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

我们是在一个市场环境中考察财政融资或医疗保险可能会对农民的医疗开支产生什么效应,这些效应又在何种程度上会影响财政平衡?本人绕过了关于农民对医疗服务与药品需求量的度量,证明了在一定条件下,我们可以根据消费者的货币支出量、支出比率、价格与收入,来估算需求的自价格弹性。我们发现,中国财政对卫生的公共支出占全国卫生总支出的比率,已到了世界最低行列！中国占人口80％的农民在非公共卫生支出中只占不到20％！中国西部(11省、区)的农民医疗卫生负担与东、中部农民相比,呈累退趋势:越穷负担越重！中国农村居民对医疗价格与药品价格的弹性为负,卫生支出对收入的弹性为正,因此,引入保险机制与财政补贴会产生医药开支的膨胀,膨胀系数为0.863！中国西部农民对医疗服务价格的需求弹性显著为负,且小于-1;中国东部农民对药品价格的需求弹性显著为负。在补助医还是补助药上,西部与东部应该采用不同的融资方式。计量结果表明,西部农民的看病、买药决策显著取决于收入水平;而在东部地区,这一关系不显著。财政支出在东部已经起到了降低农民医疗负担的功效;而在西部农村,则尚无这方面效果。

The Selection of Financing System of Medical and Health Service in the Rural Areas - a View Based on the Expending Behavior in Medical and Health Work for China's Peasants

It was against a market background that we have investigated what effects fiscal financing or medical insurance may bring about on peasants' medical outlay, and in what degree these effects may impact on fiscal balance. The writer of this article has not measured the amount of peasants' demand for medical service and medicine, but has used other methods to prove that, on some given conditions, we may, based on the amount of monetary expenditure, the proportion thereof, prices and income, estimate the price elasticity of demand. We have found that China' s public expenses from fiscal expenditure account for less than 20% ! The medical and health burden upon the peasants living in West China (11 provinces and regions) , compared with that on peasants in East and center China, is becoming heavier and heavier: the poorer the peasants, the heavier the burden! For China' s peasants, between medical prices and medicines, the elasticity is negative ; and between medical outlay and income , the elasticity is positive. Therefore , the introduction of assurance of mechanism and matching grant will result in cubic expansion of medical expenses, of which the coefficient is 0.863! It is obvious that, to the peasants in West China, the demand elasticity of medical service prices is negative and smaller than - 1; as to peasants in East China, clearly the demand elasticity of medicine prices is negative. In appropriation - in - aid, should the government support the peasants in terms of medical service or medicine? It just depends. West and East China should adopt different forms of financing. The results of measuring indicate that when the peasants in West China see a doctor or buy medicine, the policy decision made by them depends on their income level;but in East China, this relationship is not noticeable. In East China, the related fiscal expenditure has had efficacy in lightening peasants' medical burden; but in West China, it has had no such effect.