新型农村合作医疗对医疗筹资公平性的影响:基于自付医疗支出集中指数的测算

On the Influence of New Rural Cooperative Medical Scheme on the Equality of Health Care Financing: based on the Concentration Index of Out-of-pocket Medical Payment

本文基于"中国健康与营养调查"(CHNS)2004、2006、2009和2011年数据,利用集中系数和指数分解方法考察新型农村合作医疗制度对农村自付医疗支出筹资的影响,以及新农合对农民自付医疗支出不平等改善的贡献。研究发现,我国农村地区自付医疗支出筹资方式存在不平等,但不平等程度逐年降低;在对影响自付医疗支出公平性的因素分析中,新农合制度显著减少了参合农民的自付医疗支出,对自付医疗支出不平等的改善贡献率由2004年的0.31%增加到2011年的4.21%。该结论对全面评价我国新型农村合作医疗制度有着重要的意义。

Based on the data from the 2004,2006,2009 and 2011China Health and Nutrition Survey（CHNS）,this paper tests the equality of out-of-pocket payment by estimating its concentration index in rural China and assess the contribution of New Rural Cooperative Medical Scheme（NRCMS）to the improvement of inequality of out-of-pocket payment using index decomposition method.The analysis shows that there is inequality in out-of-pocket health care expenditure,but the degree of inequality reduces year by year in rural China;Through analyzing the factors affecting the equality of out-ofpocket payment,we find that NRCMS reduces the out-of-pocket payment significantly,its contribution to the improvement of inequality of out-of-pocket health care expenditure accounts from 0.31%in 2004 to 4.21%in 2011.This conclusion has important significance to evaluate comprehensively the New Rural Cooperative Medical Scheme in China.