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目的:比较东中西部城市税收、社会医疗保险、商业健康保险和居民现金卫生支出4种卫生筹资渠道的累进性。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,采用比例法描述东中西部城市4种卫生筹资渠道的分布,并计算其集中指数和kakwani指数。结果:东中西部城市不同经济水平家庭的社会医疗保险、商业健康保险和居民现金卫生支出构成差异均无统计学意义(χ2社会医疗保险=3.697,P=0.883;χ2商业健康保险=11.349,P=0.183;χ2现金卫生支出=4.146,P=0.844),而直接税构成差异具有统计学意义(χ2=17.439,P=0.026),东部城市家庭直接税的公平性好于中部城市。总体上,呈现累进性的筹资渠道是直接税、职工医疗保险、商业健康保险;呈现累退性的是间接税、居民医疗保险,而现金卫生支出在东部城市呈现累退性,在中部和西部城市呈现累进性。结论:发挥税收在筹资公平性的作用;完善社会医疗保险制度;提高卫生服务的可及性。
OBJECTIVE: To compare the progressiveness of four health financing channels for urban tax, social health insurance, commercial health insurance and residents’ cash health expenditures in the eastern, central and western regions. Methods: According to the survey data of health consultation of typical urban residents in eight community health reform programs in 2011, the distribution of four health financing channels in eastern, central and western cities was described by proportional method, and the concentration index and kakwani index were calculated. Results: There was no significant difference in the social health insurance, commercial health insurance and residents’ cash health expenditure among the households in the eastern, central and western cities at different economic levels (χ2 Social Health Insurance = 3.697, P = 0.883; χ2 Business Health Insurance = 11.349, P = 0.183; χ2 cash health expenditure = 4.146, P = 0.844), but the difference of direct taxation was statistically significant (χ2 = 17.439, P = 0.026). The fairness of direct urban households in eastern cities was better than that of central cities. In general, the progressive financing channels are direct tax, employee medical insurance and commercial health insurance. Indirect tax and resident health insurance are presented in a regressive manner. Cash health expenditure is regressive in eastern cities, presenting in central and western cities Progressive. Conclusion: To play the role of tax fairness in financing; to improve the social medical insurance system; to improve the accessibility of health services.