东中西部城市政府医疗机构补助的受益归属分析:基于社区卫生综合改革典型城市居民健康询问调查

Benefit Incidence Analysis on Government Medical Subsidy in Cities of East,Central and West Area:Based on urban residential health interview survey of typical cities under community health comprehensive reform community health reform

目的:评价东中西部城市政府医疗机构补助受益的公平性。方法:利用2011年8个社区卫生综合改革典型城市居民健康询问调查数据,采用受益归属分析方法,从相对公平和绝对公平角度,评价东中西部城市居民政府医疗机构补助的受益的公平性。结果:东中西部不同经济收入人群门诊、住院和医疗总补助的构成差异均有统计学意义(χ2门诊补助=48.101,P=0.000;χ2住院补助=30.241,P=0.000;χ2医疗总补助=34.628,P=0.000);东中西部城市居民门诊政府补助集中指数分别为0.107、0.081和0.112,中部城市绝对公平性略好于东部和西部;住院政府补助集中指数分别为0.178、0.223和0.218,东部城市绝对公平性略好于西部和中部;东中西部城市居民门诊政府补助Kakwani指数分别为-0.179、-0.214和-0.170,中部城市相对公平性略好于东部和西部,住院政府补助Kakwani指数分别为-0.108、-0.072和-0.064,东部城市相对公平性好于中部和西部。结论:东中西部城市门诊、住院政府医疗服务的相对公平性均较高;不同经济水平居民的门诊政府补助的公平性均好于住院补助。

Objectives： Evaluate the equity of government subsidies to medical institutions of cities of east, central and west parts of China. Methods： Data were collected through household health interview survey of 8 typical cities under comprehensive community health reform in 2011. Evaluate the equity of government medical institutions subsidy in east, middle and west parts of China by benefit incidence analysis, in terms of absolute equity and relative equity side. Results： The differences of composition of government subsidies among different income groups in east, middle and west parts of China were statistically significant （X2 outpatient subsidies =48.101, P=0.000;X2inpatient subsidies=30.241,P=0.000;x2 tatal medical subsidities=34.628.P=0.000; the concentration index （CI） of government subsidies to outpatients in eastern, central and western areas are 0.107, 0.081 and 0.112, the absolute fairness in the middle was better than the east and west. The CI of inpatient subsidies in east, middle and west parts of China was 0.178, 0.223 and 0.218. The absolute fairness in eastern cities is better than central and western cities. The Kakwani index of government subsidies to outpatients in east, middle and west parts of China were respectively -0.179, -0.214 and -0.170, the relative fairness in middle cities is better than eastern and western cities. The Kakwani index of inpatient subsidies in easernt, central and western areas of China were respectively -0.108, - 0.072 and -0.064. The relative fairness in eastern cities was better than middle and western cities. Conclusion： The relative fairness of inpatient subsidies and outpatient subsidies in eastern, central and western areas were relatively better; the equity of outpatient subsidies was better than inpatient subsidies for people of different economic levels.