政府卫生支出、财政压力与居民医疗服务利用机会不平等分析

Study on Government Health Expenditure,Financial Pressure and Unequal Opportunities for Residents to Utilize Medical Services

目的:分析政府卫生支出与居民医疗服务利用机会不平等之间的关系及其作用机制,为完善相关政策提供理论依据。方法:基于机会平等理论,利用CFPS2014—2020年数据测算居民医疗服务利用的机会不平等程度。结果:2014—2020年,我国居民医疗服务利用的机会不平等上限均值为0.781,下限均值为0.264,机会不平等的相对程度均值为0.337,即总不平等中有33.7%是机会不平等造成的;每增加1个单位的政府卫生支出,机会不平等程度增加4.6%,说明我国政府卫生支出存在一定的结构性问题;财政压力作为调节变量,能够削弱政府卫生支出对机会不平等的影响。结论:增加政府卫生支出能够改善欠发达地区医疗服务利用机会不平等问题,同时应从报销比例、地域、财政压力等方面,提升医疗服务利用公平性。

Objective To analyze the relationship between government health expenditure and unequal opportunities for residents to utilize medical services and its functioning mechanism,and to provide a theoretical basis for the improvement of relevant policies.Methods Based on Roemer's theory of equal opportunity,the degree of unequal access to medical services among residents was measured by using the data of CFPS from 2014 to 2020.Results The upper limit and lower limit of unequal access to medical services among residents in China from 2014 to 2020 were approximately 0.781 and 0.264,respectively.The relative degree of opportunity inequality was about 0.337,which meant that 33.7%of the total inequality was caused by opportunity inequality.It was found that every increase of 1 unit of government health expenditure actually leaded to an increase of 4.6%in the degree of opportunity inequality,indicating that there were certain structural issues in government health expenditure.As a moderating variable,financial pressure could weaken the impact of government health expenditure on inequality of opportunity.Conclusion Increasing government health expenditure can improve the problem of unequal opportunities in medical service utilization in developing areas.At the same time,it is necessary to improve equity in the utilization of medical services in terms of reimbursement ratio,geography,and financial pressure.