优先愿景下的中国儿童医疗保障双重不平等现状研究

The backward reality under the prioritized vision:A study on the current situation of double inequality medical security for children in China

目的:分析儿童优先愿景下我国儿童医疗保障水平及其不平等现状。方法:利用中国家庭追踪调查2020年数据,基于全民健康覆盖立方体框架,采用多元回归分析儿童与成人、儿童不同群体之间的医疗保障不平等现状。结果:我国儿童参保率为80.96%,住院和非住院群体医疗费用自付比例分别为64.71%和90.09%。参保率方面,儿童显著低于成人(OR=0.434,P<0.01);上学儿童显著高于未上学儿童(OR=2.075,P<0.01),留守儿童显著低于非留守儿童(OR=0.791,P<0.05)。医疗费用方面,儿童自付比例显著高于成人(β=0.066,P<0.01);6周岁及以上儿童自付医疗费用更低(β<-0.316,P<0.01),家庭收入较高(β<-0.022,P<0.05)、参保(β=-0.033,P<0.01)、住院(β=-0.270,P<0.01)儿童自付比例更低。结论:我国儿童医疗保障呈现双重不平等,即儿童保障水平显著低于成人,0~5周岁、未上学、留守以及低收入家庭儿童保障水平相对较低。建议通过优化儿童缴费标准和推行家庭联保等措施提高儿童参保率。同时,医保政策综合考虑儿童医疗卫生服务需求特点以提高保障水平。此外,重点关注和帮扶儿童医疗保障弱势群体,最终实现医疗保障领域的“儿童优先”。

Objective:The main purpose of this study is to analyse the current situation and inequity status of children s medical security in China from the vision of children first.Methods:Using data from the China Family Panel Studies 2020 and based on the framework of universal health coverage cube,multivariate regression is used to analyse the differences in medical security between children and adults and among groups of children.Results:The participation rate of children in China is 80.96%,out-of-pocket ratios are 64.71%and 90.09%for inpatient and outpatient groups respectively.In terms of participation rate,insured children are less than that of adults(OR=0.434,P<0.01);within children s groups,attending school(OR=2.075,P<0.01)significantly increases children s participation rate,while left-behind by parent(s)(OR=0.791,P<0.05)significantly decrease children s participation rate.With respect to service and cost coverage,children have higher out-of-pocket ratios compared to adults(β=0.066,P<0.01);within children s groups,children eged 6 years and older have lower out-of-pocket medical expenses(β<-0.316,P<0.01),children with higher family income(β<-0.022,P<0.05),participated(β=-0.033,P<0.01),and hospitalized(β=-0.270,P<0.01)have lower out-of-pocket ratios.Conclusion:Double in equality exists in children s medical security in China.The level of children s health security in China is significantly lower than that of adults;within children s groups,children aged 0~5 years,not in school,left-behind by parent(s),and from lower-income families are more vulnerable.It is proposed to focus on increasing the participation rate of children through measures such as optimizing the contribution for children and launching family joint insurance.Policy design should also consider the needs of children and raise the level of children s benefits.Meanwhile,the focus should be on helping vulnerable groups in children,so as to ultimately achieve“children first”in health security.