结构变动视角下山东省医改前后卫生总费用筹资构成分析

摘要

Objective:To compare and analyze the structural change of total health expenditure(THE) in Shandong before and after the medical reform so as to manage the changes and trend of THE for the government,provide evidence for reasonably making decision on leading the growth and development of THE.Methods:Methods including structural variability,structural variable value,structural variable contribution rate and driving force were used to analyze the composition changing of THE financing in Shandong before and after the medical reform.Results:The composition of out of pocket(OOP) was better after the medical reform.Social health expenditure acted as key factor for THE structural change.The gap of contribution rate between urban and rural residents' OOP existed.After the medical reform,the social insurance acted as key factor for composition of THE.Conclusion:After the medical reform,THE composition of Shandong tended to be more reasonable,which achieved certain effectiveness.However,the equity of urban and rural residents' OOP should be further optimized.%目的:对山东省医改前后卫生总费用构成变化进行对比分析,为政府部门掌握卫生总费用结构变化与趋势,合理引导卫生总费用增长与发展决策提供依据.方法:利用结构变动度、结构变动值、结构变动贡献率以及拉动力等方法分析医改前后山东省卫生总费用筹资构成变动.结果:山东省卫生总费用中个人卫生支出比例不断下降;社会卫生支出是影响卫生总费用结构主要方面;城乡居民个人现金卫生支出贡献率有差异;医改后社会医疗保障支出对于卫生总费用增长拉动力最大.结论:医改以来山东省卫生总费用构成趋于合理,取得一定成效,但还需在城乡个人现金卫生支出公平性方面进一步优化.