灾难性卫生支出的城乡差异及分配敏感性研究

目的:分析实现全民医保后我国灾难性卫生支出的发展趋势、城乡差异及分配敏感性状况。方法:利用中国家庭动态跟踪调查2012年与2014年数据,采用世界卫生组织关于灾难性卫生支出及分配敏感性计算的方法。结果:2012—2014年,灾难性卫生支出总体发生率和发生强度均有明显下降。总体而言,灾难性卫生支出的收入分配状况相对均等。但是,发生率绝对值较高,且城乡有别,农村受到的灾难性卫生支出冲击更大;穷富有别,灾难性卫生支出更多发生在穷人身上。2012年城市发生率比农村更不均等,2014年正好相反。2012—2014年,所有家庭平均差距的集中指数由负变正。结论:全民医保对于降低灾难性卫生支出发生率与发生强度有一定作用;有限的保障内容、水平可能导致医保无法改善甚至加剧灾难性卫生支出的强度;收入水平与医疗保险差异导致农村、穷人遭受更大的灾难性卫生支出发生风险。

The rural-urban difference and distribution-sensitive of Catastrophic Health Expenditure

Objective:To analyze the development trend, rural-urban difference and distribution-sensitive measures of the Catastrophic Health Expenditure (CHE) after universal health coverage in China. Methods:Using data from the 2012 CFPS (China Family Panel Studies), and employing the World Health Organization (WHO) methodology to calculate the CHE based on allocation sensitivity. Results:During the period from 2012 to 2014, CHE''s overall incidence and intensity have all decreased dramatically. This has left the health expenditures relatively evenly distributed altogether. However, the absolute value of incidence rate was relatively high, and showed differences between rural and urban areas, and between poor and rich people. The rural areas were hit harder by the CHE and the poor suffered more. In 2012, the incidence of was more uneven in cities than in rural areas, while the opposite was true in 2014. Moreover, the Concentration Index of the average gap for all families changed from negative to positive during the period from 2012 to 2014.Conclusions:The universal health coverage showed a certain effect on reducing the CHE risk (incidence and intensity) effectively. However, the dual-structure (limited content and level of safeguards) of medical insurance in rural and urban areas resulted in the inequality of CHE between rural and urban areas, poor and rich people. Differences in income levels and medical insurance lead rural and poor people to be highly exposed to the CHE risk.