美国财政医疗保障支出的均等化效果研究

Research on the Equity of America's Finance Expenditure on Medical Insurance System

采用净转移支付、收益税收之比、偏离度、秩相关系数等分析指标,对美国Medicare、Medicaid和SCHIP制度中,财政医疗保障支出的现状及公平性进行了考察,对财政巨额支出与医疗保障制度整体公平性低下的矛盾根源做出了解释。在此基础上,得出了中国财政资金首先要保证弱势人群的医疗保险和医疗救助项目;财政医疗保障支出要由中央、省、市级政府分担,县级政府不负担;以人口、人均收入等因素为基础制定标准化转移支付公式;调整医疗救助制度的目标定位,实现其与全民医疗保险的有效衔接等启示。

We analyses the equity of America＇s finance expenditure on Medicare,Medicaid and SCHIP system by using indices such as net finance transfer,degree of departure,correlation coefficient,etc.And explain the inconsistency between high government＇s expenditure and low equity of the medical insurance system.Accordingly,we put forward following suggestions for China：First,finance expenditure on medical insurance system should give priority to less advantaged groups.Second,it should be shared by central,provincial and city governments,while county government should be exempted.Third,some factors should be considered in establishing standardized finance transfer formula.Last but not the least,the target of medical assistance system should be adjusted.