不同医疗保险覆盖人群获得政府医疗补助的受益归属及公平性研究

Benefit Incidence and Equity of Government Medical Subsidy Received by People Under Different Health Insurance

目的了解不同医疗保险(医保)覆盖人群获得政府医疗补助的受益归属及公平性。方法于2014年6月,在"2014年基层卫生综合改革重点联系点家庭健康询问调查"人群中选取参加了城镇职工医保(n=5 773)、城镇居民医保(n=6 581)、新型农村合作医疗(新农合,n=9 495)的居民21 849例。按经济水平从低到高分为最贫困组(n=4 370)、次贫困组(n=4 370)、中间组(n=4 370)、次富裕组(n=4 370)及最富裕组(n=4 369),采用集中指数、Kakwani指数评价政府医疗补助的绝对公平程度和相对公平程度。结果从最贫困组到最富裕组,城镇职工医保居民的门诊补助占比分别为7.1%、12.4%、16.5%、22.7%、41.3%,住院补助占比分别为7.9%、12.7%、16.7%、24.3%、38.5%;城镇居民医保居民的门诊补助占比分别为26.9%、18.5%、15.1%、12.8%、26.8%,住院补助占比分别为16.8%、14.4%、23.6%、18.5%、26.7%;新农合居民的门诊补助占比分别为13.5%、14.5%、19.0%、25.1%、28.0%,住院补助占比分别为16.0%、16.2%、14.4%、26.5%、27.0%。城镇职工医保、城镇居民医保及新农合居民门诊补助的集中指数分别为0.260、0.076、-0.021,住院补助的集中指数分别为0.098、0.221、0.175。城镇职工医保、城镇居民医保及新农合居民门诊补助的Kakwani指数分别为-0.060、-0.265、-0.331,住院补助的Kakwani指数分别为-0.222、-0.120、-0.135。结论不同医保覆盖人群的政府医疗补助均有利于低收入人群,新医改制度下居民获得基层门诊政府补助更加公平可及。

Objective To explore the benefit incidence and equity of governmental medical subsidy received by people under different health insurance. Methods Data were taken from household survey,in June 2014,a total of 21 849 residents in ＂ household health interview survey of key points of contact in basic health comprehensive reform＂ who participated in the Basic Medical Insurance for Urban Employees（ BMIUE,n = 5 773）,the Basic Medical Insurance for Urban Residents（ BMIUR,n= 6 581）,the New Rural Cooperation of Medical Scheme（ NCMS,n = 9 495）. According to their economic level,they were divided into the poorest group（ n = 4 370）,sub- poverty group（ n = 4 370）,the middle group（ n = 4 370）,times richer group（ n = 4 370） and the richest group（ n = 4 369）, and concentration index and Kakwani index were used to evaluate absolute fairness and relative fairness degrees of government medical subsidy. Results From the poorest group to the richest group,the proportion of outpatient subsidy BMIUE were 7. 1%,12. 4%,16. 5%,22. 7%,41. 3%,inpatient subsidies were7. 9%,12. 7%,16. 7%,24. 3%,38. 5%; the proportion of outpatient subsidy BMIUR were 26. 9%,18. 5%,15. 1%,12. 8%,26. 8%,inpatient subsidies were 16. 8%,14. 4%,23. 6%,18. 5%,26. 7%; the proportion of outpatient subsidy NCMS were 13. 5%,14. 5%,19. 0%,25. 1%,28. 0%, inpatient subsidies were 16. 0%,16. 2%,14. 4%,26. 5%,27. 0%. The outpatient subsidies concentration index of BMIUE,BMIUR and NCMS were 0. 260,0. 076,- 0. 021,inpatient subsidies concentration index were 0. 098,0. 221,0. 175. The outpatient subsidies Kakwani index of BMIUE, BMIUR and NCMS were- 0. 060,- 0. 265,- 0. 331,inpatient subsidies Kakwani index were- 0. 222,- 0. 120,- 0. 135. Conclusion The government medical subsidy of people under different health insurance is more beneficial to people with low income; and it became more equitable and accessible for residents to get outpatient governmental subsidy under the new health care reform system.