中国基本医疗保障制度受益公平性的实证研究

Empirical Study on the Benefit Equity of Essential Health Insurance System in China

目的:评估中国城镇职工基本医疗保险、城镇居民基本医疗保险和新型农村合作医疗3种保障模式覆盖人口的受益公平性。方法:利用2008年第四次国家卫生服务调查数据,以住院率、住院经济负担和自付费用占家庭年收入的比例为指标,分析3种制度之间以及同一制度内不同收入群体之间的差异。结果:城镇职工基本医疗保险待遇水平高,其覆盖人口的家庭负担也较低;而新农合则报销比例低,家庭负担重。新农合覆盖人群中,高收入者利用住院服务最多,家庭负担也较轻;而低收入者住院服务利用水平较低,且家庭负担较重。结论:3种基本医疗保障制度之间存在明显的受益不公平;新农合制度内受益不公平的问题相当突出。提升新农合的待遇水平,改善受益不公平是中国基本医疗保障制度改革的当务之急。

Objective：To evaluated the benefit equity of the Basic Medical Insurance for Urban Employees（BMIUE）,the Basic Medical Insurance for Urban Residents（BMIUR） and the New Rural Cooperation of Medical Scheme（NCMS）.Method：The data were drawn from the Fourth National Health Services Survey in 2008.Admission rate,out-of-pocket payment and the proportion of copayment occupying household income were use as the indicators to measure the benefit equity between BMIUE,BMIUR and NCMS.Results：The populations covered by BMIUE had a high benefit level and low economic burden relative to those covered by BMIUR and NCMS.In NCMS,the high-income populations utilized more inpatient services with lower financial burden;in contrast,the low-income populations use less with heavier burden.Conclusions：There was benefit inequity between BMIUE,BMIUR and NCMS.In NCMS,the inequity between different income groups was significant.It is urgent for the current China＇s health reform to increase NCMS＇s benefit level and improve the equity between different health insurance systems.