健康不平等：走向可持续、和谐增长的羁绊
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摘要
健康是人类生存与发展的基础，是评价一个国家经济发展与社会进步的重要标志。健康的平等性问题始终是影响和制约社会经济可持续发展的关键性问题。健康平等性研究有利于推动“人口红利”收获，有利于小康社会目标的实现。如何利用国际、国内对健康问题研究成果，结合我国国情构建健康不平等研究的理论框架体系、明确研究方法及参数、提供政策依据，这无疑对我国社会经济全面、协调和可持续发展具有重大的理论和现实意义。
本研究包括以下几个方面的内容：一是导论，主要是研究背景、文献回顾、研究思路、框架结构及研究方法等；二是健康与社会经济指标的关系，包括健康的概念内涵及度量指标，健康与经济增长的关系及健康影响社会经济繁荣的主要机理，健康的生产函数及主要影响因素等。三是健康不平等及其经济效应，主要包括健康不平等的概念界定、度量指标及测度方法选择，健康不平等的社会经济效应等。四是健康不平等的测度方法，包括健康状况不平等的测度方法及医疗卫生制度公平性的测度方法。五是经济增长背后的中国居民健康分布，比较分析转型期我国居民健康状况的区域、城乡和人群差异，以及城乡居民收入差距与健康差异的关系。六是医疗保障可及性不平等：从中国医疗卫生制度改革视角分析，回顾并评价我国城镇、农村社会医疗保障制度的变迁及其可及性的平等性，卫生体制改革及其效应，分析医疗保障可及性不平等的原因。七是中国卫生资源配置的公平性分析，主要分析评价我国卫生资源配置公平性。八是中国卫生筹资公平性实证分析，分析评价我国宏观卫生供给公平性，并分别对我国现行城镇职工基本医疗保险和新型农村合作医疗的筹资公平性和受益公平性进行实证分析。九是结论。
通过分析得出以下几点结论，其中包含着笔者的创新之处：其一，从狭义看，健康不平等是指不同社会经济特征的人群之间健康水平的分布差异，即健康状况不平等；从广义看，健康不平等既包括健康状况差异，又包括获得良好健康状态的机会、条件差异，即医疗卫生保健的可及性不平等。无论是个体还是人群，在生病或健康不良时，医疗卫生保健服务是唯一应对措施。因此，获得医疗卫生服务是人群健康维护的必要条件。其二，大部分健康不平等是不公平的，是可以避免的。一个社会不可能完全实现人口健康平等的目标，平等只是一种相对的状况。追求健康平等的真实目的是缩小不可接受的和不公正的人群健康分布，即消除健康不公平，从而接近相对平等的状况。相关的社会经济政策可以降低健康不平等。其三，我国农村居民的健康水平低于城镇居民；东中西部地区的居民健康状况依次递减，东部较好，中部居中，西部较差；在城市和农
Health is the foundation of the human beings and development. Health is one of the most important indices for assessing a nation's economic development and social advancement. Equality in health is an intrinsically critical problem affecting and restricting socioeconomic sustainable development. Research on equality in health is significant in both promoting to gain benefits from "Population Extra Dividend" and realization of the social objective of a Well-off Society in All-rounded Way. How to use the international and national research findings in health to establish the theoretical framework based on the Chinese situations, to identify the research methodology and parameters, and provide policy options. Undoubtedly, it has great importance in underpinning the Chinese overall, balanced and sustainable socioeconomic development.
This dissertation consists of such contents as follows: Part One is introduction, including research backgrounds, literature review, train of thoughts, research framework and methodology. Part Two is titled Health and Socioeconomic Indices, discussing the conception and indices of health, the connection between health and economic growth, the mechanism of how health affect socioeconomic prosperity, the production of health function and the key factors. Part Three focuses on inequality in health and its socioeconomic effects, discussing the definition of health inequalities, measurement indices and methods, and its socioeconomic effects. Part Four is the methods of health inequality measurement, including health status measurement and equity of health care system measurement. Part Five is titled Health Distribution of Chinese People During the Period of Health Economic Growth, comparing the health status differentials among people across economic localities, between urban and rural areas, and among different economic groups. Also, it analyzes the correlation between income differentials and health differentials. Part Six focuses on unequal access to health insurance by reviewing and assessing the urban health insurance system reforms and rural CMS reforms, as well as the health service system reforming during the transitional period in China. The relevant causes are discussed. Part Seven is concerned with equity in health resource allocation in China. Part Eight is empirical study of equity in health financing system in China. It analyzes the equity in macro
本研究包括以下几个方面的内容：一是导论，主要是研究背景、文献回顾、研究思路、框架结构及研究方法等；二是健康与社会经济指标的关系，包括健康的概念内涵及度量指标，健康与经济增长的关系及健康影响社会经济繁荣的主要机理，健康的生产函数及主要影响因素等。三是健康不平等及其经济效应，主要包括健康不平等的概念界定、度量指标及测度方法选择，健康不平等的社会经济效应等。四是健康不平等的测度方法，包括健康状况不平等的测度方法及医疗卫生制度公平性的测度方法。五是经济增长背后的中国居民健康分布，比较分析转型期我国居民健康状况的区域、城乡和人群差异，以及城乡居民收入差距与健康差异的关系。六是医疗保障可及性不平等：从中国医疗卫生制度改革视角分析，回顾并评价我国城镇、农村社会医疗保障制度的变迁及其可及性的平等性，卫生体制改革及其效应，分析医疗保障可及性不平等的原因。七是中国卫生资源配置的公平性分析，主要分析评价我国卫生资源配置公平性。八是中国卫生筹资公平性实证分析，分析评价我国宏观卫生供给公平性，并分别对我国现行城镇职工基本医疗保险和新型农村合作医疗的筹资公平性和受益公平性进行实证分析。九是结论。
通过分析得出以下几点结论，其中包含着笔者的创新之处：其一，从狭义看，健康不平等是指不同社会经济特征的人群之间健康水平的分布差异，即健康状况不平等；从广义看，健康不平等既包括健康状况差异，又包括获得良好健康状态的机会、条件差异，即医疗卫生保健的可及性不平等。无论是个体还是人群，在生病或健康不良时，医疗卫生保健服务是唯一应对措施。因此，获得医疗卫生服务是人群健康维护的必要条件。其二，大部分健康不平等是不公平的，是可以避免的。一个社会不可能完全实现人口健康平等的目标，平等只是一种相对的状况。追求健康平等的真实目的是缩小不可接受的和不公正的人群健康分布，即消除健康不公平，从而接近相对平等的状况。相关的社会经济政策可以降低健康不平等。其三，我国农村居民的健康水平低于城镇居民；东中西部地区的居民健康状况依次递减，东部较好，中部居中，西部较差；在城市和农
Health is the foundation of the human beings and development. Health is one of the most important indices for assessing a nation's economic development and social advancement. Equality in health is an intrinsically critical problem affecting and restricting socioeconomic sustainable development. Research on equality in health is significant in both promoting to gain benefits from "Population Extra Dividend" and realization of the social objective of a Well-off Society in All-rounded Way. How to use the international and national research findings in health to establish the theoretical framework based on the Chinese situations, to identify the research methodology and parameters, and provide policy options. Undoubtedly, it has great importance in underpinning the Chinese overall, balanced and sustainable socioeconomic development.
This dissertation consists of such contents as follows: Part One is introduction, including research backgrounds, literature review, train of thoughts, research framework and methodology. Part Two is titled Health and Socioeconomic Indices, discussing the conception and indices of health, the connection between health and economic growth, the mechanism of how health affect socioeconomic prosperity, the production of health function and the key factors. Part Three focuses on inequality in health and its socioeconomic effects, discussing the definition of health inequalities, measurement indices and methods, and its socioeconomic effects. Part Four is the methods of health inequality measurement, including health status measurement and equity of health care system measurement. Part Five is titled Health Distribution of Chinese People During the Period of Health Economic Growth, comparing the health status differentials among people across economic localities, between urban and rural areas, and among different economic groups. Also, it analyzes the correlation between income differentials and health differentials. Part Six focuses on unequal access to health insurance by reviewing and assessing the urban health insurance system reforms and rural CMS reforms, as well as the health service system reforming during the transitional period in China. The relevant causes are discussed. Part Seven is concerned with equity in health resource allocation in China. Part Eight is empirical study of equity in health financing system in China. It analyzes the equity in macro
引文
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