居民医疗支出影响因素的实证分析
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摘要
随着改革开放和经济发展,居民生活水平有了很大的提高,但同时居民的医疗负担也越来越重。不仅如此,城乡二元化和城市化、政府医疗政策和医疗资源供给、老龄化等现象也会影响居民对医疗服务的需求。为研究这些问题,本文以Grossman的健康资本需求模型为理论基础,采用国家统计年鉴2003～2008年的省级面板数据,对居民医疗支出与相关影响因素的关系进行分析。在模型的选择上,根据前人的文献,本文采用了在测量收入弹性的同时考虑其他影响因素的实证分析方法。并且,在前人研究的基础上,本文根据现实情况对城镇和农村分别进行回归以分析其差异,并加入了城市化、出生率、政府预算卫生支出等变量,以使得对我国居民医疗支出影响因素的研究更为准确。
研究结果发现,城乡居民医疗支出的收入弹性确实存在差异,且最终结果农村高于城市：城市居民医疗支出收入弹性的最终结果为0.68,农村居民医疗支出收入弹性的最终结果为1.23。同时,考虑供需因素后收入弹性有了更准确的结果。
在测量收入弹性的同时,本文发现城市化指标与城乡居民的医疗支出均显著正相关。出生率指标、平均住院时间长度指标与城镇居民的医疗支出显著正相关,与农村居民医疗支出的关系不显著。而老龄化指标、医生数指标与城镇居民医疗支出的关系不显著,与农村居民的医疗支出显著正相关。教育指标、政府预算卫生支出指标则与城乡居民医疗支出的关系均不显著。根据这些结果,本文在进行相应的分析后提出如下建议：政府应整合城乡医疗资源、促进城乡医疗保险一体化、合理提高政府卫生投入力度、重视农村老龄化问题、并合理促进城市化。
With the reform and opening up, the inhabitant's standard of living has improved to a large extent, but the burden of medical expenditure has also enhanced; in addition, situation such as the urban-rural dual economic structure, urbanization, transition of medical policies and population aging have significant influence on medical service demand. To study these, the paper employing panel data from 31 China provinces between 2003 and 2008 to analysis medical expenditure and its influencing factors. For the model, the paper employs the empirical method of measuring income elasticity while considering other factors. Furthermore, the paper employs regression for urban and rural areas, adds variables such as urbanization rate, birth rate, government budget, which make the research of medical expenditure more accurate.
The research outcome shows that the urban area has an elasticity of 0.68 and the rural area has an elasticity of 1.23.
While measuring income elasticity, the paper finds the coefficient estimate of urbanization are statistically positive significant with both urban and rural medical expenditure. Birth rate and length of stay in hospital are statistically positive significant with urban medical expenditure. And the population aging and number of doctors are significant positive with rural expenditures. Education and government medical budget are not significant with either rural or urban expenditure.
研究结果发现,城乡居民医疗支出的收入弹性确实存在差异,且最终结果农村高于城市：城市居民医疗支出收入弹性的最终结果为0.68,农村居民医疗支出收入弹性的最终结果为1.23。同时,考虑供需因素后收入弹性有了更准确的结果。
在测量收入弹性的同时,本文发现城市化指标与城乡居民的医疗支出均显著正相关。出生率指标、平均住院时间长度指标与城镇居民的医疗支出显著正相关,与农村居民医疗支出的关系不显著。而老龄化指标、医生数指标与城镇居民医疗支出的关系不显著,与农村居民的医疗支出显著正相关。教育指标、政府预算卫生支出指标则与城乡居民医疗支出的关系均不显著。根据这些结果,本文在进行相应的分析后提出如下建议：政府应整合城乡医疗资源、促进城乡医疗保险一体化、合理提高政府卫生投入力度、重视农村老龄化问题、并合理促进城市化。
With the reform and opening up, the inhabitant's standard of living has improved to a large extent, but the burden of medical expenditure has also enhanced; in addition, situation such as the urban-rural dual economic structure, urbanization, transition of medical policies and population aging have significant influence on medical service demand. To study these, the paper employing panel data from 31 China provinces between 2003 and 2008 to analysis medical expenditure and its influencing factors. For the model, the paper employs the empirical method of measuring income elasticity while considering other factors. Furthermore, the paper employs regression for urban and rural areas, adds variables such as urbanization rate, birth rate, government budget, which make the research of medical expenditure more accurate.
The research outcome shows that the urban area has an elasticity of 0.68 and the rural area has an elasticity of 1.23.
While measuring income elasticity, the paper finds the coefficient estimate of urbanization are statistically positive significant with both urban and rural medical expenditure. Birth rate and length of stay in hospital are statistically positive significant with urban medical expenditure. And the population aging and number of doctors are significant positive with rural expenditures. Education and government medical budget are not significant with either rural or urban expenditure.
引文
[01]Adelman, Irma, "An Econometric Analysis of Population Growth"[J], American Economic Review,1963,53,314-341.
[02]Aileen Clarke, Pam Rowe, Nick Black Source., "Does a Shorter Length of Hospital Stay Affect the Outcome and Costs of Hysterectomy in Southern England?"[J], Journal of Epidemiology and Community Health,1996,50(5), 545-550.
[03]Anindya Sen., "Is Health Care a Luxury? New Evidence form OECD Data"[J], International Journal of Health Care Finance and Economics,2005,5, 147-164.
[04]Brigitte Dormont, Helene Huber., "Causes of Health Expenditure Growth: The Predominance of Changer in Medical Practices Over Population Ageing"[J], Annales D'Economie et de Statistique,2006,83/84,187-216.
[05]Cromwell Jerry, Janet B Mitchell., "Physician-induced Demand for Surgery"[J], Journal of Health Economics,1986,5,293-313.
[06]Evans Robert G., "Supplier-induced demand:Some Empirical Evidence and Implications in the Economics of health and Medical Care"[R], London: Macmillian,1974.
[07]Frank T. Denton, Byron G Spencer., "Health-care costs when the population changes"[J], The Canadian Journal of Economics,1975,8,34-48.
[08]Fuchs, Vitor R., "Some Economic Aspects of Mortality in the United States, Mimeographed"[J], New York:National Bureau of Economic Research,1965.
[09]Fuchs Victor R., "The Supply of Surgeons and the Demand for Operations" [J], Journal of Human Resources,1978,13,35-36.
[10]Gerdtham U. G., Sogaard J., Andersson F., Jonsson, Bo., "An econometric analysis of health care expenditure:A cross-section study of the OECD countries"[J], Health Economics,1992,11,63-88.
[11]Gerdtham U.-G, J. Sogaard, F. Andersson and B. Jonsson., "A Pooled Cross-Section Analysis of the Health Care Expenditures of the OECD Countries In:Peter Zweifel and H.E. Freeh (eds.)"[J], Health Economics Worldwide, Kluwer Academic Publishers,1992b.
[12]Gertham et al., "The Effect of Changes in Treatment Patterns on Drug Expenditure"[J], PharmacoEconomics,1998,13,127-134.
[13]Gordon G. Liu, Xiao Dong Wu, Chaoyang Peng and Alex Z. F, "Urbanization and Health Care in Rurul China"[J], Contemporary Economic Policy,2003,21, 11-24.
[14]Grossman, Michael,1972, "On the Concept of Health Capital and the Demand for Health"[J], Journal of Political Economics,1972,80(2),223-255.
[15]Hitris T. and J. Posnett., "The Determinants and Effects on Health Expenditure in Developed Countries"[J], Journal of Health Economics,1992,11, 173-181.
[16]Hansen, P. and A. King., "The Determinants of Health Care Expenditure:A Cointegration Approach"[J], Jounal of Health Economics,1996,15,127-137.
[17]Jonsson B. Lmdgren B., "Five common fallacies in estimating the economic gains of early discharge"[J], Social Science Medicial,1980,14,27-33.
[18]Kleiman E., "The determinants of national outlay on health, in:M. Perlman"[R], The Economics of Health and Medical Care(MacMillan, London), 1974.
[19]L. Di Matteo., "The income elasticity of health care spending:A Comparison of Parametric and Nonparametric Approaches"[J], The European Journal of Health Economics,2003,4,20-29.
[20]Leu, Robert E., "The public-privater mix and international health care costs, in:A. J. Culyer, B. Jonsson"[R], Public and Private Health Services (Basil Blackwell, Oxford),1986.
[21]Livio Di Matteo, Rosanna Di Matteo., "Evidence on the determinants of Canadian provincial government health expenditures:1965-1991"[J], Journal of Health Economics,1998,17,211-228.
[22]McPherson K., "Length of stay and health outcome"[M]. BMJ,1984.
[23]Morgan M., "Variations in length of stay at district level. In:Ham C ed"[R], Health care variations, London, King's Fund Institute,1988, Research Report No2.
[24]Newhouse, J. P., "Medical Care Expenditure:A Cross-national Survey"[J], Human Resouces,1977,12,115-137.
[25]Parkin D., McGuire A., Yule B., "Aggregate health care expenditures and national income:Is health care a luxury good"[J], Health Economics,1987,6, 109-133.
[26]Pauly Mark V., "Doctors and Their Workshops"[M], Chicago:University of Chicago Press,1980.
[27]Preston, Samuel, H., "The Changing Relation between Mortality and Level of Economic Development"[J], Population Studies,1975,29(2):231-248.
[28]Roemer Milton I., "Bed Supply and Hospital Utilization:A National Experiment"[J], Hospitals, J.A.H.A.,1961,35:988-993.
[29]Sen, Amartya, K., "Sri Lanka's Achievements:How and When"[M], in Srinivasan, T. N.&P. K. Bardhan(eds.), Rural Poverty in South Asia, New York: Columbia University Press,1998:549-556.
[30]Stano Miron., "A Further Analysis of the Physician Inducement Controversy"[J], Journal of Health Economics,1987,6:227-238.
[31]Stearns S.C. and Norton E.C., "Time to Include Time to Death? the Future of Health Care Expenditure Predictions"[J], Health Economics,2004,13,315-327.
[32]Zweifel P., Felder S. and Meiers M., "Ageing of the Population and Health Care Expenditure:a Red Herring?"[J], Health Economics,1999,8,485-496.
[33]兰宇曦.个人收入与医疗服务需求及其弹性[J].中华医院管理杂志,1997,13(10)：581-584.
[34]罗家有.“诱导需求干预研究及其对医疗费用的影响”[J].卫生经济研究,2002,7：10-11.
[35]胡琳琳、胡鞍钢.从不公平到更加公平的卫生发展：中国城乡疾病模式差距分析与建议[J].《管理世界》,2003,1.
[36]平新乔.从中国农民医疗保健支出行为看农村医疗保健融资机制的选择[J]管理世界[J].2003,11：52-63.
[37]陆铭,陈钊.城市化、城市倾向的经济政策与城乡收入差距[J].经济研究,2004,6：50-58.
[38]梁维萍,郑建中,韩颖,覃凯,贺鹭.农村居民收入与医疗服务需求及其弹性研究[J].中国农村卫生事业管理,2005,25(10)：15-17.
[39]王绍光.巨人的瘸腿：从城镇医疗不平等谈起[J].读书,2005,11.
[40]赵郁馨,陈瑛,万泉,张毓辉.2004年中国卫生总费用测算结果与卫生筹资分析[J].中国卫生经济,2006,3.
[41]陈洪海,黄丞,陈忠.卫生费用的决定因素：跨省比较研究[J].生产力研究,2006,10：84-85
[42]何平平.我国卫生总费用的弹性测算[J].统计观察,2006,5：87-90
[43]刘丽娜,徐凌中,王兴州,刘冬梅,周成超.我国城乡门诊医疗服务需求弹性研究[J].中国卫生经济,2006,25(7)：34-36.
[44]田国栋,程晓明.卫生总费用与国民经济和职工收人增长规律的比较研究[J].中国卫生经济,2006,9：122-124.
[45]徐伟.从需求弹性实证的角度谈我国医疗卫生改革[J].中国卫生经济,2006,25(11)：19-22.
[46]王凡,温小霓.“我国医疗供方诱导需求理论与实证”[J].中国卫生事业管理,2007,223(1)：12-14.
[47]尹希果,付翔,陈刚.城镇居民收入差距对医疗保健消费影响研究[J].中国卫生统计,2007,2.
[48]林相森、舒元.我国居民支出影响因素的实证分析[J].南方经济,2007,6：22-30.
[49]干春晖,周习,郑若谷.“不完美信息、供给者诱导需求与医疗服务质量”[J].财经研究,2007,33(8)：97-107.
[50]顾卫兵,张东刚.城乡居民收入与医疗保健支出关系的实证分析,消费经济,[J].2008,1：43-46.
[51]李放等.强化政府责任增进医疗卫生公平[J].中共南京市委党校学报.2008,2.
[52]吴华超、温涛.新时期我国农村居民收入与消费关系的新趋势——基于启动农村消费市场的现实背景[J].南方农村,2008,2.
[53]王一峰.论医疗费用控制中的弹性制度与激励制度[J].中国卫生经济,2008,27(3)：12-15.
[54]叶春辉,封进,王晓润.收入、受教育水平和医疗消费：基于农户微观数据的分析[J].中国农村经济,2008,8：16-24.
[02]Aileen Clarke, Pam Rowe, Nick Black Source., "Does a Shorter Length of Hospital Stay Affect the Outcome and Costs of Hysterectomy in Southern England?"[J], Journal of Epidemiology and Community Health,1996,50(5), 545-550.
[03]Anindya Sen., "Is Health Care a Luxury? New Evidence form OECD Data"[J], International Journal of Health Care Finance and Economics,2005,5, 147-164.
[04]Brigitte Dormont, Helene Huber., "Causes of Health Expenditure Growth: The Predominance of Changer in Medical Practices Over Population Ageing"[J], Annales D'Economie et de Statistique,2006,83/84,187-216.
[05]Cromwell Jerry, Janet B Mitchell., "Physician-induced Demand for Surgery"[J], Journal of Health Economics,1986,5,293-313.
[06]Evans Robert G., "Supplier-induced demand:Some Empirical Evidence and Implications in the Economics of health and Medical Care"[R], London: Macmillian,1974.
[07]Frank T. Denton, Byron G Spencer., "Health-care costs when the population changes"[J], The Canadian Journal of Economics,1975,8,34-48.
[08]Fuchs, Vitor R., "Some Economic Aspects of Mortality in the United States, Mimeographed"[J], New York:National Bureau of Economic Research,1965.
[09]Fuchs Victor R., "The Supply of Surgeons and the Demand for Operations" [J], Journal of Human Resources,1978,13,35-36.
[10]Gerdtham U. G., Sogaard J., Andersson F., Jonsson, Bo., "An econometric analysis of health care expenditure:A cross-section study of the OECD countries"[J], Health Economics,1992,11,63-88.
[11]Gerdtham U.-G, J. Sogaard, F. Andersson and B. Jonsson., "A Pooled Cross-Section Analysis of the Health Care Expenditures of the OECD Countries In:Peter Zweifel and H.E. Freeh (eds.)"[J], Health Economics Worldwide, Kluwer Academic Publishers,1992b.
[12]Gertham et al., "The Effect of Changes in Treatment Patterns on Drug Expenditure"[J], PharmacoEconomics,1998,13,127-134.
[13]Gordon G. Liu, Xiao Dong Wu, Chaoyang Peng and Alex Z. F, "Urbanization and Health Care in Rurul China"[J], Contemporary Economic Policy,2003,21, 11-24.
[14]Grossman, Michael,1972, "On the Concept of Health Capital and the Demand for Health"[J], Journal of Political Economics,1972,80(2),223-255.
[15]Hitris T. and J. Posnett., "The Determinants and Effects on Health Expenditure in Developed Countries"[J], Journal of Health Economics,1992,11, 173-181.
[16]Hansen, P. and A. King., "The Determinants of Health Care Expenditure:A Cointegration Approach"[J], Jounal of Health Economics,1996,15,127-137.
[17]Jonsson B. Lmdgren B., "Five common fallacies in estimating the economic gains of early discharge"[J], Social Science Medicial,1980,14,27-33.
[18]Kleiman E., "The determinants of national outlay on health, in:M. Perlman"[R], The Economics of Health and Medical Care(MacMillan, London), 1974.
[19]L. Di Matteo., "The income elasticity of health care spending:A Comparison of Parametric and Nonparametric Approaches"[J], The European Journal of Health Economics,2003,4,20-29.
[20]Leu, Robert E., "The public-privater mix and international health care costs, in:A. J. Culyer, B. Jonsson"[R], Public and Private Health Services (Basil Blackwell, Oxford),1986.
[21]Livio Di Matteo, Rosanna Di Matteo., "Evidence on the determinants of Canadian provincial government health expenditures:1965-1991"[J], Journal of Health Economics,1998,17,211-228.
[22]McPherson K., "Length of stay and health outcome"[M]. BMJ,1984.
[23]Morgan M., "Variations in length of stay at district level. In:Ham C ed"[R], Health care variations, London, King's Fund Institute,1988, Research Report No2.
[24]Newhouse, J. P., "Medical Care Expenditure:A Cross-national Survey"[J], Human Resouces,1977,12,115-137.
[25]Parkin D., McGuire A., Yule B., "Aggregate health care expenditures and national income:Is health care a luxury good"[J], Health Economics,1987,6, 109-133.
[26]Pauly Mark V., "Doctors and Their Workshops"[M], Chicago:University of Chicago Press,1980.
[27]Preston, Samuel, H., "The Changing Relation between Mortality and Level of Economic Development"[J], Population Studies,1975,29(2):231-248.
[28]Roemer Milton I., "Bed Supply and Hospital Utilization:A National Experiment"[J], Hospitals, J.A.H.A.,1961,35:988-993.
[29]Sen, Amartya, K., "Sri Lanka's Achievements:How and When"[M], in Srinivasan, T. N.&P. K. Bardhan(eds.), Rural Poverty in South Asia, New York: Columbia University Press,1998:549-556.
[30]Stano Miron., "A Further Analysis of the Physician Inducement Controversy"[J], Journal of Health Economics,1987,6:227-238.
[31]Stearns S.C. and Norton E.C., "Time to Include Time to Death? the Future of Health Care Expenditure Predictions"[J], Health Economics,2004,13,315-327.
[32]Zweifel P., Felder S. and Meiers M., "Ageing of the Population and Health Care Expenditure:a Red Herring?"[J], Health Economics,1999,8,485-496.
[33]兰宇曦.个人收入与医疗服务需求及其弹性[J].中华医院管理杂志,1997,13(10)：581-584.
[34]罗家有.“诱导需求干预研究及其对医疗费用的影响”[J].卫生经济研究,2002,7：10-11.
[35]胡琳琳、胡鞍钢.从不公平到更加公平的卫生发展：中国城乡疾病模式差距分析与建议[J].《管理世界》,2003,1.
[36]平新乔.从中国农民医疗保健支出行为看农村医疗保健融资机制的选择[J]管理世界[J].2003,11：52-63.
[37]陆铭,陈钊.城市化、城市倾向的经济政策与城乡收入差距[J].经济研究,2004,6：50-58.
[38]梁维萍,郑建中,韩颖,覃凯,贺鹭.农村居民收入与医疗服务需求及其弹性研究[J].中国农村卫生事业管理,2005,25(10)：15-17.
[39]王绍光.巨人的瘸腿：从城镇医疗不平等谈起[J].读书,2005,11.
[40]赵郁馨,陈瑛,万泉,张毓辉.2004年中国卫生总费用测算结果与卫生筹资分析[J].中国卫生经济,2006,3.
[41]陈洪海,黄丞,陈忠.卫生费用的决定因素：跨省比较研究[J].生产力研究,2006,10：84-85
[42]何平平.我国卫生总费用的弹性测算[J].统计观察,2006,5：87-90
[43]刘丽娜,徐凌中,王兴州,刘冬梅,周成超.我国城乡门诊医疗服务需求弹性研究[J].中国卫生经济,2006,25(7)：34-36.
[44]田国栋,程晓明.卫生总费用与国民经济和职工收人增长规律的比较研究[J].中国卫生经济,2006,9：122-124.
[45]徐伟.从需求弹性实证的角度谈我国医疗卫生改革[J].中国卫生经济,2006,25(11)：19-22.
[46]王凡,温小霓.“我国医疗供方诱导需求理论与实证”[J].中国卫生事业管理,2007,223(1)：12-14.
[47]尹希果,付翔,陈刚.城镇居民收入差距对医疗保健消费影响研究[J].中国卫生统计,2007,2.
[48]林相森、舒元.我国居民支出影响因素的实证分析[J].南方经济,2007,6：22-30.
[49]干春晖,周习,郑若谷.“不完美信息、供给者诱导需求与医疗服务质量”[J].财经研究,2007,33(8)：97-107.
[50]顾卫兵,张东刚.城乡居民收入与医疗保健支出关系的实证分析,消费经济,[J].2008,1：43-46.
[51]李放等.强化政府责任增进医疗卫生公平[J].中共南京市委党校学报.2008,2.
[52]吴华超、温涛.新时期我国农村居民收入与消费关系的新趋势——基于启动农村消费市场的现实背景[J].南方农村,2008,2.
[53]王一峰.论医疗费用控制中的弹性制度与激励制度[J].中国卫生经济,2008,27(3)：12-15.
[54]叶春辉,封进,王晓润.收入、受教育水平和医疗消费：基于农户微观数据的分析[J].中国农村经济,2008,8：16-24.