摘要
目的基于集中指数(CI)构建水平不平等指数(HI),分析不同经济水平的上海居民卫生服务利用的水平公平性,发现卫生资源配置存在的问题。方法在标准化卫生服务需求估计的基础上,采用基于CI的方法,使用中国健康营养调查(CHNS)上海地区的调查数据,测算卫生服务利用的水平公平性。结果样本人群的实际卫生服务利用、标准化卫生服务需求的CI分别为0.056,3和0.040,8,卫生服务的HI为0.015,5。在实际利用和实际需求方面,医疗服务具有亲富人的不平等性,并且卫生服务利用实际上更好地满足了高收入群体的卫生服务需求。医疗保险补偿前,不同收入组人群医疗费用的CI为-0.060,0,补偿后为-0.104,3;补偿前医疗费用主要集中于低收入人群,补偿后医疗费用的分布比补偿前更加集中于低收入人群,不公平程度有所增加。结论卫生资源配置还不能够真正满足居民的卫生服务需求,存在水平不平等。卫生服务利用实际上更好地满足了高收入群体的卫生服务需求。居民医疗保险虽然能从整体上降低居民的疾病经济负担,但未能提高医疗费用支出的公平性。在设计医疗保健系统体制时,应倾向于提高低收入居民医疗服务利用的可及性,更好地满足低收入居民由于健康因素产生的医疗服务需求,提高居民卫生服务利用的水平公平性。
Objective To construct the horizontal inequality index (HI) based on the concentration index (CI), and to analyze the horizontal equity of health service utilization of Shanghai residents at different economic levels, to find the existing problems in health resource allocation. Methods On the basis of standardized health service demand estimation, the equity of health service utilization level was calculated by using the data of CHNS survey in Shanghai area based on the method of CI. Results The CI of actual health service utilization and standardized health service demand of sample population were 0.056,3 and 0.040,8 respectively, and the HI of health service was 0.015,5. The actual utilization and actual demand of health service had the inequality in favor of the wealthy people, and the utilization of health service actually better met the health service demand of high-income groups. Before medical insurance compensation, the CI of medical expenditure of different income groups was -0.060,0;after compensation, the CI was -0.104,3. Before compensation, medical expenditure was mainly concentrated in the low-income group;after compensation, the distribution of medical expenditure was more concentrated in the low-income group than before compensation, and the degree of inequity also increased. Conclusion The allocation of health resources can not really meet the health service needs of residents, and there is horizontal inequality. In fact, health service utilization can better meet the health service needs of high-income groups. Although residents’ medical insurance can reduce their economic burden of disease as a whole, it can not improve the fairness of medical expenditure. When designing the system of health care, it should be inclined to improve the accessibility of medical service utilization of low-income residents for better meeting the medical service demand of low-income residents due to health factors, to improve the equity of residents’ health service utilization.
作者
赵戴君
Zhao Daijun(Hongkou District Center for Disease Control and Prevention, Shanghai 200082, China)
出处
《健康教育与健康促进》
2019年第2期121-125,共5页
Health Education and Health Promotion
