中国居民医疗支出不公平性分析

Inequity in Financing China's Healthcare

基于2002年大样本家计调查资料,本文以家庭为单位分析了家庭收入与医疗支出的关系。就中国整体而言,收入相关的居民医疗支出集中指数为48%,而可支配收入的基尼系数是45%,这表明医疗支出具有累退倾向。对其进行分解分析,结果表明这种不公平性根源在于中国城市与农村居民医疗支出严重失衡,城市居民的平均医疗支出几乎是农村的6倍,换句话说,医疗支出方面的公共资金大都集中于发达的城市医疗部门。在中国农村内部和城市内部也存在医疗支出不公平性问题,这种层次的不公平性大多可以归结为中国的东部、中部和西部在平均医疗支出水平上的差异。因此,可以说居民医疗支出的不公平主要是由于地域上的差异造成的。众所周知,中国公共卫生投资缺乏公平性,如果中国政府有意改变这种情况,那么在区域之间重新分配国家补贴就势在必行。在公共卫生预算不变的情况下,应该采取措施引导医疗补贴流向农村地区,特别是西部地区,而流向中国城市地区,特别是东部城市地区的补贴应该减少。

Based on large household surveys for 2002, the relation between income and subsidies respectively out-of-pocket expenditures for health care in China is analysed. The analysis pays particular attention to spatial dimensions. A major finding is that the concentration coefficient for subsidies is as high as 72 percent, much higher than the Gini coefficient of 45 percent. Thus subsidies are dissproportionaly benefiting those better off. The concentration coefficient for the household＇ s out-off pocket payments is much lower, 37 percent. These results indicate a fundamental difference with the situation in OECD countries where public sources tend to have small redistributive effects while private financing sources generally have larger negative redistributive effects. The much better off urban residents are more or less the sole gainers of subsidies, while the rural majority are excluded. Among urban household members those living in the eastern region gain on average more from subsidies than those living in other regions. The results can be used as arguments for changes in the profile of subsidies to the health care sector： If rural China, particularly the western region would receive a larger proportion of the subsidies and urban China, particularly the eastern region, would receive a smaller proportion China＇ s reputation regarding lack of fairness in funding the health sector would improve.