我国不同社会医疗保险参保群体卫生服务利用不平等研究

摘要

Objective:To analyze various groups of health services utilization of medical insurance for urban workers,medical insurance for urban residents and the new rural cooperative medical care in China,compare three groups of health service utilization degree of inequality and estimate the inequality decomposition of related factors.Methods:The utilization of health services of 9 836 residents in 6 provinces,16 cities and 31 counties was investigated by field investigation.The concentration index and concentration curve were applied to calculate the health services of provinces,cities and counties to make use of inequality.The relative inequalities and normalization inequalities of the three medical insurance systems were calculated by regression analysis and concentration index decomposition.Results:Taking the per capita household income of residents as a reference,concentration index of residents health service utilization in China were estimated.Based on the regression equation analysis with the control of the factors of economics,age,geogray,etc,the concentration index for urban employee medical insurance was 0.1332,the concentration index for urban resident medical insurance was 0.1225,the concentration index for New Rural Cooperative Medical System was 0.0994.These indexes were all improved after the change.Conclusion:From the inequality reflected by the concentration index,the health service utilization equity for the insured groups in Liaoning was fairly well,while the inequality in Shaanxi was poor.There were inequity gaps of the health services among these three social basic medical insurance group.The inequity of urban employee medical insurance was the largest,followed by the medical insurance for urban residents,the inequity of new rural cooperative medical system was minimum.%目的:分析比较我国参加城镇职工医疗保险、城镇居民医疗保险和新型农村合作医疗制度的各类群体卫生服务利用的不平等程度,并对不平等进行相关因素的分解测算.方法:利用现场调研获得的全国6个省16个市31个县市区的8 676名居民的卫生服务利用情况.利用集中指数和集中曲线测算各省、市和县的居民卫生服务利用不平等情况.利用回归分析和集中指数分解等方法测算分别参加三种医疗保险的群体卫生服务利用不平等和标化后的不平等之间的差异.结果:以居民家庭人均收入为参照,测算我国2014年居民的卫生服务利用集中指数.经回归方程分析,控制经济、年龄及地域等因素间接标化后的三种主要社会医疗保险参保群体卫生服务利用的集中指数分别是,城镇职工医疗保险为0.133 2,城镇居民医疗保险为0.122 5,新农合为0.099 4,较未标化之前都有所改善.结论:从集中指数反映的卫生服务利用不平等来看,辽宁省参保群体的卫生服务利用公平性较好,陕西省的不平等性较差.三种主要的社会基本医疗保险参保人群的卫生服务利用不平等性存在差异,城镇职工医疗保险的不平等性最大,次之为城镇居民医疗保险,新农合的不平等性最低.