发展空间；第二，我国人口老龄化加剧，预期寿命延长，健康需求增加，整体健康状况改善，但健康不平等现象依然存在，且与经济状况密切相关；第三，参加商业健康保险能够有效缓解健康不平等现象，并且商业健康保险保费支出越高，其缓解健康不平等现象的效果越好；第四，异质性分析表明，商业健康保险对东部地区及高收入群体的健康平等改善效应更强；第五，机制检验显示，医疗自付成本降低与健康风险意识提升是核心传导机制。针对上述结果，本文提出如下建议：第一，提升商业健康保险的普及率；第二，提高更加全面的健康保险保障；第三，积极推出高保障的商业健康保险产品；第四，差异化设计商业健康保险产品；第五，加强事前健康风险管理以及健康风险教育。
                                                 Abstract
With the rapid development of China's economy, the health level of residents has significantly improved, but health disparities between regions and income groups still exist. Although basic medical insurance has effectively improved residents' health, its coverage is limited, especially in the case of major diseases, where reimbursement scope, payment limits, and ratios may exacerbate health inequality. Commercial health insurance, as a supplementary mechanism, has become an important pathway to alleviate inequality by reducing out-of-pocket medical costs and enhancing health risk awareness. This paper comprehensively explores the impact of commercial health insurance on health inequality through theoretical, current status, and empirical analysis.
This paper first defines relevant concepts and theoretical foundations, separately analyzing the development status of commercial health insurance and health inequality. Further, based on panel data from the China Family Panel Studies (CFPS) for the years 2016, 2018, 2020, and 2022, using "participation in commercial health insurance" and "commercial health insurance premiums" as explanatory variables, it measures health inequality through a relative deprivation index quantified by self-rated health assessments, and constructs a fixed-effects model to analyze the relationship between commercial health insurance and health inequality. To enhance the robustness of the conclusions, the study employs sample screening, variable replacement, and the addition of fixed effects for testing; addresses endogeneity issues by introducing instrumental variable methods for correction; Finally reveals transmission mechanisms through a mediation effects model, conducting heterogeneity analysis from the perspectives of regional and income differences.
The research findings indicate: First, the development trend of commercial health insurance is positive, but there is still significant room for growth; second, China's population aging is intensifying, life expectancy is increasing, health demands are growing, overall health status is improving, but health inequality persists and is closely related to economic conditions; third, participation in commercial health insurance can effectively alleviate health inequality, and the higher the expenditure on commercial health insurance premiums, the better the effect on mitigating health inequality; fourth, heterogeneity analysis shows that commercial health insurance has a stronger effect on improving health equality in the eastern region and among high-income groups; fifth, mechanism testing reveals that the reduction of out-of-pocket medical costs and the enhancement of health risk awareness are the core transmission mechanisms. In light of these findings, this paper proposes the following recommendations: First, increase the penetration rate of commercial health insurance; second, provide more comprehensive health insurance coverage; third, actively introduce high-coverage commercial health insurance products; fourth, design differentiated commercial health insurance products; fifth, strengthen preemptive health risk management and health risk education.