新农合贫困和低收入居民灾难性卫生支出研究——基于三省份的抽样调查

目的：分析农村居民灾难性卫生支出情况以及新农合缓解灾难性卫生支出的能力。方法：2011年分别选取浙江、湖北、重庆作为样本地区，通过现场调查获取问卷1 661份，计算参合家庭的年自付医疗卫生费用、灾难性卫生支出发生率、平均差距和相对差距和集中指数。结果：补偿前后，贫困家庭的灾难性卫生支出发生率、平均差距、相对差距均最高，低收入组次之。补偿后，集中指数降低，灾难性卫生支出进一步向经济困难家庭集中。结论：通过推进农村大病医疗保险、完善医疗救助制度、实施支付方式改革和完善新农合配套措施等方式，帮助农村贫困和低收入居民抵御灾难性卫生支出。

Catastrophic health expenditure for poor and low-income rural residents under New Rural Cooperative Medical Scheme

Objective: To evaluate the catastrophic health expenditure for poor and lower-income rural residents and the ability of New Rural Cooperative Medical Scheme(NRCMS) to alleviate poverty. Methods: We selected Zhejiang, Hubei, and Chongqing provinces as sample areas and obtained 1661 questionnaires through a field survey. We calculated the out-of-pocket expenditure per year, incidence, average gap, relative gap, and concentration index of catastrophic health expenditure for participating households. Results: Both before and after compensation, incidence, average gap, and relative gap of catastrophic health payment for poverty group were the highest, followed by low-income group. After compensation, the concentration index decreased. This means that catastrophic health expenditure tends to be focused more on families with financial difficulties. Conclusion: To protect poor and low-income rural residents from catastrophic health expenditure, we should promote critical illness insurance, improve the medical assistance system, implement payment reform, and improve the NRCMS.