新型农村合作医疗政府财政补助公平性研究

项目名称： 新型农村合作医疗政府财政补助公平性研究

项目编号： No.70873001

项目类型： 面上项目

立项/批准年度： 2009

项目学科： 建筑科学

项目作者： 江启成

作者单位： 安徽医科大学

项目金额： 20万元

中文摘要： 新型农村合作医疗的目标是保障大多数农民的基本医疗服务需求。新农合医疗政府财政补助投入应遵循"低收入人口优先受益原则"。本研究采用受益归属分析（BIA）方法，通过对新农合政府财政补助在不同经济水平参合农民中的分布的分析,测算出参合农民经济水平的Gini系数为0.323、政府财政门诊补助集中指数为-0.053，Kakwani指数为-0.376，住院补助集中指数为0.508，Kakwani指数为0.185，反映新农合政府财政门诊补助的公平性较好，但是住院补助和总补助的公平性较差。由于住院级别等因素的影响，政府政策在消除贫富差距上的有效性较差，没有达到预期的目标效率。通过农村居民灾难性卫生支出状况和脆弱人群健康保障公平性的分析，发现农村家庭现金卫生支出相对较重，脆弱人群健康保障公平性受户主的文化程度、家庭人数、抚养比和性别比的影响，反映灾难性卫生支出有向富裕家庭集中的趋势，政府政策对灾难性卫生支出和脆弱人群健康保障的改善程度有限。本研究将BIA方法运用到新农合政府财政补助受益归属分析中，扩宽了其应用范围，为农村卫生研究提供借鉴；为提高新农合政府财政补助目标效率提供政策建议。

中文关键词： 合作医疗；政府补助；受益分布；公平性;灾难性卫生支出

英文摘要： The goal of New Cooperative Medical System（NCMS）is to meet the essential medical service demands of rural residents. Government financial susidy in NCMS should follow the principle low-income population priority benefit. The study researched on the distribution and level of the government subsidy in NCMS among rural residents with different incomes using the benefit analysis (BIA). The Gini coefficient is 0.323, the government subsidies focus index for outpatient is -0.053, Kakwani index is -0.376, the government subsidies focus index for inpatient is 0.508, Kakwani index is 0.185.The result reflected the fairness of the outpatient subsidies is good, but hospital subsidies is poor. Because of hospital levels and other factors, government policy cannot eliminate the relative or absolute gap in the poor and the rich life level. The efficiency of the target is limited. The analysis of the rural residents catastrophic health spending status and the fairness in health security of vulnerable populations found that the health cash spending burden is relatively heavy.Because of education background, dependency ratio,sex ratio,the fairness of the health security in vulnerable people is poor.This reflectted the government subsidies policy on catastrophic health spending and vulnerable people health security is limited. The research broadened the BIA method of applications, provided reference for other rural health the research; and provide decision-making evidence in adjustment and optimizing of NCMS finance compensation among population with different incomes.

英文关键词： Cooperative Medical System; government subsidy；benefit incidence；equity;catastrophic health spending