灾难性自付医疗支出与贫困——来自中国的微观证据  

Catastrophic Out-of-pocket Payments for Health and Poverty:Micro Evidencefrom China

作　　者：解垩[1] Xie E

机构地区：[1]山东大学经济学院,济南250100

出　　处：《复印报刊资料（社会保障制度）》2023年第12期62-76,共15页SOCIAL SECURITY SYSTEM

基　　金：国家社会科学基金重大项目(20&ZD169);国家自然科学基金项目(72073081、72203126);山东省自然科学基金项目(ZR2021QC011、ZR2022QC089);山东大学人文社会科学研究重大项目(20RWZD05)。

摘　　要：自付医疗支出随着时间的推移会变成灾难性的支出,并对个体健康公平、生活福利造成影响。高自付医疗支出造成的灾难性支出是造成贫困的重要原因,也是发展中国家减贫的主要威胁。文章基于中国家庭动态跟踪调查(CFPS)数据,首先分析了家庭灾难性自付医疗支出(out-of-pocket,OOP)发生率、强度及其对贫困变动的效应,然后研究了灾难性自付医疗支出的决定因素及该种卫生筹资的亲贫性,最后对灾难性自付医疗支出的贫困退出时间进行了测算。结果显示:使用相对贫困线标准,自付医疗支出使贫困率上升6个百分点左右;家庭成员健康状况、经济状况等变量影响着灾难性自付医疗支出的发生概率,随着时间的推移,自付医疗支出这种卫生筹资方式的亲贫性在降低;当使用社会经济不平等指标调整后,灾难性自付医疗支出的贫困退出时间变动较小,而当使用纯粹不平等指标调整后,贫困退出时间变动很大;灾难性自付医疗支出发生率、强度、亲贫性及贫困退出时间在城乡之间、不同医保类型之间存在异质性。Out-of-pocket(OOP)payments for health can become disastrous over time and have an impact on indi-vidual health equity and well-being.Catastrophic out-of-pocket payments for health due to high out-of-pocket health expenditures are an important cause of poverty and a major threat to poverty reduction in developing countries.Under the background of implementing the national strategy of Healthy China,it is of great theoretical and practical value to study the poverty effect of catastrophic out-of-pocket payments for health.Based on the data of Chinese Family Panel Studies(CFPS),firstly,this paper assesses the incidence and intensity of catastrophic out-of-pocket payments for health and its impacts on poverty status.Furthermore,it examines the determinants of catastrophic expenditures and analyzes the pro-poor characteristic of OOP in the healthcare financing system.Finally,it calculates average exit time from catastrophic out-of-pocket payments for health.When using the relative poverty line,OOP increases the poverty rate by 6%.Variables such as health status of family members and economic status of household affect the probability of catastrophic out-of-pocket payments for health.As the time goes,out-of-pocket payments for health-care financing is more unfair for poor.Using socioeconomic inequality indicators leads to small changes in the exit time;while using pure inequality indicators leads to large reductions in the exit time.In the sample of urban and rural subgroups,under the same threshold value,the incidence and intensity of catastrophic out-of-pocket payments for health in rural areas are greater than those in urban areas,no matter from the perspective of total consumption or non-food consumption.When OOP is removed from household consumption expenditures,rural poverty rates increase more than urban ones.OOP health financing in urban and rural areas has changed from pro-poor to pro-rich over time,especially in urban areas.The average exit time for catastrophic out-of-pocket payments for health is longer in r

关 键 词：灾难性自付医疗支出 贫困 贫困退出时间 

分 类 号：F126.1[经济管理—世界经济] R197[医药卫生—卫生事业管理]