全民医保与医疗服务利用的公平性研究——基于中国家庭追踪调查多轮数据的分析  

A Study on Universal Health Care Coverage and Equity in Health Care Utilization:An Analysis based on Multiple Rounds of data from the China Household Tracking Survey

作　　者：顾昕 惠文 GU Xin;HUI Wen(School of Public Affairs,Zhejiang University,Hangzhou Zhejiang 310058,China)

机构地区：[1]浙江大学公共管理学院,浙江杭州310058

出　　处：《苏州大学学报（哲学社会科学版）》2024年第5期28-38,共11页Journal of Soochow University(Philosophy & Social Science Edition)

基　　金：教育部哲学社会科学研究重大课题攻关项目“全面建设社会主义现代化国家新征程中加快实现共同富裕研究”(项目编号:21JZD019);浙江省哲学社会科学重点研究基地浙江大学民生保障与公共治理研究中心自设课题“共同富裕的社会政策之维:保护主义与发展主义的平衡与融合”(项目编号:23JDZSZD01)的阶段性成果。

摘　　要：医疗服务利用的公平性对促进健康中国建设、缩小健康不平等和实现共同富裕具有重要现实意义。基于中国家庭追踪调查(CFPS)2012年、2014年、2016年和2018年四轮追踪数据,本文分析了我国建成全民医保后医疗服务利用的横向公平性及其动态变化,并利用夏普利值分解法考察了不公平的肇因。研究发现,全民医保实现后,我国医疗服务利用依然极其不平等和不公平,其中有50%以上的不平等是不公平的。此种不公一度减弱,但2018年却有所加剧。医保制度碎片化、城乡、区域以及收入不平等是医疗服务利用不公平的四大主要来源。医保制度的贡献度在2016年城乡医保一体化之前均居首位,2018年有所下降但仍居第二位。进一步提升医保制度的公平性,从全民医保走向公平医保,提升基本公共服务的均等化,缩小贫富差距,是改善医疗服务利用横向不公的重要途径。The equity of medical service utilization is of great practical significance for promoting health equity and building a healthy China.Based on four phases of China Household Tracking Survey(CFPS)data from 2012,2014,2016 and 2018,this paper analyzes the horizontal inequality and its dynamic changes in medical service utilization after the establishment of universal health insurance in China,and uses the Sharpley value decomposition method to investigate the causes of inequality.The study finds that more than half of the high inequality in the utilization of health care services after universal health insurance was inequity,which had been declining but rebounded in 2018.The unfairness of the medical insurance system,urban-rural differences,regional differences,and income inequality are the four main sources of inequality in the use of medical services,among which the contribution of the unfairness of the medical insurance system ranked first before the integration of urban-rural medical insurance,but still ranked second after a sharp decline in 2018.The improvement of the medical insurance system is helpful in reducing the inequity of medical service utilization.Further improving the equity of the medical insurance system,improving the regional balance in the allocation of medical and health resources,and narrowing the gap between rich and poor are important ways to improve the equity in the use of medical services.

关 键 词：健康中国 医疗服务利用 横向公平 全民医保 

分 类 号：C913.7[经济管理]