城市医疗救助筹资与给付水平的地区不平等性

Regional Inequalities in Medicaid Financing and Benefit Levels in Urban China

城市医疗救助试点自2005年初开始在全国范围内实施,其筹资与给付结构呈现很大的地区不平等性。第一,人均筹资水平的基尼系数高达0.881,处于极其不平等的状态,我国东部地区不平等程度最大;对于这一不平等,省际差异的贡献率为55.45%,省内各区县之间的差异贡献了38.35%。第二,人均给付水平总的基尼系数为0.652,也呈现极其不平等的状态,而东中西三大地区之间的差异对这一不平等状态的贡献较大。第三,对医疗救助人均筹资和人均给付水平的基尼系数的分解结果显示,省级和中央政府的转移支付没有产生拉平效应,未能对公共服务水平公平的实现发挥应有的作用。因此,健全医疗救助的公共财政体系是进一步努力的方向,其中最为关键的是实现转移支付的制度化。

Since the early 2005, a pilot project of medicaid reform has been carried out throughout China, and considerable regional inequalities are shown in financing and benefit levels. First, medicaid financing on average shows extreme inequality, as is proved by the fact that Gini in- dex reaches O. 881, and in the eastern region the situation is most devastating. The interprovincial inequality adds as much as 55.45 percent to the overall inequality, and the intraprovincial one, 38.35%. Second, per capita benefit level also shows extreme inequality, for which Gini index is O. 652. The divergence in eastern, central and western regions accounts much for this inequality. Third, an analysis of the Gini indexes shows that the financing by the central and provincial governments fails to bring forth an equal accessibility as expected.