健康不平等产生机制及其治理途径探析——健康消费分层的视角  

Exploring the Mechanism of Health Inequality under Medical Reform and the Governance Approach:From a Perspective on Health Consumption Stratification

作　　者：鞠牛 梁玉成[2] Niu Ju;Yucheng Liang

机构地区：[1]中山大学公共卫生学院(深圳) [2]中山大学社会学与人类学学院

出　　处：《公共行政评论》2022年第6期154-172,199,200,共21页Journal of Public Administration

基　　金：教育部人文社会科学研究青年项目“医疗负担均等化下的健康不平等加剧研究”(17YJC840018)。

摘　　要：新医疗卫生体制改革旨在促进医疗公平化,但实际上健康不平等程度仍在增加。对于这一现象,已有研究仅限于关注医疗领域行为及政策的影响,未能全面分析健康经济行为在该现象形成中的作用和具体机制。研究基于2015年特大城市居民生活状况调查数据,分析这一政策在健康经济意义上的实际效应。结果表明,健康水平主要由医疗支出和健康休闲消费这两方面的健康经济行为决定,使得医改政策在促进医疗资源利用的同时,对健康的社会效应也产生了不同方面的阶层差异。对低阶层而言主要是不健康固化机制,即医疗支出增长会固化其健康劣势;对较高阶层而言主要是健康再生产机制,即健康休闲消费增强了其健康优势。基于上述健康不平等形成机制的新发现,研究提出健康不平等治理途径的政策建议,其中关键在于,社会有必要为低阶层在健康休闲行为上提供更多的公共资源。China’s new medical health system reform aimed to promote equity in medical care. Health inequality is still rising,however. Since previous related studies focused on the impact of medical policy,the mechanisms that allow different health economic behaviors to increase health inequality have not been systemically discussed. Based on empirical data from the survey of residents’ living conditions in megacities,this study analyzed the actual effect of the medical reform policy. It found that personal health status was determined by both medical expenditures and health leisure consumption. While the policies of health reform have promoted the utilization of medical resources followed with increasing medical expenditure,the social effects on health were characterized by social class due to different health economic behaviors. People in lower class surroundings were more likely to be involved in the solidification mechanism of bad health,indicating that the increase of medical expenditures would solidify their health disadvantages. People in higher class surroundings were more likely to follow the reproduction mechanism of well-being,indicating that health leisure consumption enhanced their health advantages. This suggests governance approaches supply health and leisure behavior resources especially for people in lower class surroundings.

关 键 词：医疗政策 医疗支出 健康休闲消费 中间阶层 健康不平等 

分 类 号：D63[政治法律—政治学]