节点文献
我国健康保障制度的公平与效率研究
【作者】 李文中；
【导师】 庹国柱；
【作者基本信息】 首都经济贸易大学 ， 劳动经济学， 2011， 博士
【摘要】 本文是在我国筹资公平性下降、卫生服务的可及性失衡导致城乡居民对卫生服务利用下降,医患关系变得紧张,有研究指出卫生体制改革既失去了效率也丧失了公平的背景下对我国建国以来健康保障制度的公平与效率进行较为全面系统的研究。笔者综合运用了基尼系数、集中系数、Kakwani指数和直接对比等方法对我国原有健康保障制度和现行健康保障制度在省际之间、城乡之间卫生服务提供公平、卫生服务利用公平、健康保障筹资公平、健康状况公平等进行了测度；运用时间序列DEA法对我国原有健康保障制度和现行健康保障制度的技术效率进行了估算。计量的结果是,改革开放前我国健康保障制度的公平性不断改善；改革开放之后,尤其是1998年社会医疗保险制度改革之后,健康保障制度的公平性和技术效率都呈现下降趋势,直到政府先后大规模建立起新型农村合作医疗和城镇居民医疗保险制度,健康保障制度的公平性和技术效率才明显改善。再从理论层面分析了实现健康保障制度公平与效率均衡的条件和路径,并重点分析了影响健康保障制度公平与效率的信息不对称问题和健康保障融资问题。最后,结合我国的实际情况提出分三步走建成“覆盖全民、层次多样、家庭互济、供需协调、运转高效”的全民健康保障制度的改革目标。
【Abstract】 This research was done under such context:the health services utilization for the urban and rural residents decreased and the doctor-patient relationship deteriorated due to the equity of financial contribution decline and health service accessibility imbalances. A study pointed out that the health system reform lost both efficiency and equity. A relatively comprehensive and systematic review about the efficiency and equity of health protection system had been done since the establishment of the People’s Republic of China.The authors used the methods such as Gini coefficient, concentration coefficient, Kakwani index and direct comparison, et al. to measure the equity of health services provision, health care utilization, financial contribution and health status between the original and the existing health security system, and between the provincial, urban and rural sites; Time series DEA method was used to evaluate the technical efficiency of the original and the existing health security system. The result showed that before Reform and Opening, the equity of the health security system continuously improved; but after Reform and Opening, especially after the social medical insurance reform in 1998, there was a downward trend in both fairness and technical efficiency in health security system. And it was not until the government established a large-scale new cooperative medical scheme for rural residents and medical insurance payment system for urban residents that the equity and technical efficiency in health security system was significantly improved.Then the conditions and the pathway to achieve equity and efficiency equilibrium of the health protection system was theoretically analyzed, and the problems of information dissymmetry and heath protection financing which had a great impact on the equity and efficiency of health protection system were selectively analyzed.Finally, according to the actual situation in our country, a three-step was proposed to achieve the reform objectives of the health protection system for the whole nation with the view of "universal coverage, multi-levels, family mutual aid, supply and demand coordination and efficient operation ".