老年人社会照料和医疗服务使用的不均等性分析

文章利用集中指数(CI)及其分解方法衡量了中国老年人在社会照料和医疗服务使用中的不均等性,以及各因素对不均等的贡献率。结果表明,相对于医疗服务,老年社会照料使用中存在明显的由非需要类变量引起的亲富人不均等,各因素对二者不均等性的影响方向基本一致,其中收入和城乡分布是不均等的主要根源,社区服务和保险等因素也都表现出了不同的影响和变化趋势。作者建议按照老年人的实际需要分配照料服务资源,并将老年服务纳入城乡和地区均衡发展战略。     

卫生投入对中国健康人力资本及经济增长影响的结构分析

文章通过分析1993～2008年中国30省份卫生结构演变特征显示,卫生投入结构的失衡是当前中国医疗卫生发展中所暴露出的突出问题之一,表现为个人比例过高,而公共比例偏低,而借助省份面板协整模型实证研究结果进一步表明,其不仅短期内直接降低了民众健康福利水平,构成了对区域经济增长的负效应,且地区间的卫生结构差距将显著影响到区域健康人力资本长期发展能力,进而对长期经济增长能力和增长方式转型也构成深远影响。文章认为,新医改内涵要立足于将改善民生健康福利与实施人力资本发展战略相结合,以理顺和完善卫生投入主体结构为切入点,促进整个医疗卫生领域的结构优化和长效发展。     

央地支出责任划分对基本医疗卫生资源配置均等化的影响

1994分税制改革后,中央政府财政收入增加,地方政府支出责任增加,造成各级政府财力和支出责任不对应。基本医疗卫生资源配置均等会直接影响居民医疗服务的利用的均等化间接影响到居民的健康水平。本文利用《中国卫生统计年鉴》和《中国财政年鉴》中数据,使用基尼系数测度基本医疗卫生资源配置的均等化,利用分位数回归分析央地支出责任划分对基本医疗卫生资源配置均等化的影响,得出我国应该通过增加地方政府财政收入和减少地方政府支出责任特别是卫生支出责任的方式提高基本医疗卫生资源配置的均等化水平。     

城乡差异、数字鸿沟与老年健康不平等北大核心CSSCI

城乡老年健康不平等是制约社会均衡发展的重要因素。人口老龄化加剧的发展趋势、城乡二元结构的现实国情和数字化时代背景三重叠加的社会环境下,城乡老年健康不平等问题亟待关注。文章基于2017年中国综合社会调查(CGSS)数据,采用回归分析法检验城乡老年健康不平等的存在性和具体表现,以逐步检验回归系数法和KHB中介效应测度法检验数字鸿沟的中介效应。研究发现城乡老年健康不平等客观存在,表现为城市老年人的身心健康显著优于农村老年人。在身体健康方面,城市老年人健康得分比农村老年人高0.367分,互联网使用中介效应在总效应中的占比为27.75%;在心理健康方面,城市老年人健康得分比农村老年人高0.306分,互联网使用中介效应在总效应中的占比为15.17%。上述结果具有稳健性。互联网功能利用的差异为城乡老年健康不平等形成提供了可能的解释,即城市老年人比农村老年人更多使用互联网健康促进功能,其健康水平得到提升。基于以上结论,社会各界应加快促进数字鸿沟的弥合,避免城乡老年健康不平等进一步加剧。以数字技术的正向功能为支撑、公共政策为必要保障,通过全方位的资源投入与支持帮助老年人融入数字化社会,充分利用数字技术的健康促进功能,使城乡老年健康不平等状况得到缓解。     

创新理念 强化流动人口服务管理

安徽省是人口大省,也是流动人口大省,有1500万人常年流动在外。近年来,全省按照“统筹管理,服务均等,信息共享,区域协作,双向考核”的全国“一盘棋”机制建设要求,对外加强与流出人口集中区域的双向协作,对内强化全省“一盘棋”工作机制,推进城乡均等化服务,突出以人为本、转型发展理念,创新工作方式方法,不断提升流动人口计划生育服务管理水平。     

劳动力市场的产业分割与劳动人口流动

在劳动力市场分割及衍生的社会不平等这一研究领域,理论关注集中在劳动力市场的城乡分割和“国有一非国有”部门分割。文章认为,20世纪90年代以来,在城乡分割和部门分割弱化的同时,向非国有经济开放的产业和由国有单位垄断的产业所构成的非农产业划分已经成为分割劳动力市场的新结构。劳动力市场的产业分割意味着就业机会的不平等。文章利用第五次全国人口普查抽样数据所做Logistic回归分析结果证实了不同劳动人口群体进入收入相对丰厚的国家垄断产业就业的机会差异。     

我国社区居家养老服务均等化研究

当前,国家对建立居家养老服务体系越来越重视,城乡社区居家养老服务得到较快发展。但是,在各地社区居家养老服务的发展过程中,还存在服务不均等、不均衡的现象。利用中国老龄科学研究中心2006年"中国城乡老年人口状况追踪调查"的数据,详细分析目前我国社区居家养老服务的需求、供给与利用状况,着重分析城市与农村,东部、中部与西部在社区居家养老服务的供给、需求与利用之间的差异。认为我国目前的社区居家养老服务存在着明显的不均等现象,需要针对城乡和不同地区社区居家养老服务的实际情况与老年人的需求状况分别制定相应的措施。     

共同富裕视角下的基本公共服务制度优化

扎实推进共同富裕是国家发展的基本任务之一。文章讨论了基本公共服务与共同富裕之间的关系,指出基本公共服务是实现共同富裕的重要基础。但是,中国基本公共服务领域存在“短板”,城乡、区域和群体之间的基本公共服务还有明显的差距,与共同富裕的要求不相适应。文章建议紧扣共同富裕建设目标,注重系统性整体设计,增强基本公共服务制度的规范性、反贫困功能和收入再分配功能,加强统筹协调,优化资源配置,保持适宜水平,稳步推进基本公共服务均等化,实现基本公共服务与经济持续发展的良性互动。现阶段的重点是,完善项目体系,改进制度设计,创新运行机制,建立标准体系,增强基层服务能力。     

卫生医疗资源的可及性与农村儿童的健康问题

文章利用中国健康与营养调查2000年数据,分析目前中国农村卫生医疗资源的可及性及其对农村儿童健康状况的影响。实证结果发现,卫生医疗资源对不同社会经济特征家庭具有不公平的可及性。新时期卫生医疗资源的投入和使用应更着眼于提高农村儿童及其家庭公平享有卫生医疗资源的程度,从而有效地提高贫困及低受教育水平家庭儿童的健康水平,促进农村地区和谐发展。     

城乡差异、就医惯性与老年人卫生服务利用

现有对城乡老年人卫生服务利用不公平的研究多忽略了长期的城乡差异所导致的隐性的农村老年人就医惯性的存在。本研究在控制了收入、医疗保障和就医可及性等因素的条件下,发现就医惯性的存在;并运用集中指数分解法发现,卫生服务的利用存在不公平,偏向于富人,而就医惯性在两种卫生服务利用中的贡献度分别为12%和5%。这种城乡固定差异造成了农村老年人在身体健康、心理健康和自我照料能力上都显著地低于城市老年人。     

The impact of income inequality on self-rated general health: Evidence from a cross-national study

Previous studies report a strong negative association between income inequality and population health at the aggregate level. However, it is still in hot debate whether this ecological association indicates a genuine, causal effect of income inequality on health, as asserted by the Wilkinson hypothesis, or it simply reflects a nonlinear effect of individual income on health, as suggested by the absolute income hypothesis. Drawing data from the 2005 round of the World Values Survey, I analyze the relationship between individual income, income inequality, and self-rated general health in a multilevel framework. Results show no independent detrimental effect of country income inequality on individual self-rated general health. In contrast, self-rated general health is strongly associated with absolute material conditions both at the individual and at the country level. Therefore, this study gives more evidence to the absolute income hypothesis, i.e., the strong ecological association between income inequality and population health is more likely a reflection of the nonlinear effect of individual income on health rather than a genuine effect of income inequality.     

Testing the relationship between income inequality and life expectancy: a simple correction for the aggregation effect when using aggregated data

In this paper, we show a simple correction for the aggregation effect when testing the relationship between income inequality and life expectancy using aggregated data. While there is evidence for a negative correlation between income inequality and a population’s average life expectancy, it is not clear whether this is due to an aggregation effect based on a non-linear relationship between income and life expectancy or to income inequality being a health hazard in itself. The proposed correction method is general and independent of measures of income inequality, functional form assumptions of the health production function, and assumptions on the income distribution. We apply it to data from the Human Development Report and find that the relationship between income inequality and life expectancy can be explained entirely by the aggregation effect. Hence, there is no evidence that income inequality itself is a health hazard.     

中国农村儿童健康不平等及其影响因素研究——基于CHNS数据的经验研究

本文使用“中国家庭营养与健康调查”（CHNS）数据,测度了中国农村儿童健康不平等程度,重点计算了收入、医疗保险、母亲教育水平等因素对健康不平等的贡献。回归基础上的集中系数及其分解结果显示：我国农村地区存在亲富人的健康不平等,高收入家庭儿童的健康状况更好;健康不平等主要的贡献因素是父母亲收入、母亲教育程度、母亲工作状况、父亲身高等：收入对于儿童健康不平等的贡献最大,但不同的收人类型表现出一定的差异。父母亲的工资收入对于儿童健康不平等的贡献为正,收入不平等会扩大健康不平等;医疗保险的不平等程度不断扩大,进一步强化了健康不平等。     

生命周期视角下与收入相关的健康不平等分析——基于组群分析的方法

本文利用中国健康与营养调查数据,从生命周期的视角对与收入相关的健康不平等的年龄特征和变动进行了基于组群分析的实证研究。研究结果表明：与收入相关的健康不平等随着年龄的增长不断扩大：不同年龄段的健康不平等均呈现不断扩大的变动趋势,45岁以上人群的变动幅度要相对大于45岁以下人群;教育、收入和医疗的不平等是与收入相关的健康不平等扩大的主要原因,但是对45岁以下人群健康不平等的影响要大于45岁以上人群;此外,本文还进一步分析了年龄老化对健康不平等变化的影响路径。     

Does regional variation affect ecological mortality research? An examination of mortality, income inequality and health infrastructure in the Mississippi Delta

Mortality research has often focused on individual-level, socioeconomic, and demographic factors indicating health outcomes. Consistent with a recent trend in the public health field, this research examines mortality at the aggregate, contextual level. Based on Wilkinson’s relative income hypothesis, specifically being manifest through an underinvestment in social goods including health infrastructure, the focus of this study is a regional examination in the effects of income inequality on mortality at the county level. Health infrastructure is included as a mediating variable in the relationship between income inequality and mortality, relating back to Wilkinson’s work. Unlike previous research, regional differences in this relationship are examined to identify variation at the county level in health outcomes. The Mississippi Delta is an adequate test bed to examine the relationship between these variables based on its socioeconomic, demographic, and high inequality characteristics. It is hypothesized that Delta-designated counties within the three-state Delta region distinguish a significant positive relationship between income inequality and mortality, that this relationship is stronger than in non-Delta classified counties, and that health infrastructure significantly mediates the relationship between income inequality and mortality.     

The Trend in International Health Inequality

Estimates of average life expectancy for 169 countries are used to compute the trend in between‐country health inequality from 1980 to 2000. Results show that inequality in the distribution of life expectancy across countries declined in the 1980s, but then increased through the 1990s. The recent turnaround in between‐country health inequality is significant because it reverses a long‐term trend of declining inequality across countries that began in the first half of the twentieth century. The primary cause of rising inequality across countries is declining life expectancy in sub‐Saharan Africa, largely owing to HIV/AIDS. Life expectancy in sub‐Saharan Africa holds the key to the future trend in between‐country inequality.     

中国农村收入、收入差距和健康

本文利用2004年和2006年中国9个省份的家庭调查面板数据,研究收入、相对收入和农村居民健康之间的关系。发现健康状况随着个人收入的增加而改善,呈现出明显的非线性关系;收入差距对健康的滞后影响,呈现倒U型关系。此外,当基尼系数在0.387以下时,农村居民健康水平将会随着基尼系数的扩大而改善,当收入差距进一步扩大时,健康水平将受到损害。而数据显示68%的农村居民在倒U右侧,健康正受到扩大的收入差距侵蚀。     

A Cross-National Analysis of Lifespan Inequality, 1950–2015: Examining the Distribution of Mortality Within Countries

Cross-national health research devotes considerable attention to lifespan and survival rate disparities that are found between countries. However, the distribution of mortality across the world is shaped mostly by what happens within countries. We address this striking gap in the literature by modeling length-of-life inequality for individual nation-states. We use life tables from the United Nation’s (2015) World Population Prospects to estimate inequality levels for 200 countries across 13 waves between 1950 and 2015. We find that lifespan inequality is steadily declining across the world, but that each country’s level of inequality, and the rate at which it declines, vary considerably. Our models account for more than 90% of the longitudinal and cross-sectional variation in country-level lifespan inequality during the 1990–2015 period. Maternal mortality is the strongest predictor in our model, while disease prevalence, access to safe water, and health interventions figure prominently, as well. Gross domestic product per capita shows the expected curvilinear association with lifespan inequality, while primary education (both overall enrollment and gender equity in enrollment), external debt, and migration also play critical roles in shaping health outcomes. By contrast, the distribution of political and economic resources (i.e., democracy and income inequality) is less important.

     

Statistical Properties of Generalized Gini Coefficient with Application to Health Inequality Measurement

In this article, we report statistical properties of two classes of generalized Gini coefficients (G1 and G2). The theoretical results were assessed via Monte Carlo simulations. Further, we used G1 and G2 on life expectancy to measure health inequalities among the provinces of China and the states of the United States. For China, the results indicated that there was statistically significant health inequality by both G1 and G2. However, for the US, the results showed that there was significant health inequality by G1 but no statistical significance was found in health inequality by G2. Overall, from our study, China has higher health inequality than the United States.     

Three faces of international inequality

Recent studies of international inequality have focused mostly on the trend in international income inequality. This article extends the analysis of international inequality to also include inequalities in education and health. Analyses of time-series data for more than 100 countries show that international income inequality declined from 1980 to 2003 as several large, poor Asian countries outpaced many Western countries in national income growth. By contrast, international health inequality followed a U-shaped trend, falling in the 1980s before rising in the 1990s. The turnaround in health inequality coincides with a trend of declining life expectancy in sub-Saharan Africa. International educational inequality experienced the sharpest recent decline, spurred by the global expansion of formal schooling. These findings confirm that there is more to international inequality than income inequality alone and suggest that patterns of inequality in the current era of globalization are likely more complex than many leading theories suggest.