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在CHNS数据的基础上,本文首先利用间接标准化方法,估算标准化需要的医疗消费支出不平等,并与实际情况进行比较,后者约为前者的1.67-2.83倍。接着,文章利用不平等的组群分解考察了是否参保对医疗服务利用不平等的影响,并进行了城乡差异比较。可以看出,2004年以后医疗保险组群间对总不平等的贡献具有明显下降趋势。最后,文章利用不平等的来源分解分析了医保报销部分对实际医疗消费支出不平等的贡献,并通过与自付部分的比较分析医疗保险对医疗服务利用不平等的影响。结果表明,1991-2000年,医保报销部分是影响医疗服务利用不平等更重要的因素,自付部分的贡献率相对较低。2000年后,个体医疗负担差距超过了医保报销的贡献,这表明医保报销趋向于平等补偿。
Abstract：Based on the multi-period CHNS data,we use indirect standardization to estimate the inequality of the indirectly standardized health expenditure,and compare it with the actual expenditure inequality which is about 1.67-2.83 times as big as the former. Then on the basis of indirect standardization,we use inequality decomposition by population subgroups to examine the influence of whether to participate in health insurance or not on health expenditure inequality,and compare the differences between urban and rural areas. It can be seen that the contribution of between-group to total inequality has a significant decline trend after 2004. Finally,we use inequality decomposition by sources to analyze the contribution of reimbursement to actual expenditure,and its influence by comparison with the co-payments. The results showed that the reimbursement is the more important factor which affect health expenditure inequality from 1991 to 2000,and the contribution ratio of co-payments is relatively low. After 2000,the gap between the medical burden exceeds the contribution of the reimbursement,suggesting that medical reimbursement tends to equal compensation.
1.Backer D.W,Joseph J.S.,Jeffrey M.A.,Elaine A.B.,Avi D.,“Lack of Health Insurance and Decline in Overall Health in Late Middle Age”,New England Journal of Medicine,2001,345:1106~1112.
2.Fleurbaey M,Schookaert E,“Equity in Health and Health Care”,Handbook of Health Economics,Amsterdam:North Holland,2011,1003~1092.
3.Lambert,Peter J.,Aronson,J.Richard,“Inequality Decomposition Analysis and the Gini Coefficient Revised”,The Economic Journal,1993,103:1221~1227.
4.Manning W G,Newhouse J P,Duan N,et al,“Health Insurance and the Demand for Medical Care:Evidence from a Randomized Experiment”,The American Economic Review,1978,251~277.
5.O`Donnel,E.van Doorslaer,A Wagstaff and M.Lindelow,“Analyzing Health Equity Using Household Survey Data:A Guide to Techniques and Implementation”,Washington`D.C.:The World Bank,2008,Chapter 15.
6.Roemer,J.E.,Equality of Opportunity,Harvard University Press,Cambridge,1998.
7.Roemer J.E.,Trannoy A.,“Equality of Opportunity”,Cowles Foundation Discussion Paper No.1921,Cowles Foundation for Research in Economics in Yale University,2013.
8.Silber,J.,“Factor Components,Population Subgroups and the Computation of the Gini Index of Inequality”,Review of Economics and Statistics,1989,71:107~115.
9.Shorrocks,Anthony F.,Guanghua Wan,“Spatial Decomposition of Inequality”,Journal of Comparative Economic Geography,2005,5(1):59~82.
10.Wagstaff A,Lindelow M,Jun G,et al,“Extendeing Health Insurance to the Rural Population:An Impact Evaluation of China’s New Cooperative Medical Scheme”,Journal of Health Economics,2009,28(1):523~552.
11.程令国、张晔:《“新农合”:经济绩效还是健康绩效?》,《经济研究》2012年第1期。
12.胡宏伟、张小燕、赵英丽:《社会医疗保险对老年人卫生服务利用的影响---基于倾向得分匹配的反事实估计》,《中国人口科学》2012年第2期。
13.黄枫、甘犁《过度需求还是有效需求?---城镇老人健康与医疗保险的实证分析》,《经济研究》2010年第6期。
14.解垩:《与收入相关的健康及医疗服务利用不平等研究》,《经济研究》2009年第2期。
15.刘国恩、蔡春光、李林:《中国老人医疗保障与医疗服务需求的实证分析》,《经济研究》2011年第3期。
16.齐良书、李子奈:《与收入相关的健康和医疗服务利用流动性》,《经济研究》2011年第9期。
17.万广华:《不平等的度量与分解》,《经济学(季刊)》2008年第1期。
18.姚瑶、刘斌、刘国恩等:《医疗保险、户籍制度与医疗服务利用---基于CHARLS数据的实证分析》,《保险研究》2014年第6期。
19.臧旭恒、裴春霞:《转轨时期中中国城乡居民消费行为比较研究》,《数量经济技术经济研究》2007年第1期。
(1)收入基尼系数为国家统计局公布数据。
基本信息:
DOI：10.14167/j.zjss.2016.05.002
中图分类号:R197.1;F842.684
引用信息:
[1]赵广川,顾海.医疗保险与医疗服务利用不平等分解[J].浙江社会科学,2016,No.237(05):14-23+155.DOI:10.14167/j.zjss.2016.05.002.
基金信息:
国家自然科学基金项目“城市化进程中城乡医疗保障的统筹模式研究:效应评估与最优模式选择”(71073077)和“统筹城乡医疗保障制度对城乡居民健康及医疗利用的影响研究———基于自然实验框架下的分析”(71373120)的资助
2016-05-15
2016-05-15