我国农村居民灾难性卫生支出的制度成因分析

Analysis on causes of catastrophic health expenditure in rural China from perspective of system analysis

目的:中国农村人口的健康问题与中国社会的可持续发展密切相关。我国农村仍存在因病致贫、因病返贫现象。利用灾难性卫生支出率和致贫率作为测量工具,来衡量新型农村合作医疗的保障力度。方法:数据来源于第四次卫生服务调查,采用WHO推荐的方法计算灾难性卫生支出。结果:农村人口的灾难性卫生支出发生率为14.4%,致贫率为9.2%,且两者与地区经济水平呈负相关,最为贫困的西部灾难性卫生支出发生率及致贫率最高,分别为15.8%和10.8%;有住院病人的农村家庭发生灾难性卫生支出和致贫的风险最大。结论与建议:中国农村灾难性卫生支出发生率较高是受多种因素共同影响的结果。其中,新农合制度的保障水平不高,缺乏遏制医疗费用快速上涨有效机制,特别是现存以服务项目付费为主导的支付方式,是导致农村灾难性卫生支出发生率较高的主要制度成因。因此,应以完善新型农村合作医疗的制度设计为重点,加大政府对医疗机构的投入,强化各种配套制度和机制的安排。

Objective ： The health status of rural population is closely related to the future of the sustainable de- velopment of China. It is a serious phenomenon that rural households are impoverished from medical expenses. In our study, we used the incidence of catastrophic health expenditure and impoverishment from medical expenses as the tool to measure the financial level of New Rural Cooperative Medical Scheme（NRCMS）. Methods： We analyzed the data from the Fourth National Health Service Survey and adopted the method of WHO to calculate the incidence of cata- strophic health expenditure and impoverishment. Results： The incidence of catastrophic health expenditure in rural China was 14.4% and the incidence of impoverishment was 9.2% ; the factors of family income level and their living regions are inversely associated with it. The poor Western region, compared to the Eastern and the Central region, suffered the highest incidence of catastrophic health expenditure and impoverishment, which was 15.8% and 10.8% respectively. The rural families having members being hospitalized subjected to the highest risk to suffer catastrophic health expenditure and impoverishment. Conclusions and suggestions ： Relative high level of catastrophic medical ex- penditure and impoverish rate in rural areas are the results of joint actions of many factors, among them, limited fi- nancial protection level, of NRCMS, ineffective mechanism to control the rising medical cost and the dominant pay- ment method of pay for service are the major underlying causes for it. Therefore, more comprehensive strategies are needed to conquer those problems.