致贫性卫生支出视角下“因病致贫”对象界定方法及标准探究

Studying on The Definition Methods and Standards of“Poverty Caused by Diseases”from The Perspective of Impoverishment Health Expenditure

目的:探索致贫性卫生支出的测量方法及其标准,为我国因病致贫家庭界定的实践操作提供理论基础和方法思路。方法:通过多阶段整群随机抽样方法,随机抽取湖北省M市3个乡镇12个村共600户住院家庭进行入户调查。利用文献研究归纳致贫性卫生支出测量方法及核心特征,并通过实证探索不同测量方法的标准及效果。结果:贫困线是致贫性卫生支出测量过程中的核心变量,常用制定方法有相对比例法、恩格尔系数法和生存需要法,M市对应的贫困线分别为3892元、2825元和4226元。其中,恩格尔系数法具有较好的敏感性、区分度和便捷性。结论:在后扶贫时代从绝对贫困向相对贫困转变的背景下,贫困线作为致贫性卫生支出测量的核心变量需要各地从相对视角下动态制定和调整。通过分组方法降低对于个体家庭经济收支能力的过度依赖,从而提高致贫性卫生支出方法在因病致贫对象界定中的可操作性。致贫性卫生支出界定方法对贫困边缘人群敏感,有利于防范当前医保扶贫及医疗救助等实施中的福利悬崖问题。

Objective To explore the methods and standards of impoverishment health expenditure in China,and provide references for improving its operability.Methods 600 hospitalized households were sampled from 12 villages,3 townships in M City of Hubei Province with multi-stage cluster random sampling.The measurement methods and core characteristics of impoverished health expenditure were summarized by literature and empirical research.Results Based on the core variable of poverty line,the measurement methods includes relative ratio,Engel coefficient and survival needs methods.The poverty line of sampled region was 3892,2825 and 4226 RMB Yuan,respectively.In which the Engel coefficient method has better sensitivity,discrimination and simplicity.Conclusion Poverty line has been taken as the core variable based on the region situations from a relative poverty perspective.The income/consumption grouping method could reduce the excessive dependence on families’capacity to payment and improve their operability.Meanwhile,the impoverishment health expenditure method is sensitive to population near poverty line,and could be used to prevent the"welfare cliff"problems.