东中西部城市卫生筹资再分配效应比较：基于社区卫生综合改革典型城市居民健康询问调查

摘要

Objective: The paper is to compare health financing redistributive effect (RE) of family tax, social medical insurance and out of pocket in cities of eastern, central and western areas. Methods: With data collected through household health interview survey of 8 typical cities under comprehensive community health reform in 2011, taking methodology of Aronson-Johnson-Lambert redistributive effect analysis to estimate the vertical equity, horizontal inequity and re-ranking effect of health financing. Results: The redistributive effect of family tax financing in eastern, central and western areas are negative, and the RE were respectively -0.013 1 ,-0.003 2 and-0.001 2. In the eastern area, social medical insurance under health financing redistribution (RE=0.002 8) is higher than the west (RE=-0.000 4) and the central area (RE=-0.001 6); RE of out of pocket (OOP) in east, middle and west was respectively-0.008 8, -0.009 1 and -0.005 5. Conclusion: Urban employees’ medical insurance played a weak positive role in health financing redistribution;tax, urban residents’ medical insurance and OOP did not play positive role in redistribution.%目的：比较东中西部城市家庭税收、社会医疗保险和现金卫生支出三方面的卫生筹资的公平性和再分配效应。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Aronson-Johnson-Lambert再分配分解法，测算卫生筹资的垂直公平、水平不公平及再排序效应。结果：东中西部城市家庭税收渠道筹资再分配效应均为负，其RE值分别为-0.0131，-0.0032和-0.0012；东部城市社会医疗保险的卫生筹资再分配效应（RE=0.0028）高于西部（RE=-0.0004）和中部（RE=-0.0016）；东中西部城市现金卫生支出的再分配效应（RE值）分别为-0.0088，-0.0091和-0.0055。结论：城镇职工医疗保险在卫生筹资再分配中发挥了较弱的正向作用；税收、城镇居民医疗保险和个人现金卫生支出未显现出正向再分配作用。