云南省大理州卫生筹资累进性分析

Analyzing the progressivity of health financing in Dali City

目的:通过分析大理白族自治州(大理州)卫生筹资情况及各卫生筹资渠道的累进性,对大理州的卫生筹资结构和筹资累进性作出评价,为大理州卫生筹资公平性评价提供依据,并探索改善大理州卫生筹资公平性的方法。方法:测算Kakwani指数和绘制Lorenz曲线。结果:政府卫生支出、新农合、商业保险和家庭现金卫生支出各筹资渠道的Kakwani指数均小于0,为负值,因此在样本人群中4种筹资渠道都是累退的;结合Lorenz曲线分析,政府卫生支出、家庭新农合支出筹资渠道在整个人群中均呈累退,而家庭现金卫生支出和商业医疗保险筹资渠道的累进还是累退在整个人群中是有变化的。结论:扩大政府预算卫生支出的比重,缩小居民个人卫生支出的比重;对于过低的新农合筹资水平则可以按照家庭的经济情况有差别的调整参合保费,对部分经济困难的家庭实施医疗补助。

Objective To analyze the progressivity of health financing in Dali City, and provide references for evaluating the fairness of health financing and improving it. Methods To measure the Kakwani index and Lorenz curve. Results The Kakwani indexes of health expenditure, new rural cooperative medical system, commercial insurance and family health expenditure to governmental financing channels were negative and less than zero, which meant that the four kinds of financing channels were regressive in sample population. Combined with Lorenz curve analysis, the financing channels of governmental expenditure on health and family payment on the new rural cooperative medical system were regressive in the whole population, while they were changing in family cash expenditures on healthcare and commercial medical insurance financing channel. Conclusion It is needed to increase the governmental budget on healtheare expenditure, and decrease personal health expenditure. The lower financing of new rural cooperative medical system can be adjusted and assisted in accordance with the family＇s economic conditions.