我国健康服务利用的机会不平等研究——基于CHNS2009数据的实证分析

A Study on the Inequality of Opportunity in Health Care Utilization:Evidence from CHNS 2009

直接观测我国居民健康服务利用结果上的不平等,可能无法揭示实质上的医疗不公平,本文指出政策制定者的关注焦点应由医疗结果不平等转为医疗机会不平等。本研究将Roemer机会平等理论纳入到卫生经济学公平性分析框架中,并利用CHNS2009数据进行实证研究,结果显示:我国居民健康服务利用的不平等中,有54.4%来源于机会的不平等(其下限约为46.2%,上限约为85.0%)。进一步,户籍、地域、共付率这些"环境"因素是造成机会不平等的最主要原因,前两者对健康服务利用不平等起着直接作用,共付率还通过影响个体就医偏好而起间接作用。本文分析思路对于研究我国医疗卫生公平性问题有很大启发借鉴意义。不过,本研究只关注了"鼓励原则"这一个方面,从"补偿原则"视角下进行分析将会是另一个有意义的研究话题。

The objective of this paper is to illustrate and examine the substantial inequity in health care utilization rather than the inequality which obtained from the statistical data directly. This paper expounds how to combining Roemer's framework of equality of opportunity and the research about equity in health economic. Inequality of opportunity in health care utilization is used for indicating the substantial inequity under the reward principle. Cross-section data of CHNS2009 is adopted to conduct the empirical study. The results show that 54.4% of the total health care inequality is due to inequality of opportunity which lies in the range of[46.2%,85.0%]. Furthermore,the main factors leading to the inequality of health care are the disparities of household register,region and out-of-pocket which are belonged to circumstance. The first two have direct effect on the health care inequality,and the out-of-pocket has an indirect effect on it through individuals' preference. The key limitation is that this study only focuses on the reward principle,ignoring the compensation principle which shed light on another aspect of the inequity of the health care.This research can assist managers in properly switching their attention from health inequality to health inequality of opportunity.This paper plants the seed of a broad conception in the domain of health care equity. Also,the identification strategy of how to examine the inequality of opportunity can be used in other empirical studies which relative to the topic of equity.