东中西部城市卫生筹资累进性比较:基于社区卫生综合改革典型城市居民健康询问调查  

Progressivity Comparison of Health Financing of Cities of East, Middle and West of China: Based on Urban Residential Health Interview Survey of Typical Cities under Community Health Comprehensive Reform

作　　者：张丽芳[1] 张艳春[1] 刘涵[2] 吴宁[1] 秦江梅[1] 

机构地区：[1]卫生部卫生发展研究中心,北京100191 [2]石河子大学医学院,新疆石河子832000

出　　处：《中国卫生经济》2013年第9期69-71,共3页Chinese Health Economics

基　　金：中澳卫生与艾滋病项目(HSS409)

摘　　要：目的:比较东中西部城市税收、社会医疗保险、商业健康保险和居民现金卫生支出4种卫生筹资渠道的累进性。方法:利用2011年8个社区卫生综合改革典型城市居民健康询问调查数据,采用比例法描述东中西部城市4种卫生筹资渠道的分布,并计算其集中指数和kakwani指数。结果:东中西部城市不同经济水平家庭的社会医疗保险、商业健康保险和居民现金卫生支出构成差异均无统计学意义(χ2社会医疗保险=3.697,P=0.883;χ2商业健康保险=11.349,P=0.183;χ2现金卫生支出=4.146,P=0.844),而直接税构成差异具有统计学意义(χ2=17.439,P=0.026),东部城市家庭直接税的公平性好于中部城市。总体上,呈现累进性的筹资渠道是直接税、职工医疗保险、商业健康保险;呈现累退性的是间接税、居民医疗保险,而现金卫生支出在东部城市呈现累退性,在中部和西部城市呈现累进性。结论:发挥税收在筹资公平性的作用;完善社会医疗保险制度;提高卫生服务的可及性。Objective： To compare the progressivity of four health financing resources of tax, social medical insurance, commercial health insurance and out of pocket health payment（OOP）of cities of east, middle and west parts of China. Methods： With data collected through household health interview survey in 2011, adopt scaling method to analyze the distribution of the four financing approaches of cities of different parts , and calculate the Concentration Index （ CI ） and Kakwani index . Results： The differences of social medical insurance, commercial health insurance and OOP in different economic families of eastern, central and western cities didn ’ t have statistical significance （χ2social medical insurance =3.697, P=0.883; χ2commercial health insurance=11.349, P=0.183; χ2oop=4.146, P=0.844）, but there is significant difference of direct tax, and the east was better than the middle. As a whole, direct tax, social medical insurance and commercial health insurance were progressive, but indirect tax was regressive. OOP was regressive in the east, but it was progressive in cities of the middle and west parts. Conclusion： To exert the function of tax in financing equity, perfect the social medical insurance system and improve the accessibility of health services.

关 键 词：社会区卫生服务 东中西部城市 卫生筹资 累进性 

分 类 号：R197.1[医药卫生—卫生事业管理]