医疗保险制度对降低我国居民灾难性卫生支出的效果分析

Effect analysis on universal insurance coverage to reduce the incidence of catastrophic health expenditure in China

目的:2008年中国的医保制度已经覆盖87.9%的居民,接近全民医保覆盖的目标。然而,仍存在部分居民现金卫生支出比例过高的现象,导致家庭由于支付医疗卫生费用而陷入经济困境。本文通过计算中国灾难性卫生支出发生率和致贫率,来探究中国医疗保险制度的保障力度与水平。方法:本文利用第四次卫生服务调查的数据,通过世界卫生组织推荐的方法计算灾难性卫生支出和致贫率。结果:灾难性卫生支出发生率为13.0%,且发生率随着家庭经济水平的提高而降低;总体致贫率为7.5%;家庭中含有住院病人、慢性病人、肺结核病人及60岁以上老人,其发生灾难性卫生支出的风险高。结论与建议:通过分析脆弱人群发生灾难性卫生支出风险及影响因素,为今后完善医疗保险制度设计提供具有可操作性的政策建议,增强其对居民抵御疾病经济风险的保障能力。

Objective： The medical insurance system of China has developed rapidly and 87.9% of Chinese people has been covered by various medical insurance schemes by 2008, which nearly realized universal coverage. However, it is still a common phenomenon that high out-of-pocket expenditure makes Chinese households trapped in the dilemma of economic difficulties by paying for health services. In our study, we calculated the incidence of catastrophic health expenditure and incidence of impoverishment by medical expenses, to evaluate the financial protection ability of medical insurance system of China. Methods： We derived the data from the fourth national health service survey and used the methods of WHO to calculate the incidence of catastrophic health expenditure and the incidence of impoverishment by medical expenses. Results：The total incidence of catastrophic health expenditure was 13.0%, which was decreased with the raising economic level of the family. The total incidence of impoverishment by medical expenses was 7.5%. The vulnerable families, including chronic disease patients, hospitalizations, tuberculosis patients and elder people, were more risky to suffer catastrophic health expenditure. Conclusions and suggestion： we analyzed factors influencing the risk of vulnerable populations who suffered catastrophic health expenditure and provided policy recommendations for the future insurance design on priority areas, which eventually enhance the ability of residents to resist financial risk induced by disease.