我国灾难性卫生支出标准的界定:基于医疗支出对家庭基本生活消费的影响

Definition of standards for catastrophic health expenditure in China:Based on the effect of medical expenditure on household basic living expenses

目的:基于医疗支出对家庭基本生活消费的影响,对适合我国国情的灾难性卫生支出标准进行界定。方法:利用中国家庭追踪调查(CFPS)2012年、2014年、2016年和2018年四期的非平衡面板数据,运用双向固定效应模型和倾向得分匹配方法进行分析。结果:医疗支出强度与家庭基本生活消费并不是简单的线性关系,而是存在拐点的“倒U型”关系;异质性分析表明,医疗支出强度与家庭基本生活消费之间的“倒U形”关系主要表现在农村居民家庭和中等收入家庭,城市居民家庭和低收入家庭、高收入家庭不明显;适合我国实际情况的灾难性卫生支出标准与WHO提出的标准有所差异。建议:针对重点救助对象的医疗救助政策应该继续实施,且覆盖范围需不断扩大;以灾难性卫生支出为指标识别医疗支出型贫困,并根据我国国情制定其标准。

Objective:Based on the effect of medical expenditure on household basic living expenses,this paper defines standards for Catastrophic Health Expenditure suitable for China.Methods:Two-way fixed effect model and propensity score matching(PSM)method are applied in the analysis,based on unbalanced panel data from China Family Panel Studies(CFPS)of 2012,2014,2016 and 2018.Results:The relationship between intensity of medical expenditure and basic living expenses of individual households is not a simple linear one but a inverted U-shape one.Heterogeneity analysis shows that the“inverted U-shape”relationship is mainly manifested in rural households and middle-income households,while it is not so obvious in urban households,households with low and high incomes..And there are certain differences between standards for catastrophic health expenditure suitable for China and that proposed by WHO.Suggestions:Keep operating the policy of medical assistance for main targets of aid and continuously expand coverage of the policy.Besides,poverty caused by medical expenditure is to be identified with catastrophic health expenditure and its standards are to be made according to the specific situation of China.