中美卫生费用地区公平性的比较研究

摘要

Objective:Taking the United States as a reference,the regional equality of health care expenditure in China was explored so as to seek for further improvement and provide empirical evidence and suggestions for policy makers on health resource allocation. Methods:Both cross-sectional and panel data of per capita health care expenditure and per capita gross domestic product(GDP)in China in 1981-2013 and in the United States in 1981-2009 were analyzed withσ-convergence and β-convergence models and comparisons were made between the two countries. Results:There wasσ-convergence in data of per capita health care expenditure neither in China in 1981-2013 nor in the United States in 1981-2009. Based on the results from cross-sectional and panel data analysis,there was absoluteβ-convergence of per capita health care expenditure in China in 1981-2013 and in the United States in 1981-2009,respectively. Taking initial level of per capita GDP as the covariate,no conditionalβ-convergence was found in China but existed in the United States in this period. It was found that the initial level of per capita GDP had positive impact on annual average growth rate of the per capita health care expenditure but negative interaction with the initial level of per capita health care expenditure. Conclusion:There was no significant converging trend in per capita health care expenditure in China in 1981-2013. The disparity of per capita health care expenditure between different provinces in China still remains to be narrowed. More efforts needs to be made to achieve the coordinated development between provinces in China in terms of resource allocation and policy guidance.%目的：以美国卫生费用地区公平性水平为参照对象，考察中国卫生费用地区公平性的现状、自身特点与改进方向，为中国卫生政策的制定、卫生资源的配置提供实证依据。方法：对中国各省1981—2013年以及美国各州1981—2009年的人均卫生费用和人均国内生产总值（GDP）的横断面数据和面板数据，进行σ和β收敛性分析，并进行两国间的比较。结果：中国1981—2013年以及美国1981—2009年间各省（州）的人均卫生费用均不存在σ收敛。横断面数据和面板数据的收敛性分析结果显示，中国1981—2013年以及美国1981—2009年间各省（州）的人均卫生费用存在绝对β收敛。以各省（州）人均GDP的期初水平为协同变量，美国数据存在条件β收敛，而中国数据不存在条件β收敛。期初人均GDP水平对于中国各省人均卫生费用的年均增长速度具有正向作用，但期初人均GDP与期初人均卫生费用间存在负交互作用。结论：与美国相比，中国1981—2013年各省的人均卫生费用未出现明显的收敛趋势，省份间人均卫生费用的差距仍有待进一步缩小，需在资源配置、政策引导等方面加强改进，以实现地区间卫生费用的协同发展。