我国家庭灾难性卫生支出公平性分析

Analysis of the Equity of Household Catastrophic Health Expenditure in China

目的:了解我国家庭灾难性卫生支出的公平性现状,探讨各影响因素对灾难性卫生支出不公平的贡献程度,为促进健康公平与实现共同富裕目标提供参考。方法:基于中国健康与养老追踪调查(China health and retirement longitudinal survey,CHARLS)2013、2015和2018三年构成的面板数据,根据WHO的标准计算灾难性卫生支出发生率,运用集中指数测量灾难性卫生支出的公平性,并采用集中指数法进行分解分析。结果:2013-2018年灾难性卫生支出的发生率分别为22.94%、20.24%和27.55%。2013-2018年灾难性卫生支出的集中指数分别为-0.1578、-0.0968和-0.0976。经济状况、教育程度、地区和年龄是影响灾难性卫生支出公平性最主要的因素。结论:灾难性卫生支出主要集中在经济状况差的家庭中。缩小贫富差距、提供均等的受教育机会、缩小城乡差距及提高慢性病防治能力,对于降低灾难性卫生支出不公平性具有重要意义。

Objective:To understand the equity status of catastrophic health expenditure in China,and to explore the contribution of the determinants to the inequity of catastrophic health expenditure,so as to provide references for promoting health equity and achieving the goal of common prosperity in China.Methods:Based on the panel data of China health and retirement longitudinal survey 2013,2015 and 2018,the incidence of catastrophic health expenditure were calculated by the definition proposed by WHO,and the equity of catastrophic health expenditure was measured by the concentration index.Concentration index method was adopted for decomposition analysis.Results:The incidence of catastrophic health expenditure from 2013 to 2018 was 22.94%,20.24%and 27.55%,respectively.The concentration index of catastrophic health expenditures from 2013 to 2018 was-0.1578,-0.0968 and-0.0976,respectively.Economic status,education level,region and age made the largest contribution to the equity in catastrophic health expenditure.Conclusion:Catastrophic health expenditures are concentrated among economically disadvantaged households.Therefore,narrowing the gap between the rich and the poor,providing equal access to education,narrowing the gap between urban and rural areas and improving the ability to prevent and treat chronic diseases are of great significance for reducing such inequity of catastrophic health expenditure.