居民卫生筹资与医疗费用负担实证分析:以上海为例

Study of residents health financing and medical expenses in Shanghai

降低居民医疗负担是本轮医改的重要目标,了解和分析居民医疗负担是采取针对性措施推进相关改革的基础。本文从宏观层面分析了上海市居民在卫生筹资中的负担,从微观层面分析了其在医疗费用中的自付比例,并分析了不同人群医疗费用负担分布情况。发现上海市居民个人现金卫生支出占卫生总费用比例处于较低水平,医疗费用中医保报销比例较高;但医疗费用中,医保报销范围外自付费用高,且医疗费用负担在不同年龄组、不同医保类型、城乡人群中分布不均衡,造成医疗费用负担重的情况仍然存在。建议长期监测居民医疗费用负担情况,对重点人群"靶向"减负,加大自付费用控制力度等。

Alleviating the medical burden of residents is an important goal of new health care reform. Analy- zing residents＇ medical burdens can provide essential information for refomn. In this paper, we analyze the responsi- bility for medical financing, copayment, and distribution for Shanghai residents. The results showed that the propor- tion of Out-of-pocket health expenditure and copayments are already low in Shanghai, but the affordability of health care is still not very good. The distribution of medical costs is unbalanced among different age groups and insurance types and differs between urban and rural areas. We suggest that the government should monitor residents＇ medical costs and control costs not covered by medical insurance in order to reduce the burden on vulnerable people.