我国西部典型地区卫生筹资公平性实证分析

Analysis the Equity of Health Financing in Typical Areas of West China

目的:分析我国西部地区卫生筹资公平性及变化。方法:利用2013年和2015年我国基层卫生综合改革西部典型地区的居民家庭健康询问调查数据,结合中国统计年鉴中相关年份各省份的各种消费性支出税率,计算各消费性支出的直接税、间接税;计算直接税、间接税、社会医疗保险、商业健康保险、个人现金卫生支出的集中指数和Kakwani指数,反映五种卫生筹资渠道的公平性。结果:2016年西部典型地区直接税、间接税、社会医疗保险、商业健康保险和现金卫生支出的集中指数分别为0.615、0.366、0.285、0.423、0.262,Kakwani指数分别为0.256、0.007、-0.074、0.064、-0.097,与2014年相比,直接税和商业健康保险集中指数分别增加0.120和0.118,现金卫生支出降低0.028;直接税和商业健康保险Kakwani指数分别增加0.106和0.104,现金卫生支出减低0.042,其他筹资渠道集中指数和Kakwani指数变化不大。结论:西部典型地区卫生筹资公平性有所改善,直接税和商业健康保险累进程度进一步增高,对贫困人群有利;现金卫生支出筹资公平性趋好。

Objective： To analyze the equity and its change of health financing in the western China. Methods： Based on the data from the Resident Family ttealth Survey in the western typical regions of China primary health comprehensive health reform in 2013 and 2015, the direct tax and indirect tax of consumption expenditure were calculated by combining the various consumption expenditure tax rates of each province in the relevant year of China Statistical Yearbook; the direct tax, indirect tax, social health insurance, commercial health insurance, out-of-picket health expenditure payment and Kakwani index were calculated to reflect the equity of 5 health financing channels. Results： The concentration index of direct tax, indirect tax, social medical insurance, commercial health in- surance and cash health expenditure in the west typical areas in 2016 were 0.615, 0.366, 0.285, 0.423 and 0.262. Kakwani index were 0.256, 0.007, -0.074, 0.064 and -0.097. Compared with 2014, direct tax and commercial health insurance concentration index in- creased by 0：120 and 0.118, cash health expenditure decreased by 0.028; direct tax and the commercial health insurance Kakwani index increased by 0.106 and 0.104, cash health expenditure decreased by 0.042, other financing concentration index and Kakwani in- dex changes were not obvious. Conclusion： The equity of health financing in the typical areas of western China were improved. The progressive degree of the direct tax and commercial health insurance were further increased, which were beneficial to the poor. The equity of out of pocket was well.