居民收入与医疗服务及其弹性研究
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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,医疗支出增长迅速。城乡二元化和城市化、政府医疗政策和医疗资源供给、老龄化是居民医疗支出的重要应影响因素。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。采用了考虑收入及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省级行政单位按照人均收入高低分为高中低三个区域,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、床位利用率、人均医生数等控制变量,得出更加准确的医疗支出的收入弹性。
研究结果表明,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；高收入地区城市的医疗支出弹性高于低收入地区；而农村医疗支出的收入弹性的地区差异并不明显。考虑城市化指标后,城镇居民医疗支出的收入弹性显著降低。并且城市化指标与城市居民的医疗支出均显著正相关。高收入地区人均医生数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、床位利用率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。
最后,本文在进行相应的分析后提出如下建议：加大社会保障力度,对农村和低收入人群倾斜；医疗体系市场化的同时应加大对医疗服务机构的监管；切实保障城市化进程中外来人员的医疗利益；提高农村医疗的边际效率,切实减轻农民的医疗负担。
With reform, opening-up and economic development, the living standards improved to a large extent and medical costs increase rapidly. The urban-rural dual economic structure, urbanization, transition of medical policies from government, and the aging people are influencing factors for medical expenditure.the paper is based on Grossman's heath capital model of demand for health, employing panel data from 31 China provinces between 2003 and 2008 to analysis medical expenditure and its influencing factors with a model employing the empirical method of considering income and other factors. Based employs the empirical method of measuring income elasticity while considering other factors. Based upon reality, the thesis calculate the elasticity of medical expenditure more accurately, dividing provinces into three groups as high, middle and low income group, adding controlling variables such as urbanization and bed utilization rate.
Results show that there is difference of income elasticity of medical expenditure between cities and rural areas. The elasticity in rural areas is greater than that in cities the elasticity of cities in high income group is greater than low income group; the income elasticity of rural areas shows no significant difference between groups. After considering urbanization, the income elasticity has dropped dramatically and shows a positive relation. The number of doctors correlates the medical expenditure in cities positively, but shows no significant relation in rural areas. Aging index shows no significant relation in cities, but correlates positively in rural areas.
Finally, this thesis suggests:improve social security system, put more emphasis on low income group; strengthen supervision upon medical facilities; protect medical benefit of workers from rural areas in the process of urbanization;improve marginal efficiency of rural medical care, alleviate the medical care burden of rural residents.
研究结果表明,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；高收入地区城市的医疗支出弹性高于低收入地区；而农村医疗支出的收入弹性的地区差异并不明显。考虑城市化指标后,城镇居民医疗支出的收入弹性显著降低。并且城市化指标与城市居民的医疗支出均显著正相关。高收入地区人均医生数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、床位利用率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。
最后,本文在进行相应的分析后提出如下建议：加大社会保障力度,对农村和低收入人群倾斜；医疗体系市场化的同时应加大对医疗服务机构的监管；切实保障城市化进程中外来人员的医疗利益；提高农村医疗的边际效率,切实减轻农民的医疗负担。
With reform, opening-up and economic development, the living standards improved to a large extent and medical costs increase rapidly. The urban-rural dual economic structure, urbanization, transition of medical policies from government, and the aging people are influencing factors for medical expenditure.the paper is based on Grossman's heath capital model of demand for health, employing panel data from 31 China provinces between 2003 and 2008 to analysis medical expenditure and its influencing factors with a model employing the empirical method of considering income and other factors. Based employs the empirical method of measuring income elasticity while considering other factors. Based upon reality, the thesis calculate the elasticity of medical expenditure more accurately, dividing provinces into three groups as high, middle and low income group, adding controlling variables such as urbanization and bed utilization rate.
Results show that there is difference of income elasticity of medical expenditure between cities and rural areas. The elasticity in rural areas is greater than that in cities the elasticity of cities in high income group is greater than low income group; the income elasticity of rural areas shows no significant difference between groups. After considering urbanization, the income elasticity has dropped dramatically and shows a positive relation. The number of doctors correlates the medical expenditure in cities positively, but shows no significant relation in rural areas. Aging index shows no significant relation in cities, but correlates positively in rural areas.
Finally, this thesis suggests:improve social security system, put more emphasis on low income group; strengthen supervision upon medical facilities; protect medical benefit of workers from rural areas in the process of urbanization;improve marginal efficiency of rural medical care, alleviate the medical care burden of rural residents.
引文
[1]曹燕.医疗保健支出对我国农村居民家庭经济状况影响的调查.中国卫生统计[J]2008,6.
[2]陈信勇、王运福.建立农村医疗保障体系的路径选择—一个需求演化的视角.浙江社会科学[J].2004,1.
[3]陈迎春.农村贫困地区政府卫生支出及对卫生机构补偿的变化趋势分析.卫生软科学[J]1999,1.
[4]封进.中国农村医疗消费行为变化及其政策含义.世界经济文汇[J]2006,1.
[5]顾卫兵.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]2008,2.
[6]顾昕,方黎明.自愿性与强制性之间—中国农村合作医疗的制度嵌入性与可持续发展分析.社会科学研究[J]2004,5.
[7]国家统计局四川调查总队.四川城镇中低收入家庭医疗问题研究.西南金融[J]2008,10.
[8]何平平.经济增长、人口老龄化与医疗费用增长.财经理论与实践[J]2006,3.
[9]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.管理世界[J]2003,1.
[10]李斌.黑龙江省卫生筹资累进性研究.中国卫生经济[J]2006,1.
[11]李放等.强化政府责任增进医疗卫生公平.中共南京市委党校学报[J]2008,2.
[12]梁维萍.农村收入与医疗服务需求及其弹性研究.中国农村卫生事业管理[J]2005,10.
[13]林闽钢.中国农村合作医疗制度的公共政策分析.江海学刊[J]2002,3.
[14]欧阳志刚.农民医疗卫生支出影响因素的综列协整分析.世界经济[J]2007,9.
[15]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.管理世界[J]2003,11.
[16]唐圣春等.东中西部地区农村卫生发展比较(三)—卫生筹资比较及农村卫生发展对策.中国卫生经济[J]2006,4.
[17]魏众,B·古斯塔夫森.中国居民医疗支出不公平性分析.经济研究[J]2005,2.
[18]尹希果.城镇居民收入差距对医疗保健消费影响研究.中国卫生统计[J]2007,4.
[19]谢启瑞,林建甫,游慧光.台湾医疗保健支出成长原因之探讨.人文及社会科学季刊[J]1998,3.
[20]应晓华.不同收入人群家庭筹资公平性研究.中华医院管理杂志[J]2004,8.
[21]赵郁馨等.中国卫生总费用发展变化趋势及影响因素.卫生经济研究[J]2000,1.
[22]郑岩.新型农村合作医疗的公平与效率问题.经济研究导刊[J]2007,12.
[23]周绿林.我国医疗费用趋势预测研究.中国卫生经济[J]2008,5.
[24]朱玲.乡村医疗保险和医疗救助.金融研究[J]2000,5.
[25]Adam Wagstaff. Equity in The Finance of Health Care:Some Further International Comparisons. Journal of Health Economics [J] 1999,18:263-290.
[26]Alex. Y. CHENJOS,E J. ESCARCE. Health Status Adjustment and Income-Related Inequality in Health Care Delivery.Health Services & Outcomes Research Methodology[J]2004,5:75-85.
[27]Evans R G. Supplier-Induced Demand:Some Empirical Evidence and Implications in Perlman. the Economics of Health and Medical Care[J] 1974,8:162-173.
[28]Folland S, Goodman A C, Stano M. The Economics of Health and Health care.New York. Macmillan Publishing Company [M] 2001.
[29]FUCHES V R. Forecasting Health Expenditures:Short,Medium and Lon (Long)Term. Journal of Healthcare Finance[J]1998,26(3):56-72.
[30]GERDTHAM U G, JONSSON B.An Econometric Analysis of Health Care Expenditure, A Cross Section Study of OECD Countries.Journal of Health Economics[J]1992,11(1):63-68.
[31]Grossman, M. On the Concept of Health Capital and the Demand for Health. The Journal of Political Economy[J].1972,8(2):223-255.
[32]Gerdtham U G, Jonsson B. An Econometric Analysis of Health Care Expenditure, A Cross Section Study of OECD Countries.Journal of Health Economics[J]1992,11(1):63-68.
[33]GETEN T E. Population Aging and the Growth of Health Expenditures. Journal of Gerontology[J]1992,47:98-104.
[34]HITIRIS T,POSNET J.The Determinants and the Effects of Health Expenditure in Developed Countries.Journal of Health Economics[J] 1992,11(2):173-181.
[35]John Bryant,Audrey Sonerson.Population Aging and Government Health Expenditure. http://www. treasury.govt.nz/publications/research-poicy/ppp/2005/05/-1/tpp05-01.pdf[R],2005.
[36]Kei Kawabata, Felicia Knaul.Workshop on Evidence for health policy: burden of disease,cost effectiveness,and health system. Fairness in financial contribution-concepts,WHO Fair Financing Methodology Draft 17/07/2001 WHOM 2000,session 3.14:4-7.
[37]Leu Robert.The Public-private Mix and International Health Care Costs.Journal of Health Economics[J],1986,8(1):167-191.
[38]Maria Alicia Dominguez Uga,Isabela Soares Santos.An Analysis Of Equity In Brazilian Health System Financing.Health Affairs 26[J]2007,4: 1017-1028.
[39]Murthy N R V, U Kpolo V. Aggregate Health Care Expenditure in the United States:Evidence from Cointegration Test.Applied Economics[J] 1992,26(8):797-802.
[40]Newhouse J P. Medical Care Expenditure:A Cross National Survey. Journal of Human Resources[J]1977,12(1):115-125.
[41]Paul Y, Mark V, Satterhwatte Mark A. The Pricing of Primary Care Physicians Services:A Test of The Role Consumer Information.Bell Journal of Economics[J]1981,12:488-346.
[42]Zweifel P S, Fleder, Meiers M. Aging of Population and Health Care Expenditure:A Red Herring?Health Economics[J]1999,8:485-496.
[2]陈信勇、王运福.建立农村医疗保障体系的路径选择—一个需求演化的视角.浙江社会科学[J].2004,1.
[3]陈迎春.农村贫困地区政府卫生支出及对卫生机构补偿的变化趋势分析.卫生软科学[J]1999,1.
[4]封进.中国农村医疗消费行为变化及其政策含义.世界经济文汇[J]2006,1.
[5]顾卫兵.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]2008,2.
[6]顾昕,方黎明.自愿性与强制性之间—中国农村合作医疗的制度嵌入性与可持续发展分析.社会科学研究[J]2004,5.
[7]国家统计局四川调查总队.四川城镇中低收入家庭医疗问题研究.西南金融[J]2008,10.
[8]何平平.经济增长、人口老龄化与医疗费用增长.财经理论与实践[J]2006,3.
[9]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.管理世界[J]2003,1.
[10]李斌.黑龙江省卫生筹资累进性研究.中国卫生经济[J]2006,1.
[11]李放等.强化政府责任增进医疗卫生公平.中共南京市委党校学报[J]2008,2.
[12]梁维萍.农村收入与医疗服务需求及其弹性研究.中国农村卫生事业管理[J]2005,10.
[13]林闽钢.中国农村合作医疗制度的公共政策分析.江海学刊[J]2002,3.
[14]欧阳志刚.农民医疗卫生支出影响因素的综列协整分析.世界经济[J]2007,9.
[15]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.管理世界[J]2003,11.
[16]唐圣春等.东中西部地区农村卫生发展比较(三)—卫生筹资比较及农村卫生发展对策.中国卫生经济[J]2006,4.
[17]魏众,B·古斯塔夫森.中国居民医疗支出不公平性分析.经济研究[J]2005,2.
[18]尹希果.城镇居民收入差距对医疗保健消费影响研究.中国卫生统计[J]2007,4.
[19]谢启瑞,林建甫,游慧光.台湾医疗保健支出成长原因之探讨.人文及社会科学季刊[J]1998,3.
[20]应晓华.不同收入人群家庭筹资公平性研究.中华医院管理杂志[J]2004,8.
[21]赵郁馨等.中国卫生总费用发展变化趋势及影响因素.卫生经济研究[J]2000,1.
[22]郑岩.新型农村合作医疗的公平与效率问题.经济研究导刊[J]2007,12.
[23]周绿林.我国医疗费用趋势预测研究.中国卫生经济[J]2008,5.
[24]朱玲.乡村医疗保险和医疗救助.金融研究[J]2000,5.
[25]Adam Wagstaff. Equity in The Finance of Health Care:Some Further International Comparisons. Journal of Health Economics [J] 1999,18:263-290.
[26]Alex. Y. CHENJOS,E J. ESCARCE. Health Status Adjustment and Income-Related Inequality in Health Care Delivery.Health Services & Outcomes Research Methodology[J]2004,5:75-85.
[27]Evans R G. Supplier-Induced Demand:Some Empirical Evidence and Implications in Perlman. the Economics of Health and Medical Care[J] 1974,8:162-173.
[28]Folland S, Goodman A C, Stano M. The Economics of Health and Health care.New York. Macmillan Publishing Company [M] 2001.
[29]FUCHES V R. Forecasting Health Expenditures:Short,Medium and Lon (Long)Term. Journal of Healthcare Finance[J]1998,26(3):56-72.
[30]GERDTHAM U G, JONSSON B.An Econometric Analysis of Health Care Expenditure, A Cross Section Study of OECD Countries.Journal of Health Economics[J]1992,11(1):63-68.
[31]Grossman, M. On the Concept of Health Capital and the Demand for Health. The Journal of Political Economy[J].1972,8(2):223-255.
[32]Gerdtham U G, Jonsson B. An Econometric Analysis of Health Care Expenditure, A Cross Section Study of OECD Countries.Journal of Health Economics[J]1992,11(1):63-68.
[33]GETEN T E. Population Aging and the Growth of Health Expenditures. Journal of Gerontology[J]1992,47:98-104.
[34]HITIRIS T,POSNET J.The Determinants and the Effects of Health Expenditure in Developed Countries.Journal of Health Economics[J] 1992,11(2):173-181.
[35]John Bryant,Audrey Sonerson.Population Aging and Government Health Expenditure. http://www. treasury.govt.nz/publications/research-poicy/ppp/2005/05/-1/tpp05-01.pdf[R],2005.
[36]Kei Kawabata, Felicia Knaul.Workshop on Evidence for health policy: burden of disease,cost effectiveness,and health system. Fairness in financial contribution-concepts,WHO Fair Financing Methodology Draft 17/07/2001 WHOM 2000,session 3.14:4-7.
[37]Leu Robert.The Public-private Mix and International Health Care Costs.Journal of Health Economics[J],1986,8(1):167-191.
[38]Maria Alicia Dominguez Uga,Isabela Soares Santos.An Analysis Of Equity In Brazilian Health System Financing.Health Affairs 26[J]2007,4: 1017-1028.
[39]Murthy N R V, U Kpolo V. Aggregate Health Care Expenditure in the United States:Evidence from Cointegration Test.Applied Economics[J] 1992,26(8):797-802.
[40]Newhouse J P. Medical Care Expenditure:A Cross National Survey. Journal of Human Resources[J]1977,12(1):115-125.
[41]Paul Y, Mark V, Satterhwatte Mark A. The Pricing of Primary Care Physicians Services:A Test of The Role Consumer Information.Bell Journal of Economics[J]1981,12:488-346.
[42]Zweifel P S, Fleder, Meiers M. Aging of Population and Health Care Expenditure:A Red Herring?Health Economics[J]1999,8:485-496.