不同收入等级农村居民基本医疗保险受益公平性研究

Study on Benefit Equity of Basic Medical Insurance for Rural Residents with Different Income Levels—Based on the Survey of Poverty-stricken Ethnic Minority Counties in Hubei Province

公平普惠是我国卫生和健康事业建设的目标,基本医疗保险是实现目标的制度保障。本文基于安德森医疗服务利用行为理论,采用三阶段随机抽样方法采集湖北省少数民族贫困县965个农村参保者的调查数据,通过收入五等分法、二元选择模型和两部分模型对基本医疗保险受益公平性进行分析。结果发现:均等化的医疗保险政策不仅实现了规则公平,实践中也提高了低收入参保者的医疗服务利用行为,即低收入组与高收入组有相似的就诊行为,且最低收入组比最高收入组还有更高的报销可能性。但是从医疗服务利用结果和疾病经济负担来看,低收入者仍然处于劣势。最低收入组和较低收入组均比最高收入组有更高的慢性病患病可能性和更差的自我健康评价,同时低收入组有着更重的疾病经济负担。此外,少数民族居民、失业者、年长者、有配偶的居民可能有更差的医疗服务利用结果。因此,中国在实现全民医保的基础上,未来还要进一步提高医保受益公平性。

Fair-benefit is the goal of China's health construction,and the basic medical insurance is the institutional guarantee to achieve the goal.Based on the Andersen's behavioral theory of health services utilization,this paper uses three-stage random sampling method to collect the survey data of 965 rural insured persons in poverty-stricken ethnic minority counties in Hubei,and analyzes the benefit equity of basic medical insurance through using income quintile method,binary choice model and two-part model.It is found that the equalization of medical insurance policy not only realizes the rule fairness,but also improves the medical service utilization behavior of the low-income insured persons in practice.That is,the low-income groups have similar treatment behavior with the high-income groups,and the lowest income group has higher reimbursement probability than the highest income group.However,in terms of the results of medical services utilization and the economic burden of diseases,the low-income people are still at a disadvantage.Both the lowest and lower income groups have higher risk of chronic disease and worse self-health evaluation than the highest income group,while the lower-income groups have a heavier economic burden.In addition,minority residents,the unemployed,the elderly,and the residents with a spouse may have worse health care utilization results.Therefore,on the basis of realizing universal health insurance,further equity in health insurance should be enhanced in China.