人口结构对中国卫生费用影响的再测算——基于改进因素分解法的研究

Re-measuring the Impact of Demographic Structure on Health Costs in China:An Estimate Based on an Improved Factor Decomposition Method

人口结构转变对卫生费用变化有重要影响。基于中国卫生支出的城乡二元结构特征,改进了卫生费用的影响因素分解法,该改进模型有助于更加全面和准确地分析人口结构对卫生费用的影响,一方面把人口城乡结构转变的影响从其他因素中分解出来,另一方面区分了城镇和农村年龄结构各自的影响,最终把影响卫生费用的人口结构因素细分为人口城乡结构、城镇年龄结构和农村年龄结构三项。使用改进后的因素分解法,测算了1990—2020年间人口结构因素对中国卫生总费用占GDP比重变化的贡献。测算结果显示,人口结构因素对该比重提高的合计贡献率达到77.8%,其中人口城乡结构、城镇年龄结构和农村年龄结构的贡献率分别为58.3%、14.8%和4.7%。进一步分析发现,不同人口结构因素的影响存在不同特点。首先,城镇化是过去30年卫生费用占GDP比重提高的主导因素,且其作用在不同时期保持稳定。其次,年龄结构的影响存在显著的城乡差异和阶段性差异:分区域来看,尽管农村老龄化程度和速度都远比城镇严重,但农村年龄结构对卫生费用的影响远低于城镇地区;分时期来看,2010年以前,老龄化主要发生在农村,年龄结构的整体影响并不突出,但2010年以后,随着城镇老龄化开始加速,年龄结构的整体影响显著增大,且随着中国人口老龄化的主战场从农村转向城镇,预计未来人口老龄化的影响将快速增大。最后,测算结果还表明,扣除年龄结构影响后,中国卫生支出的二元结构现象最近10年来有所改善。

Demographic shifts have an important impact on health cost changes.Based on China’s urban-rural dual track health care system,this paper improves the decomposition method on the influencing factors of health cost,which helps us to analyze the influence of demographic structure on health costs more comprehensively and accurately.In this model,we first separate the effects of the urban-rural structure shift of population from other factors,and then divide the age structure effects into urban age structure effect and rural age structure effect.Finally,we refine demographic structure into three components:urban-rural structure of population,urban age structure and rural age structure.Using the improved factor decomposition method above,this paper measures the contribution of demographic factors to the change in the ratio of total health cost to GDP in China over the period of 1990-2020.More specifically,the factors of demographic structure overall contributed 77.8%of the ratio’s increase,of which,the changes of urban-rural structure(urbanization)contributed 58.3%,urban and rural age structure contributed 14.8%and 4.7%respectively.Further analysis shows that there are different characteristics on the effects of different demographic factors.Firstly,urbanization was the major driving force behind the increase in the proportion of health costs to GDP in the past 30 years,and its effect had been stable.Secondly,there are significant urban-rural and stage-specific differences in the effects of age structure.Concerning different sectors,though the rural sector has a higher and faster population ageing,its age structure effect has been much lower than that of the urban sector.Concerning different periods,the overall effects of age structure were relatively low before 2010,because population ageing mainly happened in the rural sector.However,since 2010,the overall effects of age structure have increased dramatically as urban aging began to accelerate,and is expected to increase rapidly in the future as the main battlefield of China’s population aging shifts from rural to urban areas.Finally,the measurement results also show that the urban-rural gap on health cost has been improved in the last 10 years,after deducting the effect of age structure.