The Inequality and Evolution of Health Expenditure for Rural Residents in China

在CHnS数据的基础上,本文利用夏普里值分解方法实证分析中国农村居民医疗消费支出不平等问题,估算了各因素对医疗支出不平等及其变动的贡献率,并进一步探讨了不平等演变的内在机制。为了修正样本选择偏误和大量零医疗支出的影响,文章分别对医疗消费总支出和净支出建立了HECkMAn选择模型和两部模型。结果表明,1991—2006年农村居民医疗消费支出的基尼系数保持在0.8以上的较高水平,其中健康、医院类型、收入、到达最近医疗机构的距离、地区等因素是造成医疗消费支出不平等及其演变的主要原因。Based on the CHNS data,the research analyzes the inequality of health expenditure for rural residents in China by using Shapley Value Decomposition,estimates the contribution of various factors on the inequality and its change,and further explores the internal mechanism of the inequality evolution.To correct the sample selection bias and the impact of a large number of zero expenses,it uses the Heckman sample-selection model to estimate total health expenditure and two-part model to estimate net expenditure respectively.The result shows that the gini coefficient of health expenditure in Chinese rural residents is over 0.8 from 1991 to 2006,which is a high level.And the main reasons for the inequality and its evolution are the factors of health,hospital level,income,the distance to the nearest health care provider and the region.国家自然科学基金项目“统筹城乡医疗保障制度对城乡居民健康及医疗利用的影响研究——基于自然实验框架下的分析”(71373120)和“城市化进程中城乡医疗保障的统筹模式研究:效应评估与最优模式选择”(71073077)的资