中國地區醫療支出與所得差距之計量研究

Abstract

Doorslaer等人在1977年的一篇關於OECD自評健康狀況與收入不均現象的研究中發現，自評健康狀況並非與人均醫療支出、公共支出或人均收入有關，而是與收入不均有正的關係且關係顯著。近年Deaton (2003) 在一篇對健康、不均以及經濟發展文獻回顧的論文中提出，健康不佳與收入不均本身並無直接關係，由資料所顯示的這類的關係，很可能是由收入不均以外的因素造成的。值得留意的是，Deaton 所做的文獻回顧大多數集中在已開發國家的研究成果。由於醫療健康不均的社會經濟問題，在開發中國家也同具重要性，因此研究開發中國家醫療保健不均與收入不均之關係，是極為有趣的課題。 中國自1978年推行經濟改革和開放政策以來，在醫療部門也做了相當大的改革，例如讓私人醫療支出替代公共支出等。經濟改革進行三十年了，到底改革對醫療部門的影響如何，是許多人想探討的問題。中國的改革經驗，對其他依賴市場機制來訂定醫療改革政策的開發中國家來說，其參考價值為何呢? 中國的醫療改革，一直是個國際關注的課題。本研究擬利用中國區域性的醫療與收入的數據，探討Deaton (2003) 提出的醫療不均與收入不均之關係的問題。本研究擬利用結合橫截面與時間序列的面板資料做分析。因為文獻上做中國方面的分析多採橫截面資料，而採用面板資料分析的研究尚不多見。這也構成提出本研究計畫的另外一個原因。

In a comparative study of nine OECD countries on income-related inequalities in self-assessed health, van Doorslaer et al. (1997) found that inequality in self-assessed health was not significantly associated with per capita health care expenditure, the percentage spent publicly, or per capita gross domestic product, but was positively and significantly associated with income inequality. More recently, Deaton (2003) did a comprehensive literature review in health, inequality and economic development, and concluded that there is no direct link to ill health from income inequality per se; the raw correlations that exist in (some of the) data are most likely the result of factors other than income inequality. It is noteworthy that Deaton’s literature review has largely focused on the research for industrial countries. As the socioeconomic inequalities in health are equally important in less developed countries, it is therefore of great interest to investigate the relationship between health inequality and income inequality for less developed countries. China has implemented its open door policy since 1978. Reform policies were not only applied to agricultural, commercial, and industrial sectors, but also to the health care system. With the centrally planned health care system reformed into a market-based one, public financing was replaced by private financing. Having experienced three decades of health care reforms, China provides an excellent case in studying how it has been doing in terms of health services delivery and access. China’s experience may have important implications for countries which plan to undergo market-based health care reforms. This project focuses on the health and income inequality issue in China after its reform. Another reason for working on China is the research on the relationship between China’s health inequality and income inequality is relatively scarce in the literature. This project is probably the first attempt to address the problem of regional inequalities in health and income in a panel setting by combining cross-section with time series data in China.