新型农村合作医疗制度需方公平性研究
|
摘要
研究背景:
公平是人类社会文明进步的重要标志。保证新型农村合作医疗(以下简称新农合)制度覆盖全体农民和参合农民(即需方)得到公平有效的新农合制度保障是政府在社会建设领域追求的重要目标之一。需方公平性是新农合制度内在固有的本质属性和核心价值追求,其大小决定着这项制度的优劣、效果和可持续发展。自2003年开始试点,新农合制度将在2008年全国实现全面覆盖。这项广泛试点和全面推开的新农合制度,其需方在覆盖面、资金筹集、卫生服务利用、费用补偿和医疗救助等环节,都或多或少地没有把公平性有机地融入这项制度,也导致了这项制度未能更好地发挥应有效用。近年来,卫生决策者和研究者开始注重新农合公平性问题,但迄今为止,尚未见系统的新农合制度需方公平性理论研究;对新农合公平性所作的实证研究,往往是在微观层次上对某一个环节(如卫生服务利用或受益),或某个环节中一个方面(如家庭筹资)的公平性进行评价等,且存在各自的局限性和概念内涵不统一、指标归类不合理等,有待从不同角度、选择适宜方法对需方公平性进行全面、系统的探讨;在需方公平性的宏观或整体评价方面,尚未见对新农合制度或其他社会保障制度等需方公平性评价指标体系(模型)专门的研究报导。基于上述,提出本研究课题。
研究目的:
本研究从理论和实证两个方面、微观和宏观两个层次对需方公平性进行探讨。(1)理论研究。从现行政策和社会经济学等理论领域中涉及公平性的假设、原理和规律,探求需方公平性的思想和理论依据;研究需方公平性的概念、内涵和评价标准;对现行新农合制度需方公平性进行分析。(2)济南市新农合制度需方公平性实证研究。描述样本县和不同收入组需方的基本情况,分析需方在覆盖面、资金筹集、卫生服务利用、费用补偿和医疗救助等环节的公平性,注重患慢性病需方在不同环节公平性的大小,探讨影响公平性的因素。(3)建立一个量化的,具有适用性和可操作性的新农合制度需方公平性模型;结合样本县数据资料,运用该模型从整体上计算各样本县需方公平性得分并排序;检验模型的效度、信度、适用性和可操作性等。(4)提出改善需方公平性的政策建议。
研究方法:
根据不同的研究目的和内容,采取不同的研究方法。(1)理论研究。采用文献复习法,通过比较与分类、分析与综合、归纳与演绎及类比推理等方法,对新农合实践经验进行深入总结、悉心领略和缜密思考,探寻需方公平性的一般理论问题,并分析现行新农合制度需方公平性。(2)济南市新农合制度需方公平性实证研究。利用济南市样本县作为研究现场,采用定性与定量研究相结合、现场调查和文献资料相结合的方法,运用分层抽样调查方法收集样本县基本情况、新农合运行情况、需方的基本信息和卫生服务筹资、需要、利用、费用、补偿及救助等数据资料。对定量资料,根据不同研究内容,采用了率、构成比、相对比、t检验或方差分析、极差法、恩格尔系数(EC)、卫生筹资贡献率(HFC)、卫生筹资公平性指数(FFC)、家庭灾难性卫生支出(CEH)、利用/需要比(Use/needratio)、集中指数(CI)、差异指数(ID)、多元线性回归模型、Logistic回归模型等描述性分析、比较性分析和多因素分析方法。(3)新农合制度需方公平性模型研究。采用改进的Delphi法进行指标筛选,确定指标的权重系数,最终建立需方公平性模型;采用因子分析、克朗巴赫系数、聚类分析和方差分析方法进行模型的结构效度、信度和区分度检验。
主要结果与发现:
1、理论研究。(1)现阶段关于公平的主导思想、社会保障理论、边际效用递减规律、罗尔斯正义理论、帕累托最优和改进等对新农合制度需方公平性理论的建立能够提供借鉴和依据。(2)提出了全面覆盖、量能负担等需方公平性的五项原则,明确了需方公平性若干方面的内涵和评价标准。(3)现行新农合制度尚未从主观上和政策法规层面上明确把需方公平性提到应有的高度,理性认识不足,重视程度不够,需方每个环节都不同程度地存在着公平缺失或偏离公平问题。
2、济南市新农合制度需方公平性实证研究。不同收入组需方在性别、年龄、婚姻状况、文化水平和职业分布等方面存在不同程度的差异。
(1)覆盖面公平性:贫困人口、流动人口参合率均低于当地农民平均参合率;农民参合率随家庭收入增加而升高。尽管3个样本县农民参合率高达94.45%～98.42%之间,但在自愿参合原则下仍然存在覆盖面不公平和逆向选择现象。
(2)筹资公平性:①各级财政资助需方采取均一等额法,其实质是一种累退性资助方式:集体经济组织总体上没有形成扶持新农合的长效机制。②需方个人以均一等额法缴费,必然导致不同地区、不同收入需方家庭之间很强的缴费累退性负担。③不同收入组需方家庭的HFC呈明显递减趋势;对需方家庭HFC影响最大的是慢性病因素,其次是收入因素,性别、年龄、婚姻状况、文化程度和职业因素对需方家庭HFC也有影响;患慢性病需方家庭医疗费用负担明显高于非慢性病需方家庭。
(3)卫生服务利用公平性:①随着收入的增加,不同收入组需方两周就诊率呈明显递增趋势,两周未就诊率和因经济原因未就诊比例呈明显递减趋势;低收入组需方更多地利用基层卫生资源;EC和慢性病是影响需方就诊概率的主要因素,年龄、婚姻状况、收入、家庭人口规模对需方就诊概率有影响,说明收入因素影响门诊卫生服务利用公平性。②低收入组需方住院服务利用较高;随着收入的增加,不同收入组需方应住院而未住院率和因经济原因未住院比例略呈递减趋势;不同收入组需方在不同级别医疗机构住院服务利用结构差别不大。收入因素对住院服务利用公平性影响不大可能与住院弹性较小和低收入组需方住院服务利用释放程度较大有关。③随着收入的增加,不同收入组需方慢性病患者年内治疗率呈递增趋势。④需方慢性病患者的两周就诊率、两周未就诊率、因经济原因未就诊比例分别是非慢性病患者的3.05倍、1.64倍和1.52倍;慢性病患者更多地利用村和乡镇级医疗资源,非慢性病患者更多地利用县级及以上医疗资源。⑤需方慢性病患者既是卫生服务高利用群体,又是卫生服务高未利用群体,医疗费用负担重,容易成为因病致贫和返贫的对象。
(4)需方医疗费用补偿公平性:①3个样本县新农合基金在门诊和住院之间的基金分配比例、“以大病统筹为主”政策的体现和需方受益存在差别。②极差比、构成比、CI和ID计算结果均反映了高收入组需方门诊受益率大于低收入组需方,需方门诊受益面存在不公平性,而住院受益面向低收入组需方倾斜,公平性较好。③百分比、极差比、构成比、CI和ID计算结果均反映了需方在门诊补偿低水平受益程度下,存在新农合资金由低收入家庭向高收入家庭流动的倾向;门诊医疗费用比门诊补偿费用的公平性略高。④极差比、构成比、CI和ID计算结果均反映需方在住院补偿低水平受益程度下,比较明显地存在新农合资金由低收入家庭向高收入家庭流动的倾向;住院医疗费用的公平性略低于住院补偿费用的公平性。需方门诊费用及补偿费用指标与需方住院费用及补偿费用指标相比,后者的公平性更差,尽管后者住院医疗费用经补偿后不公平程度有所改善。⑤需方慢性病患者的医疗费用和补偿费用均有向高收入组集中趋势,且慢性病患者医疗费用的公平性略低于补偿费用的公平性。⑥在CEH与家庭可支付能力比值30%、40%、50%3个临界点上,随着收入的增加,CEH发生率均呈下降趋势;新农合补偿后,CEH发生率在高收入组下降比例较大,而在低收入组下降比例较小。新农合大病补偿水平很低,缓解大病住院费用对家庭致贫的作用还很有限,且存在不公平现象。⑦最低收入组需方的CEH高于其他组,随着收入的增加,发生CEH的可能性降低。收入、年龄、婚姻状况、家庭人口规模和慢性病因素对需方CEH有影响。
在需方公平性的一个环节或方面应用多种方法进行测量,并得到了具有一致性的结果是本研究的一个特点。同时,发现或验证了某些研究方法应用于需方公平性不同环节所具有的优缺点。
(5)3个样本县实施医疗救助均明显滞后于新农合,且存在进度不一,管理不规范,覆盖面低,筹资困难和水平极低等问题,未能承载起底线公平的作用。
3、新农合制度需方公平性模型的建立和应用。(1)指标筛选科学,权重系数确定合理,建立的新农合制度需方公平性模型,具有适用性和可操作性。(2)本研究制定济南市新农合制度需方公平性指标解释、评价方法和评分标准表,利用需方公平性模型,分别求得3个样本县需方公平性加权累加综合得分结果。分析3个样本县需方公平性实现程度,具有良好的信度、效度和区分度,证明新农合制度需方公平性模型能够运用于工作实践,并具有普遍意义和推广应用价值,但尚需在实践中进一步验证,并随着认识的深化而不断完善。
政策建议:
(1)各级政府应高度关注需方公平性,明确把“注重需方公平,提高保障效用”纳入新农合制度应遵循原则,逐步实现从“低水平,广覆盖”向“适宜水平,全面覆盖;量能负担,差别对待;统一补偿方案,满足基本需求”的方向转变。(2)运用确立的需方公平性目标,分阶段、分内容、分层次、分人群地逐步改善需方不同环节和方面的公平性。(3)立法普遍实施,全民强制参合,推进新农合制度覆盖全体农民,全面实现覆盖面公平。(4)完善筹资机制,按照“四步走”战略,采取由粗到细、先定额后定比、先地区后家庭,逐步化小筹资单位的方法,分步骤地改善筹资公平性。(5)注重农村基层医疗卫生机构配套建设,引导和提高需方对农村基层卫生机构的利用水平。(6)按照逆“马太效应”理念,完善需方补偿制度设计,在普遍提高受益面和受益程度的同时,最大限度地缩小不同收入需方的受益差距。(7)积极推进医疗救助制度建设;创造条件,把医疗救助制度有机融入新农合制度保障体系,形成以新农合制度为主导、医疗救助制度为补充的统一管理体制和运行机制。(8)加大对慢性病患者医疗费用分类补偿的范围、项目和比例水平。
Background
Equity is an important indicator to measure the civilization and progress of a society. One of the important goals of a government in the area of social construction is to assure that all its peasants are covered by the New Rural Cooperative Medical System (NCMS) and to insure the peasants of NCMS get a fair and effective medical guarantee. Thus, equity of the insured peasants (i.e. demand sides) is the nature, and the core pursuits of NCMS, and determines the advantages and disadvantages, effectiveness and sustainable development of it. Since began in some pilot areas in 2003, NCMS will cover all the country in 2008.The equity in the coverage, financing, utilization of health services, the cost of compensation and medical aid, etc. of demand sides is not organically integrated in the extensive pilot and comprehensively implemented NCMS more or less, which resulted in weakened effects. In recent years, health policy-makers and researchers have began to focus on the equity of NCMS, but systemic theoretical study of the equity of the insured peasants of NCMS has not been reported so far. As for the microcosmic aspects, the existing empirical researches of the equity of NCMS often only focus on a particular procedure (e.g. utilization or benefits incidence analysis of health services), or a particular aspect of a procedure (e.g. family-financing) and the indexes of equity and their concepts and contents are not unified, etc. Therefore, it is need to undertake a comprehensive and systematic study from different aspects and selecting appropriate indexes. As for macroscopical aspects, the study on the fairness of the evaluation index system (i.e. model) of NCMS or other medical insurance systems has not been reported. Based on the above background, the objectives of the study are proposed.
Objectives
This study explores the equity of demand sides from both theoretical and empirical aspects in line with both microcosmic and macroscopical levels. (1) As regards the theoretical study, it is to seek the ideological and theoretical basis and the concept, content and to define standards of the equity of insured peasants, and to provide analysis on the existing NCMS from theories such as existing policies and social economics related to the assumptions, principle and the law of equity. (2) In accordance with the empirical study of the equity of insured peasants of NCMS in Jinan City. The basic situation of demand sides in three sample counties is described in different income groups. In addition, the equity in the coverage, financing, utilization of health services, the cost of compensation and medical aid, and other factors are analyzed. In particular, the study pays attention to the insured peasants who have chronic diseases. Furthermore, the factors affecting the equity are explored. (3) The study constructs a quantitative, practical and operable model of equity of insured peasants of NCMS, evaluates the equity of three sample counties and tests the validity, reliability, applicability and feasibility of the model. (4) Some policy recommendations are proposed to improve the equity of the insured peasants.
Methods
The different methods are used in accordance with the objectives and contents of the different studies. (1) Theoretical study. Literature review, comparison and classification, analysis and synthesis, analog summarized and deductive reasoning methods are adopted to summarize and think on the practical experience of NCMS in-depth, to explore the general theoretical basis of NCMS, and to evaluate the equity of the existing NCMS. (2) Empirical study of the equity of insured peasants of NCMS in Jinan City. Three counties in Jinan City were selected as the study sites. The stratified sample method was used to collect the data of sample counties, the operation conditions of NCMS and the basic information of 3240 families (12,011 persons) and their conditions in health services funding, the needs, utilization, cost, compensation and medical aid and so on. The method includes both qualitative and quantitative study, field investigation and literature review. The quantitative method includes the analysis of rate, ratio, relative ratio, t-test, analysis of variance, range, Engel's Coefficient (EC), Health Financing Contribution (HFC), Fairness of Financing Contribution (FFC), Catastrophic Expenditure Household (CEH), use/need ratios, Concentration Index (CI), the Index of Dissimilarity (ID), Logistic regression models, and other descriptive analysis, comparative analysis and multivariate analysis methods. (3) Model study of the equity of insured peasants of NCMS. Improved Delphi method was adopted for the screening of indicators, and their weighting coefficients, and a model of the equity of insured peasants of NCMS was established ultimately; Methods of Factor Analysis, CronbachαFactor Analysis and Cluster Analysis of variance were used to test the structure validity, reliability and the distinction of the model.
Main Results and Findings
1. Theory Study. (1)The main thought on equity at present, theory on social insurance, law of diminishing marginal utility, A Theory of Justice by John Rawls, Pareto optimality and Pareto improvement can be used for reference to establish the equity theory of insured peasants. (2)The study summarized the "Five Cardinal Principles" to the equity of insured peasants, including comprehensive coverage to all peasants, paying for NCMS premium according to one's family economic burden, and so on. It states the content and evaluation criteria to a fair number of links and aspects to the equity of insured peasants. (3)The equity of insured peasants has not been improved to the height of it's own subjectively, both in policy and on law level. We should pay attention to a correct understanding, rational knowledge. All the insured peasants have more or less deletion from the fair question of equity.
2. Demonstration study on the equity of insured peasants of Jinan City. The insured peasants of different income groups have different levels of difference by gender, age, marital status, educational level and occupational distribution.
(1) Equity of Coverage: Participation rates of the poverty population and the floating population are lower than those of the local peasants on an average. Participation rates of the peasants increased as the household income increases. Healthy groups and unhealthy groups, rich groups and poor groups have not been reflected the function of risk pooling fully. Coverage unfairness and adverse selection phenomena need to be improved.
(2) Financing fairness:①Adopting uniform payment amount to every insured peasant, financial support of governments at all levels is a regressive subsidy to the essence. Collective economic organizations have not formed a long-term support mechanism to NCMS on the whole.②Adopting uniform payment amount, individual of the insured peasant will inevitably lead to a highly regressive subsidy and burden to the essence to different regions and different family.③The families' HFC of different income groups showed decreasing trend on the insured peasants. The greatest impact factor affecting family HFC was chronic disease, followed by income. Gender, age, marital status, education and vocational factors on the demand side also affected family HFC. Medical burden to families suffering from chronic diseases was significantly higher than that of non-chronic-disease family.
(3)Equity of the utilization of health services:①The two-week attendance rate was increased significantly with the increased income increase among the different insured peasants. The two-week non-attendance rate and that for economic reasons were decreased significantly with the income increase among the different insured peasants. Low-income insured peasants utilized more primary health resources. Factors as such EC and chronic diseases mainly affected the attendance probability at the demand sides. Age, marital status, income, and family size of the population impacted the attendance probability of the demand sides. Income factors affected the equity of the out-patient health service utilization.②Utilization ratios of the inpatient health service of low-income insured peasants were higher than those of the others. Non-hospitalization rate which is due to economic reasons were decreased with the income increase among different insured peasants. Different income groups of the insured were different slightly from different levels of medical hospitals. Income factors which have little impact on the equity of the inpatient health service utilization were likely due to tow reasons. In other words, one was smaller flexibility of hospitalization, the other was relating to the larger release of the low-income groups.③With the increase in income, chronic patients in different insured peasants showed a progressive trend.④The ratio of hospitalizing within two-weeks, not hospitalizing within two-weeks, and not hospitalizing for economic reasons of insured peasants with chronic diseases is 3.05 times, 1.64 times and 1.52 times of those of insured peasants without chronic diseases respectively. Patients with chronic diseases are inclined to use village-level and town-level health care resources, while patients without chronic diseases are inclined to use county-level medical resources and above.⑤Insured peasants with chronic diseases are not only the population who make high use of health care resources, but also the population who make low use of health care resources. With high medical expense burden and low health insurance, they are more inclined to become poverty caused by diseases.
(4) Equity of compensation for medical expense of insured peasants.①The ratio of NCMS fund distribution between out-patient and in-patient, the embodiment of the policy "mainly to catastrophe" and the benefit incidence of insured peasants are different among the three sample counties.②The calculated results using range method, composing ratio, CI and ID reflect that the demand side out-patient's benefit rate of the high-income group is higher than the low-income groups. The out-patient's benefit rate of the demand-side is unfair, however, the cover benefit of hospitalization inclines to the low-income groups which its fairness is well comparatively.③The calculated results from percentage, range ratio, composing ratio, CI and ID reflect in the lower rate benefit level of out-patient compensation of the demand side, showed that the NCMS funds flowed from low-income families to high-income ones. Not only that, after the NCMS compensates the out-patient medical expenses, the fairness of the out-patient compensation expenses has not only unimproved, but also slightly increased the trend of unfairness.④The calculation results reflected that the NCMS funds incline obviously from low-income families to the high-income families, even though in a condition of lower compensation degree to demand-side hospitalization benefit. After the NCMS compensates the hospitalization medical expenses, the degree of unfairness is improved. Comparing the out-patient fees and the compensation funds of the demand-side to the in-patient fees and compensation funds of the demand-sides, the fairness of the latter is worse than the former, although the unfairness of the latter's hospital medical expenses is improved after compensation.⑤There is a concentration trend of medical expenses and compensation for patients with chronic disease to the high-income group, and the equity was improved after compensation.⑥There was a descending trend of CEH with the increasing of income on the critical points of 30%, 40%, 50%, and the CEH of high-income groups showed a relatively larger declining trend than that of low-income groups. The compensation level of serious disease was very low and the relief effect to catastrophe is still very limited, and the inequity still exists.⑦The CEH of the lowest income group is higher than the other groups. The incidence of CEH reduced with the increase in income. The factors from the age, marital status, the population of the family and chronic diseases influence the incidence of CEH of the demand sides.
The characteristic of the study is that many methods are used to measure the fairness of the demand sides in one point and get the consistent results. At the same time, it is found out or showed that advantages and disadvantages are all coexistence when some research methods are used for the fairness on the different links of the demand sides.
(5) Medical salvations which were carried out in three sample counties are more significantly behind NCMS. Moreover, there are also some questions, e.g. uneven progress, unstandard management, low coverage to the poor, and the extremely low level of funding difficulties and so on, that could not provide basic medical security for the impoverished population, and bear the weight of "carrying the bottom line of the fairness".
3. The establishment and application of evaluation indexes system for demand-side of NCMS. (1)Because of the logic selection for the indexes, the rationality for the weighting coefficients, the established evaluation indexes system for fairness at the demand-side of NCMS is applicable and exercisable. (2) This study makes the explanation for the indexes of the demand-side's fairness, valuation methods and standards score table of NCMS in Jinan City, and then makes use demand-side model of fairness to get three sample counties' weighted cumulative combined scores of the equity of the demand sides. It is the degree of the fairness which is carried out in three sample counties has good reliability, validity and distinction by the analysis, that proves the model of the fairness of the demand-sides can be carried out in practice and has universal significance and extended application value. However, it is necessary to be further validated in practice, and constantly improved along with the cognition which is becoming maturated.
Policy Recommendations:
(1) Governments should pay more attention to the equity of demand sides, and prioritize the "emphasizing demand side equity, improving medical security utility" into principles of NCMS explicitly. The NCMS should realize the transition to the direction progressively from the "low level, wide coverage" to the "appropriate level, comprehensive coverage, paying premium according to economic level, meeting basic medical demands, equal benefit and differential treatment of demand sides". (2) Applying established aim of demand side equity, the policy to improve the demand side equity should be implemented gradually depending on stages, contents, levels and population groups. (3) Legislation is generally implemented, and NCMS should be translated into compulsory insurance, only by which can NCMS accomplish general coverage and equity in social inclusion. (4) Reforming and improving financing methods should be based on "four stages" strategy, which is from rough to exquisite, from quota to ratio, from area to family, reducing unit of financing and improving equity in financing gradually. (5) Emphasizing corresponding infrastructural construction of rural primary health care facilities, and improving utilization level of these facilities. (6) According to anti-Matthew principle, demand side subsidy design should be improved to minimize the benefit gap, as well as wide benefit population and benefit level generally. (7) Facilitating construction of medical aid scheme, which is supplemental to and combined with NCMS to form the unified administrative system and operation mechanism. (8) For chronic patient, the classification reimbursement scheme should enlarge the reimbursement scope and level.
公平是人类社会文明进步的重要标志。保证新型农村合作医疗(以下简称新农合)制度覆盖全体农民和参合农民(即需方)得到公平有效的新农合制度保障是政府在社会建设领域追求的重要目标之一。需方公平性是新农合制度内在固有的本质属性和核心价值追求,其大小决定着这项制度的优劣、效果和可持续发展。自2003年开始试点,新农合制度将在2008年全国实现全面覆盖。这项广泛试点和全面推开的新农合制度,其需方在覆盖面、资金筹集、卫生服务利用、费用补偿和医疗救助等环节,都或多或少地没有把公平性有机地融入这项制度,也导致了这项制度未能更好地发挥应有效用。近年来,卫生决策者和研究者开始注重新农合公平性问题,但迄今为止,尚未见系统的新农合制度需方公平性理论研究;对新农合公平性所作的实证研究,往往是在微观层次上对某一个环节(如卫生服务利用或受益),或某个环节中一个方面(如家庭筹资)的公平性进行评价等,且存在各自的局限性和概念内涵不统一、指标归类不合理等,有待从不同角度、选择适宜方法对需方公平性进行全面、系统的探讨;在需方公平性的宏观或整体评价方面,尚未见对新农合制度或其他社会保障制度等需方公平性评价指标体系(模型)专门的研究报导。基于上述,提出本研究课题。
研究目的:
本研究从理论和实证两个方面、微观和宏观两个层次对需方公平性进行探讨。(1)理论研究。从现行政策和社会经济学等理论领域中涉及公平性的假设、原理和规律,探求需方公平性的思想和理论依据;研究需方公平性的概念、内涵和评价标准;对现行新农合制度需方公平性进行分析。(2)济南市新农合制度需方公平性实证研究。描述样本县和不同收入组需方的基本情况,分析需方在覆盖面、资金筹集、卫生服务利用、费用补偿和医疗救助等环节的公平性,注重患慢性病需方在不同环节公平性的大小,探讨影响公平性的因素。(3)建立一个量化的,具有适用性和可操作性的新农合制度需方公平性模型;结合样本县数据资料,运用该模型从整体上计算各样本县需方公平性得分并排序;检验模型的效度、信度、适用性和可操作性等。(4)提出改善需方公平性的政策建议。
研究方法:
根据不同的研究目的和内容,采取不同的研究方法。(1)理论研究。采用文献复习法,通过比较与分类、分析与综合、归纳与演绎及类比推理等方法,对新农合实践经验进行深入总结、悉心领略和缜密思考,探寻需方公平性的一般理论问题,并分析现行新农合制度需方公平性。(2)济南市新农合制度需方公平性实证研究。利用济南市样本县作为研究现场,采用定性与定量研究相结合、现场调查和文献资料相结合的方法,运用分层抽样调查方法收集样本县基本情况、新农合运行情况、需方的基本信息和卫生服务筹资、需要、利用、费用、补偿及救助等数据资料。对定量资料,根据不同研究内容,采用了率、构成比、相对比、t检验或方差分析、极差法、恩格尔系数(EC)、卫生筹资贡献率(HFC)、卫生筹资公平性指数(FFC)、家庭灾难性卫生支出(CEH)、利用/需要比(Use/needratio)、集中指数(CI)、差异指数(ID)、多元线性回归模型、Logistic回归模型等描述性分析、比较性分析和多因素分析方法。(3)新农合制度需方公平性模型研究。采用改进的Delphi法进行指标筛选,确定指标的权重系数,最终建立需方公平性模型;采用因子分析、克朗巴赫系数、聚类分析和方差分析方法进行模型的结构效度、信度和区分度检验。
主要结果与发现:
1、理论研究。(1)现阶段关于公平的主导思想、社会保障理论、边际效用递减规律、罗尔斯正义理论、帕累托最优和改进等对新农合制度需方公平性理论的建立能够提供借鉴和依据。(2)提出了全面覆盖、量能负担等需方公平性的五项原则,明确了需方公平性若干方面的内涵和评价标准。(3)现行新农合制度尚未从主观上和政策法规层面上明确把需方公平性提到应有的高度,理性认识不足,重视程度不够,需方每个环节都不同程度地存在着公平缺失或偏离公平问题。
2、济南市新农合制度需方公平性实证研究。不同收入组需方在性别、年龄、婚姻状况、文化水平和职业分布等方面存在不同程度的差异。
(1)覆盖面公平性:贫困人口、流动人口参合率均低于当地农民平均参合率;农民参合率随家庭收入增加而升高。尽管3个样本县农民参合率高达94.45%～98.42%之间,但在自愿参合原则下仍然存在覆盖面不公平和逆向选择现象。
(2)筹资公平性:①各级财政资助需方采取均一等额法,其实质是一种累退性资助方式:集体经济组织总体上没有形成扶持新农合的长效机制。②需方个人以均一等额法缴费,必然导致不同地区、不同收入需方家庭之间很强的缴费累退性负担。③不同收入组需方家庭的HFC呈明显递减趋势;对需方家庭HFC影响最大的是慢性病因素,其次是收入因素,性别、年龄、婚姻状况、文化程度和职业因素对需方家庭HFC也有影响;患慢性病需方家庭医疗费用负担明显高于非慢性病需方家庭。
(3)卫生服务利用公平性:①随着收入的增加,不同收入组需方两周就诊率呈明显递增趋势,两周未就诊率和因经济原因未就诊比例呈明显递减趋势;低收入组需方更多地利用基层卫生资源;EC和慢性病是影响需方就诊概率的主要因素,年龄、婚姻状况、收入、家庭人口规模对需方就诊概率有影响,说明收入因素影响门诊卫生服务利用公平性。②低收入组需方住院服务利用较高;随着收入的增加,不同收入组需方应住院而未住院率和因经济原因未住院比例略呈递减趋势;不同收入组需方在不同级别医疗机构住院服务利用结构差别不大。收入因素对住院服务利用公平性影响不大可能与住院弹性较小和低收入组需方住院服务利用释放程度较大有关。③随着收入的增加,不同收入组需方慢性病患者年内治疗率呈递增趋势。④需方慢性病患者的两周就诊率、两周未就诊率、因经济原因未就诊比例分别是非慢性病患者的3.05倍、1.64倍和1.52倍;慢性病患者更多地利用村和乡镇级医疗资源,非慢性病患者更多地利用县级及以上医疗资源。⑤需方慢性病患者既是卫生服务高利用群体,又是卫生服务高未利用群体,医疗费用负担重,容易成为因病致贫和返贫的对象。
(4)需方医疗费用补偿公平性:①3个样本县新农合基金在门诊和住院之间的基金分配比例、“以大病统筹为主”政策的体现和需方受益存在差别。②极差比、构成比、CI和ID计算结果均反映了高收入组需方门诊受益率大于低收入组需方,需方门诊受益面存在不公平性,而住院受益面向低收入组需方倾斜,公平性较好。③百分比、极差比、构成比、CI和ID计算结果均反映了需方在门诊补偿低水平受益程度下,存在新农合资金由低收入家庭向高收入家庭流动的倾向;门诊医疗费用比门诊补偿费用的公平性略高。④极差比、构成比、CI和ID计算结果均反映需方在住院补偿低水平受益程度下,比较明显地存在新农合资金由低收入家庭向高收入家庭流动的倾向;住院医疗费用的公平性略低于住院补偿费用的公平性。需方门诊费用及补偿费用指标与需方住院费用及补偿费用指标相比,后者的公平性更差,尽管后者住院医疗费用经补偿后不公平程度有所改善。⑤需方慢性病患者的医疗费用和补偿费用均有向高收入组集中趋势,且慢性病患者医疗费用的公平性略低于补偿费用的公平性。⑥在CEH与家庭可支付能力比值30%、40%、50%3个临界点上,随着收入的增加,CEH发生率均呈下降趋势;新农合补偿后,CEH发生率在高收入组下降比例较大,而在低收入组下降比例较小。新农合大病补偿水平很低,缓解大病住院费用对家庭致贫的作用还很有限,且存在不公平现象。⑦最低收入组需方的CEH高于其他组,随着收入的增加,发生CEH的可能性降低。收入、年龄、婚姻状况、家庭人口规模和慢性病因素对需方CEH有影响。
在需方公平性的一个环节或方面应用多种方法进行测量,并得到了具有一致性的结果是本研究的一个特点。同时,发现或验证了某些研究方法应用于需方公平性不同环节所具有的优缺点。
(5)3个样本县实施医疗救助均明显滞后于新农合,且存在进度不一,管理不规范,覆盖面低,筹资困难和水平极低等问题,未能承载起底线公平的作用。
3、新农合制度需方公平性模型的建立和应用。(1)指标筛选科学,权重系数确定合理,建立的新农合制度需方公平性模型,具有适用性和可操作性。(2)本研究制定济南市新农合制度需方公平性指标解释、评价方法和评分标准表,利用需方公平性模型,分别求得3个样本县需方公平性加权累加综合得分结果。分析3个样本县需方公平性实现程度,具有良好的信度、效度和区分度,证明新农合制度需方公平性模型能够运用于工作实践,并具有普遍意义和推广应用价值,但尚需在实践中进一步验证,并随着认识的深化而不断完善。
政策建议:
(1)各级政府应高度关注需方公平性,明确把“注重需方公平,提高保障效用”纳入新农合制度应遵循原则,逐步实现从“低水平,广覆盖”向“适宜水平,全面覆盖;量能负担,差别对待;统一补偿方案,满足基本需求”的方向转变。(2)运用确立的需方公平性目标,分阶段、分内容、分层次、分人群地逐步改善需方不同环节和方面的公平性。(3)立法普遍实施,全民强制参合,推进新农合制度覆盖全体农民,全面实现覆盖面公平。(4)完善筹资机制,按照“四步走”战略,采取由粗到细、先定额后定比、先地区后家庭,逐步化小筹资单位的方法,分步骤地改善筹资公平性。(5)注重农村基层医疗卫生机构配套建设,引导和提高需方对农村基层卫生机构的利用水平。(6)按照逆“马太效应”理念,完善需方补偿制度设计,在普遍提高受益面和受益程度的同时,最大限度地缩小不同收入需方的受益差距。(7)积极推进医疗救助制度建设;创造条件,把医疗救助制度有机融入新农合制度保障体系,形成以新农合制度为主导、医疗救助制度为补充的统一管理体制和运行机制。(8)加大对慢性病患者医疗费用分类补偿的范围、项目和比例水平。
Background
Equity is an important indicator to measure the civilization and progress of a society. One of the important goals of a government in the area of social construction is to assure that all its peasants are covered by the New Rural Cooperative Medical System (NCMS) and to insure the peasants of NCMS get a fair and effective medical guarantee. Thus, equity of the insured peasants (i.e. demand sides) is the nature, and the core pursuits of NCMS, and determines the advantages and disadvantages, effectiveness and sustainable development of it. Since began in some pilot areas in 2003, NCMS will cover all the country in 2008.The equity in the coverage, financing, utilization of health services, the cost of compensation and medical aid, etc. of demand sides is not organically integrated in the extensive pilot and comprehensively implemented NCMS more or less, which resulted in weakened effects. In recent years, health policy-makers and researchers have began to focus on the equity of NCMS, but systemic theoretical study of the equity of the insured peasants of NCMS has not been reported so far. As for the microcosmic aspects, the existing empirical researches of the equity of NCMS often only focus on a particular procedure (e.g. utilization or benefits incidence analysis of health services), or a particular aspect of a procedure (e.g. family-financing) and the indexes of equity and their concepts and contents are not unified, etc. Therefore, it is need to undertake a comprehensive and systematic study from different aspects and selecting appropriate indexes. As for macroscopical aspects, the study on the fairness of the evaluation index system (i.e. model) of NCMS or other medical insurance systems has not been reported. Based on the above background, the objectives of the study are proposed.
Objectives
This study explores the equity of demand sides from both theoretical and empirical aspects in line with both microcosmic and macroscopical levels. (1) As regards the theoretical study, it is to seek the ideological and theoretical basis and the concept, content and to define standards of the equity of insured peasants, and to provide analysis on the existing NCMS from theories such as existing policies and social economics related to the assumptions, principle and the law of equity. (2) In accordance with the empirical study of the equity of insured peasants of NCMS in Jinan City. The basic situation of demand sides in three sample counties is described in different income groups. In addition, the equity in the coverage, financing, utilization of health services, the cost of compensation and medical aid, and other factors are analyzed. In particular, the study pays attention to the insured peasants who have chronic diseases. Furthermore, the factors affecting the equity are explored. (3) The study constructs a quantitative, practical and operable model of equity of insured peasants of NCMS, evaluates the equity of three sample counties and tests the validity, reliability, applicability and feasibility of the model. (4) Some policy recommendations are proposed to improve the equity of the insured peasants.
Methods
The different methods are used in accordance with the objectives and contents of the different studies. (1) Theoretical study. Literature review, comparison and classification, analysis and synthesis, analog summarized and deductive reasoning methods are adopted to summarize and think on the practical experience of NCMS in-depth, to explore the general theoretical basis of NCMS, and to evaluate the equity of the existing NCMS. (2) Empirical study of the equity of insured peasants of NCMS in Jinan City. Three counties in Jinan City were selected as the study sites. The stratified sample method was used to collect the data of sample counties, the operation conditions of NCMS and the basic information of 3240 families (12,011 persons) and their conditions in health services funding, the needs, utilization, cost, compensation and medical aid and so on. The method includes both qualitative and quantitative study, field investigation and literature review. The quantitative method includes the analysis of rate, ratio, relative ratio, t-test, analysis of variance, range, Engel's Coefficient (EC), Health Financing Contribution (HFC), Fairness of Financing Contribution (FFC), Catastrophic Expenditure Household (CEH), use/need ratios, Concentration Index (CI), the Index of Dissimilarity (ID), Logistic regression models, and other descriptive analysis, comparative analysis and multivariate analysis methods. (3) Model study of the equity of insured peasants of NCMS. Improved Delphi method was adopted for the screening of indicators, and their weighting coefficients, and a model of the equity of insured peasants of NCMS was established ultimately; Methods of Factor Analysis, CronbachαFactor Analysis and Cluster Analysis of variance were used to test the structure validity, reliability and the distinction of the model.
Main Results and Findings
1. Theory Study. (1)The main thought on equity at present, theory on social insurance, law of diminishing marginal utility, A Theory of Justice by John Rawls, Pareto optimality and Pareto improvement can be used for reference to establish the equity theory of insured peasants. (2)The study summarized the "Five Cardinal Principles" to the equity of insured peasants, including comprehensive coverage to all peasants, paying for NCMS premium according to one's family economic burden, and so on. It states the content and evaluation criteria to a fair number of links and aspects to the equity of insured peasants. (3)The equity of insured peasants has not been improved to the height of it's own subjectively, both in policy and on law level. We should pay attention to a correct understanding, rational knowledge. All the insured peasants have more or less deletion from the fair question of equity.
2. Demonstration study on the equity of insured peasants of Jinan City. The insured peasants of different income groups have different levels of difference by gender, age, marital status, educational level and occupational distribution.
(1) Equity of Coverage: Participation rates of the poverty population and the floating population are lower than those of the local peasants on an average. Participation rates of the peasants increased as the household income increases. Healthy groups and unhealthy groups, rich groups and poor groups have not been reflected the function of risk pooling fully. Coverage unfairness and adverse selection phenomena need to be improved.
(2) Financing fairness:①Adopting uniform payment amount to every insured peasant, financial support of governments at all levels is a regressive subsidy to the essence. Collective economic organizations have not formed a long-term support mechanism to NCMS on the whole.②Adopting uniform payment amount, individual of the insured peasant will inevitably lead to a highly regressive subsidy and burden to the essence to different regions and different family.③The families' HFC of different income groups showed decreasing trend on the insured peasants. The greatest impact factor affecting family HFC was chronic disease, followed by income. Gender, age, marital status, education and vocational factors on the demand side also affected family HFC. Medical burden to families suffering from chronic diseases was significantly higher than that of non-chronic-disease family.
(3)Equity of the utilization of health services:①The two-week attendance rate was increased significantly with the increased income increase among the different insured peasants. The two-week non-attendance rate and that for economic reasons were decreased significantly with the income increase among the different insured peasants. Low-income insured peasants utilized more primary health resources. Factors as such EC and chronic diseases mainly affected the attendance probability at the demand sides. Age, marital status, income, and family size of the population impacted the attendance probability of the demand sides. Income factors affected the equity of the out-patient health service utilization.②Utilization ratios of the inpatient health service of low-income insured peasants were higher than those of the others. Non-hospitalization rate which is due to economic reasons were decreased with the income increase among different insured peasants. Different income groups of the insured were different slightly from different levels of medical hospitals. Income factors which have little impact on the equity of the inpatient health service utilization were likely due to tow reasons. In other words, one was smaller flexibility of hospitalization, the other was relating to the larger release of the low-income groups.③With the increase in income, chronic patients in different insured peasants showed a progressive trend.④The ratio of hospitalizing within two-weeks, not hospitalizing within two-weeks, and not hospitalizing for economic reasons of insured peasants with chronic diseases is 3.05 times, 1.64 times and 1.52 times of those of insured peasants without chronic diseases respectively. Patients with chronic diseases are inclined to use village-level and town-level health care resources, while patients without chronic diseases are inclined to use county-level medical resources and above.⑤Insured peasants with chronic diseases are not only the population who make high use of health care resources, but also the population who make low use of health care resources. With high medical expense burden and low health insurance, they are more inclined to become poverty caused by diseases.
(4) Equity of compensation for medical expense of insured peasants.①The ratio of NCMS fund distribution between out-patient and in-patient, the embodiment of the policy "mainly to catastrophe" and the benefit incidence of insured peasants are different among the three sample counties.②The calculated results using range method, composing ratio, CI and ID reflect that the demand side out-patient's benefit rate of the high-income group is higher than the low-income groups. The out-patient's benefit rate of the demand-side is unfair, however, the cover benefit of hospitalization inclines to the low-income groups which its fairness is well comparatively.③The calculated results from percentage, range ratio, composing ratio, CI and ID reflect in the lower rate benefit level of out-patient compensation of the demand side, showed that the NCMS funds flowed from low-income families to high-income ones. Not only that, after the NCMS compensates the out-patient medical expenses, the fairness of the out-patient compensation expenses has not only unimproved, but also slightly increased the trend of unfairness.④The calculation results reflected that the NCMS funds incline obviously from low-income families to the high-income families, even though in a condition of lower compensation degree to demand-side hospitalization benefit. After the NCMS compensates the hospitalization medical expenses, the degree of unfairness is improved. Comparing the out-patient fees and the compensation funds of the demand-side to the in-patient fees and compensation funds of the demand-sides, the fairness of the latter is worse than the former, although the unfairness of the latter's hospital medical expenses is improved after compensation.⑤There is a concentration trend of medical expenses and compensation for patients with chronic disease to the high-income group, and the equity was improved after compensation.⑥There was a descending trend of CEH with the increasing of income on the critical points of 30%, 40%, 50%, and the CEH of high-income groups showed a relatively larger declining trend than that of low-income groups. The compensation level of serious disease was very low and the relief effect to catastrophe is still very limited, and the inequity still exists.⑦The CEH of the lowest income group is higher than the other groups. The incidence of CEH reduced with the increase in income. The factors from the age, marital status, the population of the family and chronic diseases influence the incidence of CEH of the demand sides.
The characteristic of the study is that many methods are used to measure the fairness of the demand sides in one point and get the consistent results. At the same time, it is found out or showed that advantages and disadvantages are all coexistence when some research methods are used for the fairness on the different links of the demand sides.
(5) Medical salvations which were carried out in three sample counties are more significantly behind NCMS. Moreover, there are also some questions, e.g. uneven progress, unstandard management, low coverage to the poor, and the extremely low level of funding difficulties and so on, that could not provide basic medical security for the impoverished population, and bear the weight of "carrying the bottom line of the fairness".
3. The establishment and application of evaluation indexes system for demand-side of NCMS. (1)Because of the logic selection for the indexes, the rationality for the weighting coefficients, the established evaluation indexes system for fairness at the demand-side of NCMS is applicable and exercisable. (2) This study makes the explanation for the indexes of the demand-side's fairness, valuation methods and standards score table of NCMS in Jinan City, and then makes use demand-side model of fairness to get three sample counties' weighted cumulative combined scores of the equity of the demand sides. It is the degree of the fairness which is carried out in three sample counties has good reliability, validity and distinction by the analysis, that proves the model of the fairness of the demand-sides can be carried out in practice and has universal significance and extended application value. However, it is necessary to be further validated in practice, and constantly improved along with the cognition which is becoming maturated.
Policy Recommendations:
(1) Governments should pay more attention to the equity of demand sides, and prioritize the "emphasizing demand side equity, improving medical security utility" into principles of NCMS explicitly. The NCMS should realize the transition to the direction progressively from the "low level, wide coverage" to the "appropriate level, comprehensive coverage, paying premium according to economic level, meeting basic medical demands, equal benefit and differential treatment of demand sides". (2) Applying established aim of demand side equity, the policy to improve the demand side equity should be implemented gradually depending on stages, contents, levels and population groups. (3) Legislation is generally implemented, and NCMS should be translated into compulsory insurance, only by which can NCMS accomplish general coverage and equity in social inclusion. (4) Reforming and improving financing methods should be based on "four stages" strategy, which is from rough to exquisite, from quota to ratio, from area to family, reducing unit of financing and improving equity in financing gradually. (5) Emphasizing corresponding infrastructural construction of rural primary health care facilities, and improving utilization level of these facilities. (6) According to anti-Matthew principle, demand side subsidy design should be improved to minimize the benefit gap, as well as wide benefit population and benefit level generally. (7) Facilitating construction of medical aid scheme, which is supplemental to and combined with NCMS to form the unified administrative system and operation mechanism. (8) For chronic patient, the classification reimbursement scheme should enlarge the reimbursement scope and level.
引文
1.吴仪.在2 008年全国新型农村合作医疗工作会议的讲话[EB/OL].http://www.moh.gov.cn/newshtml/21164.htm.2008-02-15.
2.本报评论员.新农合全面覆盖是历史的新起点[N].健康报,2008-2-18(1).
3.汪宏,Winnie Yip,张里程等.中国农村合作医疗的受益公平性[J].中国卫生经济,2005,24(2):16-19.
4.田庆丰,李小芳,李中琳,等.新型农村合作医疗的受益公平性研究[J].医学与哲学,2006,27(8):8-9,16.
5.李晓梅,董留华,喻箴等.改善新型农村合作医疗实施中卫生服务公平性的探讨[J].中国农村卫生事业管理,2006,26(1):13-15.
6.方丽霖,袁兆康,肖云昌等.新型农村合作医疗实施前后卫生服务利用公平性的比较研究[J].中国农村卫生事业管理,2006,26(5):6-9.
7.贺鹭,郑建中,韩颖.山西省新型农村合作医疗家庭筹资公平性分析[J].中国农村卫生事业管理,2006,26(11):3-6.
8.徐立柱.新型农村合作医疗制度下参合农民受益公平性研究[D].济南:山东大学卫生管理与政策研究中心,2007:1-2.
9.焦岩.新型农村合作医疗受益分布研究[D].济南:山东大学卫生管理与政策研究中心,2007:1-2.
10.任苒,金凤,等.新型农村合作医疗实施后卫生服务可及性和医疗负担的公平性研究[J].中国卫生经济,2007,26(1):27-31.
11.车刚,赵涛.新型农村合作医疗对农村居民卫生服务利用公平性的影响研究[J].卫生软科学,2007,21(1):1-4.
12.卫生部统计信息中心.中国新型农村合作医疗进展及其效果研究--2005年新型农村合作医疗试点调查报告[J].中国农村卫生事业管理,2006,26(11):3-6.
13.徐凌中,邴媛媛,柳丽华.卫生筹资政策对公平性的影响[J].中华医院管理杂志,2001,17(5):268-271.
14.李斌.卫生筹资公平性研究进展[J].中国卫生经济,2004,23(2):15-18.
15.何义林,马李,胡爱香.新型农村合作医疗实施地区卫生服务公平性研究[J].现代预防医学,2006,33(12):2283-2286.
16.张立.医疗保险制度公平:国内近年研究的若干进展[J].财经政法资讯,2006.4:45-49.
17.曹建华,陈俊国,霍江涛,等.卫生服务公平性理论及方法研究[J].西北医学教育,2006,14(6):788-792.
18.陈家应,龚幼龙,舒宝刚,等.卫生服务公平性的理论和现实意义[J].中国卫生资源,2000,3(4):167-169.
19.徐凌中,邴嫒嫒.卫生服务的公平性研究进展[J].中华医院管理杂志,2001,17(5):265-267.
20.修燕,徐飚.卫生服务公平性研究[J].中国卫生事业管理,2002,6:328-329.
21.时黎,张开宁,姜润生.卫生服务公平性理论框架的探讨[J].中国卫生事业管理,2003,1:4-5,47.
22.姚有华,冯学山.关于改善我国卫生服务公平性的思考[J].中国卫生资源,2004,7(1):3-5.
23.李顺平,孟庆跃.卫生服务公平性及其影响因素研究综述[J].中国卫生事业管理,2005,3:132-134.
24.孟庆跃,严非.中国城市卫生服务公平与效率评价研究[M].济南:山东大学出版社,2005.
25.程广德,葛余兆.新型农村合作医疗评价指标体系初探[J].中国卫生资源,2005,8(1):39-41.
26.王晓锋,黄兴黎,杨铨.云南新型农村合作医疗评价指标体系及标准研究[J].卫生软科学,2004,18(6):293-298.
27.新型农村合作医疗实用评价指标[J].中国初级卫生保健,2005,19(5):42-44.
28.赵文龙,郑美雁,路小亮.对我国城镇职工基本医疗保险评价指标体系的研究[J].中国医学伦理学,2005,18(2):76-78.
29.杜进林,李颍琰,王禄生.新型农村合作医疗综合评价指标体系建立[J].中国卫生统计,2006,23(5):413-416.
30.杜进林,李颍琰,王禄生.新型农村合作医疗综合评价指标体系研究[J].中国公共卫生,2006,22(3):257-259.
31.杜进林,李颍琰,程学敏,等.新型农村合作医疗综合评价指标体系检验[J].河南预防医学杂志,2006,17(3):95-97.
32.杜进林,李颍琰,程学敏,等.新型农村合作医疗综合评价指标体系的应用[J].河南预防医学杂志,2007,18(2):81-83.
33.李林贵,李士雪,许亮文,等.新型农村合作医疗常规评价指标体系的研究[J].中国卫生经济,2007,26(3):70-74.
34.刘丹,兰庆高.新型农村合作医疗综合评价指标体系初探[J].农业经济,2006,1:59-60
35.UMA G.GUPTA and Robert E.Clarke.the theory and applications of Delphi Technique:A Bibliography(1975-1994).Technological Forecasting and Social Change,53:185-211(1996).
36.Arnold Leving.A model for health projections using knowledgeable informantion.World Health Statistics Quart,1984,37:310.
37.In Seong Chang,Yasuhiro Tsugimura,Mitsuo Gen,et al.An efficient approach for large scale project planning based on Fuzzy Delphi method.Fuzzy Ses and Systems 76(1995):277-288.
38.Brent Graham,Glenn Regehr,James G.Wright.Delphi as a method to establish consensus for diagnostic criteria.Journal of Clinical Epidemiology 56(2003)1150-1156.
39.Barbara Star Field Health Service Research:A working model.The New England Journal of Medicine,July 1973,19:132-135.
40.蒋烽,刘顺利.应用Delphi法筛选卫生事业管理指标[J].中国卫生统计,1998,5(2):12-131.
41.中华人民共和国国家统计局.统计指标解释--人民生活[EB/OL].http://www.stats.gov.cn/tjzd/tjzbjs/t20020327_14290.htm.
42.卫生部统计信息中心.中国卫生服务调查研究:第三次国家卫生服务调查分析报告[M].北京:中国协和医科大学出版社,2004,82-92.
43.王洁贞,李颖琰,施学中.医学统计学[M].郑州:郑州大学出版社,2002.17-22.
44.世界卫生组织.2000年世界卫生报告:卫生系统:改进业绩[M].北京:人民卫生出版社,2000.148.
45.Kawabta K,Knaul F,Xu K,et al.WHO Fair Financing Methodology[S].WHO,Geneva,2000,2-6.
46.应晓华,李国红,胡善联,等.家庭卫生筹资公平性研究[J].中华医院管理杂志,2004,20(8):449-453.
47.Murray CJL,Julio F.WHO Framework for Health System Performance Assessment[S].GPE Discussion Paper,2001,3-5.
48.WHO.Fairness in Financing Contribution-Concepts,3.14 session [J].Workshop on Evidence for Health Policy:Burden of disease,cost -effectiveness,and health systems.2002,10-15.
49.陶四海,赵郁馨,万泉,等.灾难性卫生支出分析方法研究[J].中国卫生经济,2004,23(4):9-11.
50.应晓华,江芹,刘宝,等.灾难性支出家庭对卫生筹资公平性的影响[J].中华医院管理杂志,2004,20(8):461-463.
51.朱敏,徐凌中,王兴洲,等.威海市农村家庭灾难性卫生支出的影响因素研究[J].中国卫生事业管理,2006,6:327-328,358.
52.焦岩.新型农村合作医疗受益分布研究[D].山东大学硕士学位论文,2007:18-27.
53.Adam Wagstaff,el al.On the Measurement of Inequalities in Health.Soc.Sci.Med,1991.5.
54.邵爱玉,李玉华.健康不公平性的测量:基尼系数和集中指数简介[J].《国外医学》 卫生经济分册,2003,20(3):135-136,144.
55.饶克勤,姚岚,秦立轩.健康公平的测量方法[J].中国卫生经济,1998,17(12):30-32.
56.胡琳琳.我国与收入相关的健康不平等实证研究[J].卫生经济研究,2005,12:13-16).
57.王艳,周燕荣.健康不公平性问题的测量方法[J].中国卫生经济,2001,20(5):40-42).
58.刘宝,胡善联.收入相关健康不平等实证研究[J].卫生经济研究,2003,1:14-16.
59.中国杜会科学院语言研究所词典编辑室.现代汉语词典[M].北京:商务印书馆,1996.
60.[古希腊]柏拉图著.韩斌和等译.理想国[M].北京:商务印书馆,1989.
61.[英]米尔恩著,夏勇等译.人的权利和人的多样性-人权哲学[M].北京:中国大百科全书出版杜,1995.
62.郭永松.关于卫生保健公平性的理性思考与实践原则[J].中国卫生事业管理,2002,3:135-137.
63.应晓华,陈文,黄丽君等.卫生领域中的公平性和筹资公平性[J].中国卫生经济,2004,23(1):52-54.
64.World Health Organization.The World health report 2000:health systems:improving performance.Printed in France:2000.188-191.
65.卫生部、财政部、农业部.关于建立新型农村合作医疗制度的意见[EB/OL].http://www.moh.gov.cn/newshtml/17791.htm,2003-1-16.
66.中共中央、国务院.关于进一步加强农村卫生工作的决定[EB/OL].http://www.china.org.cn/chinese/PI-c/225082.htm,2002-10-30.
67.成昌慧,李士学,贾晓斐等.新型农村合作医疗法制化建设若干问题探讨[J].中国卫生经济,2007,26(9):14-17.
68.Sherman Folland,Allen C.Goodman,Miron Stano 著,王健,孟庆跃,译.The Economics of Health and Health Care(Third Edition).北京:中国人民大学出版社,2004.455-476.
69.曼昆.经济学原理[M].北京:北京大学出版社,1999.53-56.
70.胡锦涛.在中国共产党第十七次全国代表大会上的讲话[M].北京:人民卫生出版社,2007.37-41.
71.劳动和社会保障部社会保险研究所.贝弗里奇报告--社会保险和相关服务[M].北京:中国劳动社会保障出版社,2004.
72.王健,孟庆跃.卫生经济学[M].北京:人民卫生出版社,2007.37-41.
73.John Rawls原著,何怀宏,何包钢,廖申白译.《正义论》(外国伦理学名著译丛)[M].北京:中国社会科学出版社,2006.
74.张笑天,王保真.医疗保险原理与方法[M].北京:中国人口出版社,1996.86-96.
75.冯海波.中国农民负担的公平性分析[J].兰州商学院学报,2004,20(3):5-11.
76.成昌慧.山东省农村合作医疗筹资、利用和费用之间数量关系模型研究[D].济南:山东医科大学研究生学位论文,1996:10-14.
77.国务院研究室课题组.农村合作医疗保健制度研究[M].北京:北京医科大学、中国协和医科大学联合出版社,1994.50-58.
78.宁永功.制定新型农村合作医疗实施方案的基本策略[J].中国卫生经济,2006, 25(10):30-33.
79.朱丽萍.新型农村合作医疗筹资的合理性和可持续性评价[J].中国卫生经济,2004,23(5):23-24.
80.李华.中国农村合作医疗制度研究[M].北京:经济科学出版社,2007.161-163.
81.民政部、卫生部、财政部.关于实施农村医疗救助的意见[EB/OL].民发[2003]158号.http://www.moh.gov.cn.
82.农村卫生政策信息.中华人民共和国卫生部[EB/OL].http://www.moh.gov.cn/menunews/B703.htm.
83.新华社讯.新农合今年将增加补助全面覆盖[N].健康报,2008-2-18(1).
84.王国才.按照科学发展观要求抓好新农合工作[J].中国医院管理,2005,25(6):8-10).
85.广东省卫生厅合作医疗办公室.新农合的十二个为什么[EB/OL].http://weisheng.enping.gov.cn/Article/ArticleShow.aspArticleID225.
86.景天魁.围绕农民健康问题:政府、市场、社会的互动[J].河北学刊,2006,26(4):54-62.
87.贾堂宏.农村合作医疗制度若干理论问题研究(下)[J].山东卫生,2005,3:37-39.
88.吴明.卫生部通报新型农村合作医疗试点情况[EB/OL].http://www.96116.net/edu/kjyw/iaoyuxinwen/2006/9/29.2006-9-29.
89.中华人民共和国卫生部.卫生部新型农村合作医疗试点工作评估专题新闻发布会文字实录[EB/OL].http://www.moh.gov.cn/newshtml/15673.htm,2006-09-27.
90.卫生部.第三次国家卫生服务调查主要结果[EB/OL].http://www.moh.gov.cn/open/uploadfile/2004-12-03.
91.周晓媛,毛正中,蒋家林等.对新型农村合作医疗补偿方案中起付线的探讨[J].中国卫生经济,2008,27(1):47-49.
92.李良军,杨树勤.保险因子的初步研究[J].中国卫生事业管理,1994,6:295-299.
93.吴之寿.深圳市医疗保险两种模式的比较[J].中国医院管理,1995,15(9):30-32.
94.田成平.社会保障制度建设[M].北京:人民出版社,2006.19-21.
95.李静.以“覆盖率”和“公平性”衡量社保水平[EB/OL].http://www.theory.people.com.cn/GB/49154/49156/4942238.html,2006-10-21.
96.何德旭,刘奕.中国医疗卫生服务业的体制改革与创新:基于公平和效率视角[M].北京:社会科学文献出版社,2007.209-234.
97.周明浩,李延平,史祖民,等.德尔菲法在卫生城市建设综合评价指标筛选种的应用[J].中国公共卫生管理,2001,17(4):260-263.
98.曾光.现代流行病学方法与应用[M].北京:北京医科大学中国协和医科大学联合出版社,1994.250-270.
99.孙振球,徐勇勇.医学统计学[M].北京:人民卫生出版社,2005.
100.Christophe Sapin,Marie-Claude Simeoni.Reliability and validity of the VSP-A,a health-related quality of life instrument for ill and healthy adolescents.Journal of Adolescent Health 36(2005)327-336.
101.刘平安.医疗救助资金投入要加大[N].健康报,2008-2-18(1).
102.杜乐勋,张文鸣.医疗卫生绿皮书:中国医疗卫生发展报告No.3[M].北京:社会科学文献出版社,2007.98-103.
103.蒋中一.特困人口医疗救助制度和农村新型合作医疗制度的结合[EB/OL].http://www.hbzyw.gov.cn/shownews.asp?id=7553/2007-4-2.
104.卫生部统计信息中心.中国新型农村合作医疗进展及其效果研究[M].北京:中国协和医科大学出版社,2007.41-46.
105.李华.中国新型农村合作医疗制度研究[M].北京:经济科学出版社,2007.172-177.
106.高梦滔,高广颖,刘可.从需求角度分析新型农村合作医疗制度运行的效果[J].中国卫生经济,2005,24(5):9-12.
107.高梦滔,王健.从供给角度对新农合可持续性的思考[J].卫生经济研究,2004,9:3-8.
108.卫生部统计信息中心.中国新型农村合作医疗进展及其效果研究[M].北京:中国协和医科大学出版社,2007.9-19,41-46.
109.冯珊珊.浅议新型农村合作医疗的“自愿参与”原则[J].中国农村卫生事业管理,2005,25(9):14-15.
110.彭光华,郑远俊,何永华.新型农村合作医疗试点工作的实践与思考[EB/OL].http://www.sannong.gov.cn/fxyc/ncjjfx/200412031301.htm/2005-10-12.
111.林闽钢.我国农村合作医疗制度治理结构的转型[J].农业经济问题,2006,5:22-28.
112.高梦滔,高广颖,刘可.对云南省三个新型农村合作医疗试点县(市)的调查报告[J].卫生经济研究,2005,9:3-5.
113.赵晓强,张雪梅.贫困地区农村新型合作医疗参合率和利用率研究--贵州省X 县农村新型合作医疗的调查[J].农业经济问题,2006,6:23-27.
114.钱峰.新农合补助资金拨付办法调整[N].健康报,2007-03-01(1).
115.李斌.论全面实现小康社会的卫生公平性标准[J].中国公共卫生管理,2004,20(1):1-3.
116.王小合.发达地区新型农村合作医疗可持续筹资的路径选择[J].中国卫生经济,2008,27(1):43-46.
117.宁夏回族自治区统计局.2003年宁夏回族自治区国民经济和社会发展公报[EB/OL].http://www.cpirc.org.cn/tjsj/tjsj_gb_detail.asp?id=2807/2004-3-16.
118.宁夏回族自治区统计局.宁夏回族自治区2006年国民经济和社会发展公报[EB/OL].http://cn.chinagate.com.cn/economics/2007-04/09/content_2371941.htm/2007-04-09.
119.山东省统计局.2003年山东省国民经济和社会发展统计公报[EB/OL].http://www.shandong.gov.cn/art/2005/11/10/art_5470_55517.html/2004-2-26.
120.山东省统计局.2006年山东省国民经济和社会发展统计公报[EB/OL].http://www.shandong.gov.cn/art/2007/03/13/art10453_337195.html/2007-03-13.
121.朱伟,田庆丰,朱洪彪.河南省农村地区卫生服务公平性研究[J].卫生经济研究,2001,1:27-29.
122.孟玮,杨士保,谭红专,等.湖南省洞庭湖洪灾区卫生服务公平性研究[J].中国卫生事业管理.2003,(3):138-139.
123.井明霞,刘军,秦江梅,等.乌鲁木刘市居民卫生服务公平性的评价[J].河子大学学报(自然科学版),2003,7(1):29-32.
124.李春芳,王绪建,等.医改对参保职工卫生服务公平性影响作用分析[J].卫生经济研究,2001,(12):41-43.
125.WHO.The World Health Report 2000-Health Systems:Improving Performance.Paris,France.June 2000:188-191.
126.应晓华,刘宝,胡善联,等.不同收入人群家庭筹资公平性研究[J].中华医院管理杂志,2004,20(8):457-460.
127.毛丽梅,方鹏骞,杨年红,等.中国贫困地区特困家庭经济、健康状况卫生服务利用分析评价[J].中国妇幼保健,2002,17(7):406-409.
128.龚幼龙.卫生服务研究[M].上海:复旦大学出版社,2002.
129.李晓梅,罗家洪,何利平,等.云南省新型农村合作医疗试点县农民卫生服务需要分析[J].中国初级卫生保健,2006,20(10):29-31.
130.尹冬梅,胡善联,程晓明,等.中国贫困农村地区卫生服务公平性研究[J].中国卫生经济,1999,18(3):7-10.
131.卫生部统计信息中心.中国新型农村合作医疗进展及其效果研究[M].北京:中国协和医科大学出版社,2007.28-36.
132.叶冬青,何义林,马李,等.安徽省岳西县新型合作医疗对健康和卫生服务公平性影响的研究[J].中华流行病学杂志,2006,27(11):934-938.
133.欧序生.三峡贫困地区农村卫生服务公平性研究[J].中国卫生事业管理,2001,12:746-748.
134.刘丽娜,徐凌中,孙辉,等.威海市农村地区卫生服务需要和利用分析[J].中国卫生经济,2006,25(10):42-44.
135.卫生部统计信息中心.中国卫生服务调查研究:第三次国家卫生服务调查分析报告[M].北京:中国协和医科大学出版社,2004.39.
136.卫生部统计信息中心.中国卫生服务调查研究:第三次国家卫生服务调查分析报告[M].北京:中国协和医科大学出版社,2004.102.
137.朱敏,徐凌中,王兴洲,等.威海市农村居民卫生服务公平性研究[J].中国卫生事业管理,2006,9:557-559.
138.王靖元,邵高泽,徐文彦,等.论新型农村合作医疗基金分割机制与补偿比例[J].中国卫生经济,2005,24(10):9-30.
139.新型农村合作医疗试点工作评估组编著.发展中的中国新型农村合作医疗-新型农村合作医疗试点工作评估报告[M].北京:人民卫生出版社,2006.38-40.
140.任苒,张琳.中国农村贫困地区居民住院医疗服务需求及其影响因素分析[J].中国卫生经济,2002,21(12):1-3.
141.WHO.Who benefits and by how much Who benefits from health sector subsidies? Quantitative Techniques for Health Equity Analysis.Technical Note.12:1-9.
142.Christopher JL Murray,Felicia Knaul,Philip Musgrovc,Ke Xu,Kei Kawabata.Defining and measuring fairness in financial contribution to the health system,World Health Organization,GPE Discussion Paper Series.24.
143.Tin Tin Su,Boear Kouyate,Stefen Flessa.Catastrophic household expenditure for health Cal″e in a low-income society:a study from Nouna District.Burkina Faso.Bulletin of the WOrld Health Organization,2006,84:21-27.
144.杨红燕.建立农村医疗救助制度的若干难点分析[J].卫生经济研究,2005,5:20-22.
145.周恩泽,官波,范国富,等.镇江市医疗救助制度在维护医疗保障公平性中的作用[J].中国卫生经济,2004,23(9):34-35.
146.朱玲.对农牧人口医疗补助的公平性问题的调研[J].卫生经济研究,2006,:14-15.
147.朱玲.农村特困群体医疗救助效果研究[R].农村卫生政策应用研究课题完工报告汇编之二-农村特困医疗救助.北京:卫生部国外贷款办公室,2006.
148.李银河编译.[美]艾尔巴比.社会研究方法[M].成都:四川人民出版社,1987.
149.李颍琰,韩耀风,周文贞,等.农村合作医疗评价指标体系初探[J].中国卫生经济,2004,23(3):21-24.
2.本报评论员.新农合全面覆盖是历史的新起点[N].健康报,2008-2-18(1).
3.汪宏,Winnie Yip,张里程等.中国农村合作医疗的受益公平性[J].中国卫生经济,2005,24(2):16-19.
4.田庆丰,李小芳,李中琳,等.新型农村合作医疗的受益公平性研究[J].医学与哲学,2006,27(8):8-9,16.
5.李晓梅,董留华,喻箴等.改善新型农村合作医疗实施中卫生服务公平性的探讨[J].中国农村卫生事业管理,2006,26(1):13-15.
6.方丽霖,袁兆康,肖云昌等.新型农村合作医疗实施前后卫生服务利用公平性的比较研究[J].中国农村卫生事业管理,2006,26(5):6-9.
7.贺鹭,郑建中,韩颖.山西省新型农村合作医疗家庭筹资公平性分析[J].中国农村卫生事业管理,2006,26(11):3-6.
8.徐立柱.新型农村合作医疗制度下参合农民受益公平性研究[D].济南:山东大学卫生管理与政策研究中心,2007:1-2.
9.焦岩.新型农村合作医疗受益分布研究[D].济南:山东大学卫生管理与政策研究中心,2007:1-2.
10.任苒,金凤,等.新型农村合作医疗实施后卫生服务可及性和医疗负担的公平性研究[J].中国卫生经济,2007,26(1):27-31.
11.车刚,赵涛.新型农村合作医疗对农村居民卫生服务利用公平性的影响研究[J].卫生软科学,2007,21(1):1-4.
12.卫生部统计信息中心.中国新型农村合作医疗进展及其效果研究--2005年新型农村合作医疗试点调查报告[J].中国农村卫生事业管理,2006,26(11):3-6.
13.徐凌中,邴媛媛,柳丽华.卫生筹资政策对公平性的影响[J].中华医院管理杂志,2001,17(5):268-271.
14.李斌.卫生筹资公平性研究进展[J].中国卫生经济,2004,23(2):15-18.
15.何义林,马李,胡爱香.新型农村合作医疗实施地区卫生服务公平性研究[J].现代预防医学,2006,33(12):2283-2286.
16.张立.医疗保险制度公平:国内近年研究的若干进展[J].财经政法资讯,2006.4:45-49.
17.曹建华,陈俊国,霍江涛,等.卫生服务公平性理论及方法研究[J].西北医学教育,2006,14(6):788-792.
18.陈家应,龚幼龙,舒宝刚,等.卫生服务公平性的理论和现实意义[J].中国卫生资源,2000,3(4):167-169.
19.徐凌中,邴嫒嫒.卫生服务的公平性研究进展[J].中华医院管理杂志,2001,17(5):265-267.
20.修燕,徐飚.卫生服务公平性研究[J].中国卫生事业管理,2002,6:328-329.
21.时黎,张开宁,姜润生.卫生服务公平性理论框架的探讨[J].中国卫生事业管理,2003,1:4-5,47.
22.姚有华,冯学山.关于改善我国卫生服务公平性的思考[J].中国卫生资源,2004,7(1):3-5.
23.李顺平,孟庆跃.卫生服务公平性及其影响因素研究综述[J].中国卫生事业管理,2005,3:132-134.
24.孟庆跃,严非.中国城市卫生服务公平与效率评价研究[M].济南:山东大学出版社,2005.
25.程广德,葛余兆.新型农村合作医疗评价指标体系初探[J].中国卫生资源,2005,8(1):39-41.
26.王晓锋,黄兴黎,杨铨.云南新型农村合作医疗评价指标体系及标准研究[J].卫生软科学,2004,18(6):293-298.
27.新型农村合作医疗实用评价指标[J].中国初级卫生保健,2005,19(5):42-44.
28.赵文龙,郑美雁,路小亮.对我国城镇职工基本医疗保险评价指标体系的研究[J].中国医学伦理学,2005,18(2):76-78.
29.杜进林,李颍琰,王禄生.新型农村合作医疗综合评价指标体系建立[J].中国卫生统计,2006,23(5):413-416.
30.杜进林,李颍琰,王禄生.新型农村合作医疗综合评价指标体系研究[J].中国公共卫生,2006,22(3):257-259.
31.杜进林,李颍琰,程学敏,等.新型农村合作医疗综合评价指标体系检验[J].河南预防医学杂志,2006,17(3):95-97.
32.杜进林,李颍琰,程学敏,等.新型农村合作医疗综合评价指标体系的应用[J].河南预防医学杂志,2007,18(2):81-83.
33.李林贵,李士雪,许亮文,等.新型农村合作医疗常规评价指标体系的研究[J].中国卫生经济,2007,26(3):70-74.
34.刘丹,兰庆高.新型农村合作医疗综合评价指标体系初探[J].农业经济,2006,1:59-60
35.UMA G.GUPTA and Robert E.Clarke.the theory and applications of Delphi Technique:A Bibliography(1975-1994).Technological Forecasting and Social Change,53:185-211(1996).
36.Arnold Leving.A model for health projections using knowledgeable informantion.World Health Statistics Quart,1984,37:310.
37.In Seong Chang,Yasuhiro Tsugimura,Mitsuo Gen,et al.An efficient approach for large scale project planning based on Fuzzy Delphi method.Fuzzy Ses and Systems 76(1995):277-288.
38.Brent Graham,Glenn Regehr,James G.Wright.Delphi as a method to establish consensus for diagnostic criteria.Journal of Clinical Epidemiology 56(2003)1150-1156.
39.Barbara Star Field Health Service Research:A working model.The New England Journal of Medicine,July 1973,19:132-135.
40.蒋烽,刘顺利.应用Delphi法筛选卫生事业管理指标[J].中国卫生统计,1998,5(2):12-131.
41.中华人民共和国国家统计局.统计指标解释--人民生活[EB/OL].http://www.stats.gov.cn/tjzd/tjzbjs/t20020327_14290.htm.
42.卫生部统计信息中心.中国卫生服务调查研究:第三次国家卫生服务调查分析报告[M].北京:中国协和医科大学出版社,2004,82-92.
43.王洁贞,李颖琰,施学中.医学统计学[M].郑州:郑州大学出版社,2002.17-22.
44.世界卫生组织.2000年世界卫生报告:卫生系统:改进业绩[M].北京:人民卫生出版社,2000.148.
45.Kawabta K,Knaul F,Xu K,et al.WHO Fair Financing Methodology[S].WHO,Geneva,2000,2-6.
46.应晓华,李国红,胡善联,等.家庭卫生筹资公平性研究[J].中华医院管理杂志,2004,20(8):449-453.
47.Murray CJL,Julio F.WHO Framework for Health System Performance Assessment[S].GPE Discussion Paper,2001,3-5.
48.WHO.Fairness in Financing Contribution-Concepts,3.14 session [J].Workshop on Evidence for Health Policy:Burden of disease,cost -effectiveness,and health systems.2002,10-15.
49.陶四海,赵郁馨,万泉,等.灾难性卫生支出分析方法研究[J].中国卫生经济,2004,23(4):9-11.
50.应晓华,江芹,刘宝,等.灾难性支出家庭对卫生筹资公平性的影响[J].中华医院管理杂志,2004,20(8):461-463.
51.朱敏,徐凌中,王兴洲,等.威海市农村家庭灾难性卫生支出的影响因素研究[J].中国卫生事业管理,2006,6:327-328,358.
52.焦岩.新型农村合作医疗受益分布研究[D].山东大学硕士学位论文,2007:18-27.
53.Adam Wagstaff,el al.On the Measurement of Inequalities in Health.Soc.Sci.Med,1991.5.
54.邵爱玉,李玉华.健康不公平性的测量:基尼系数和集中指数简介[J].《国外医学》 卫生经济分册,2003,20(3):135-136,144.
55.饶克勤,姚岚,秦立轩.健康公平的测量方法[J].中国卫生经济,1998,17(12):30-32.
56.胡琳琳.我国与收入相关的健康不平等实证研究[J].卫生经济研究,2005,12:13-16).
57.王艳,周燕荣.健康不公平性问题的测量方法[J].中国卫生经济,2001,20(5):40-42).
58.刘宝,胡善联.收入相关健康不平等实证研究[J].卫生经济研究,2003,1:14-16.
59.中国杜会科学院语言研究所词典编辑室.现代汉语词典[M].北京:商务印书馆,1996.
60.[古希腊]柏拉图著.韩斌和等译.理想国[M].北京:商务印书馆,1989.
61.[英]米尔恩著,夏勇等译.人的权利和人的多样性-人权哲学[M].北京:中国大百科全书出版杜,1995.
62.郭永松.关于卫生保健公平性的理性思考与实践原则[J].中国卫生事业管理,2002,3:135-137.
63.应晓华,陈文,黄丽君等.卫生领域中的公平性和筹资公平性[J].中国卫生经济,2004,23(1):52-54.
64.World Health Organization.The World health report 2000:health systems:improving performance.Printed in France:2000.188-191.
65.卫生部、财政部、农业部.关于建立新型农村合作医疗制度的意见[EB/OL].http://www.moh.gov.cn/newshtml/17791.htm,2003-1-16.
66.中共中央、国务院.关于进一步加强农村卫生工作的决定[EB/OL].http://www.china.org.cn/chinese/PI-c/225082.htm,2002-10-30.
67.成昌慧,李士学,贾晓斐等.新型农村合作医疗法制化建设若干问题探讨[J].中国卫生经济,2007,26(9):14-17.
68.Sherman Folland,Allen C.Goodman,Miron Stano 著,王健,孟庆跃,译.The Economics of Health and Health Care(Third Edition).北京:中国人民大学出版社,2004.455-476.
69.曼昆.经济学原理[M].北京:北京大学出版社,1999.53-56.
70.胡锦涛.在中国共产党第十七次全国代表大会上的讲话[M].北京:人民卫生出版社,2007.37-41.
71.劳动和社会保障部社会保险研究所.贝弗里奇报告--社会保险和相关服务[M].北京:中国劳动社会保障出版社,2004.
72.王健,孟庆跃.卫生经济学[M].北京:人民卫生出版社,2007.37-41.
73.John Rawls原著,何怀宏,何包钢,廖申白译.《正义论》(外国伦理学名著译丛)[M].北京:中国社会科学出版社,2006.
74.张笑天,王保真.医疗保险原理与方法[M].北京:中国人口出版社,1996.86-96.
75.冯海波.中国农民负担的公平性分析[J].兰州商学院学报,2004,20(3):5-11.
76.成昌慧.山东省农村合作医疗筹资、利用和费用之间数量关系模型研究[D].济南:山东医科大学研究生学位论文,1996:10-14.
77.国务院研究室课题组.农村合作医疗保健制度研究[M].北京:北京医科大学、中国协和医科大学联合出版社,1994.50-58.
78.宁永功.制定新型农村合作医疗实施方案的基本策略[J].中国卫生经济,2006, 25(10):30-33.
79.朱丽萍.新型农村合作医疗筹资的合理性和可持续性评价[J].中国卫生经济,2004,23(5):23-24.
80.李华.中国农村合作医疗制度研究[M].北京:经济科学出版社,2007.161-163.
81.民政部、卫生部、财政部.关于实施农村医疗救助的意见[EB/OL].民发[2003]158号.http://www.moh.gov.cn.
82.农村卫生政策信息.中华人民共和国卫生部[EB/OL].http://www.moh.gov.cn/menunews/B703.htm.
83.新华社讯.新农合今年将增加补助全面覆盖[N].健康报,2008-2-18(1).
84.王国才.按照科学发展观要求抓好新农合工作[J].中国医院管理,2005,25(6):8-10).
85.广东省卫生厅合作医疗办公室.新农合的十二个为什么[EB/OL].http://weisheng.enping.gov.cn/Article/ArticleShow.aspArticleID225.
86.景天魁.围绕农民健康问题:政府、市场、社会的互动[J].河北学刊,2006,26(4):54-62.
87.贾堂宏.农村合作医疗制度若干理论问题研究(下)[J].山东卫生,2005,3:37-39.
88.吴明.卫生部通报新型农村合作医疗试点情况[EB/OL].http://www.96116.net/edu/kjyw/iaoyuxinwen/2006/9/29.2006-9-29.
89.中华人民共和国卫生部.卫生部新型农村合作医疗试点工作评估专题新闻发布会文字实录[EB/OL].http://www.moh.gov.cn/newshtml/15673.htm,2006-09-27.
90.卫生部.第三次国家卫生服务调查主要结果[EB/OL].http://www.moh.gov.cn/open/uploadfile/2004-12-03.
91.周晓媛,毛正中,蒋家林等.对新型农村合作医疗补偿方案中起付线的探讨[J].中国卫生经济,2008,27(1):47-49.
92.李良军,杨树勤.保险因子的初步研究[J].中国卫生事业管理,1994,6:295-299.
93.吴之寿.深圳市医疗保险两种模式的比较[J].中国医院管理,1995,15(9):30-32.
94.田成平.社会保障制度建设[M].北京:人民出版社,2006.19-21.
95.李静.以“覆盖率”和“公平性”衡量社保水平[EB/OL].http://www.theory.people.com.cn/GB/49154/49156/4942238.html,2006-10-21.
96.何德旭,刘奕.中国医疗卫生服务业的体制改革与创新:基于公平和效率视角[M].北京:社会科学文献出版社,2007.209-234.
97.周明浩,李延平,史祖民,等.德尔菲法在卫生城市建设综合评价指标筛选种的应用[J].中国公共卫生管理,2001,17(4):260-263.
98.曾光.现代流行病学方法与应用[M].北京:北京医科大学中国协和医科大学联合出版社,1994.250-270.
99.孙振球,徐勇勇.医学统计学[M].北京:人民卫生出版社,2005.
100.Christophe Sapin,Marie-Claude Simeoni.Reliability and validity of the VSP-A,a health-related quality of life instrument for ill and healthy adolescents.Journal of Adolescent Health 36(2005)327-336.
101.刘平安.医疗救助资金投入要加大[N].健康报,2008-2-18(1).
102.杜乐勋,张文鸣.医疗卫生绿皮书:中国医疗卫生发展报告No.3[M].北京:社会科学文献出版社,2007.98-103.
103.蒋中一.特困人口医疗救助制度和农村新型合作医疗制度的结合[EB/OL].http://www.hbzyw.gov.cn/shownews.asp?id=7553/2007-4-2.
104.卫生部统计信息中心.中国新型农村合作医疗进展及其效果研究[M].北京:中国协和医科大学出版社,2007.41-46.
105.李华.中国新型农村合作医疗制度研究[M].北京:经济科学出版社,2007.172-177.
106.高梦滔,高广颖,刘可.从需求角度分析新型农村合作医疗制度运行的效果[J].中国卫生经济,2005,24(5):9-12.
107.高梦滔,王健.从供给角度对新农合可持续性的思考[J].卫生经济研究,2004,9:3-8.
108.卫生部统计信息中心.中国新型农村合作医疗进展及其效果研究[M].北京:中国协和医科大学出版社,2007.9-19,41-46.
109.冯珊珊.浅议新型农村合作医疗的“自愿参与”原则[J].中国农村卫生事业管理,2005,25(9):14-15.
110.彭光华,郑远俊,何永华.新型农村合作医疗试点工作的实践与思考[EB/OL].http://www.sannong.gov.cn/fxyc/ncjjfx/200412031301.htm/2005-10-12.
111.林闽钢.我国农村合作医疗制度治理结构的转型[J].农业经济问题,2006,5:22-28.
112.高梦滔,高广颖,刘可.对云南省三个新型农村合作医疗试点县(市)的调查报告[J].卫生经济研究,2005,9:3-5.
113.赵晓强,张雪梅.贫困地区农村新型合作医疗参合率和利用率研究--贵州省X 县农村新型合作医疗的调查[J].农业经济问题,2006,6:23-27.
114.钱峰.新农合补助资金拨付办法调整[N].健康报,2007-03-01(1).
115.李斌.论全面实现小康社会的卫生公平性标准[J].中国公共卫生管理,2004,20(1):1-3.
116.王小合.发达地区新型农村合作医疗可持续筹资的路径选择[J].中国卫生经济,2008,27(1):43-46.
117.宁夏回族自治区统计局.2003年宁夏回族自治区国民经济和社会发展公报[EB/OL].http://www.cpirc.org.cn/tjsj/tjsj_gb_detail.asp?id=2807/2004-3-16.
118.宁夏回族自治区统计局.宁夏回族自治区2006年国民经济和社会发展公报[EB/OL].http://cn.chinagate.com.cn/economics/2007-04/09/content_2371941.htm/2007-04-09.
119.山东省统计局.2003年山东省国民经济和社会发展统计公报[EB/OL].http://www.shandong.gov.cn/art/2005/11/10/art_5470_55517.html/2004-2-26.
120.山东省统计局.2006年山东省国民经济和社会发展统计公报[EB/OL].http://www.shandong.gov.cn/art/2007/03/13/art10453_337195.html/2007-03-13.
121.朱伟,田庆丰,朱洪彪.河南省农村地区卫生服务公平性研究[J].卫生经济研究,2001,1:27-29.
122.孟玮,杨士保,谭红专,等.湖南省洞庭湖洪灾区卫生服务公平性研究[J].中国卫生事业管理.2003,(3):138-139.
123.井明霞,刘军,秦江梅,等.乌鲁木刘市居民卫生服务公平性的评价[J].河子大学学报(自然科学版),2003,7(1):29-32.
124.李春芳,王绪建,等.医改对参保职工卫生服务公平性影响作用分析[J].卫生经济研究,2001,(12):41-43.
125.WHO.The World Health Report 2000-Health Systems:Improving Performance.Paris,France.June 2000:188-191.
126.应晓华,刘宝,胡善联,等.不同收入人群家庭筹资公平性研究[J].中华医院管理杂志,2004,20(8):457-460.
127.毛丽梅,方鹏骞,杨年红,等.中国贫困地区特困家庭经济、健康状况卫生服务利用分析评价[J].中国妇幼保健,2002,17(7):406-409.
128.龚幼龙.卫生服务研究[M].上海:复旦大学出版社,2002.
129.李晓梅,罗家洪,何利平,等.云南省新型农村合作医疗试点县农民卫生服务需要分析[J].中国初级卫生保健,2006,20(10):29-31.
130.尹冬梅,胡善联,程晓明,等.中国贫困农村地区卫生服务公平性研究[J].中国卫生经济,1999,18(3):7-10.
131.卫生部统计信息中心.中国新型农村合作医疗进展及其效果研究[M].北京:中国协和医科大学出版社,2007.28-36.
132.叶冬青,何义林,马李,等.安徽省岳西县新型合作医疗对健康和卫生服务公平性影响的研究[J].中华流行病学杂志,2006,27(11):934-938.
133.欧序生.三峡贫困地区农村卫生服务公平性研究[J].中国卫生事业管理,2001,12:746-748.
134.刘丽娜,徐凌中,孙辉,等.威海市农村地区卫生服务需要和利用分析[J].中国卫生经济,2006,25(10):42-44.
135.卫生部统计信息中心.中国卫生服务调查研究:第三次国家卫生服务调查分析报告[M].北京:中国协和医科大学出版社,2004.39.
136.卫生部统计信息中心.中国卫生服务调查研究:第三次国家卫生服务调查分析报告[M].北京:中国协和医科大学出版社,2004.102.
137.朱敏,徐凌中,王兴洲,等.威海市农村居民卫生服务公平性研究[J].中国卫生事业管理,2006,9:557-559.
138.王靖元,邵高泽,徐文彦,等.论新型农村合作医疗基金分割机制与补偿比例[J].中国卫生经济,2005,24(10):9-30.
139.新型农村合作医疗试点工作评估组编著.发展中的中国新型农村合作医疗-新型农村合作医疗试点工作评估报告[M].北京:人民卫生出版社,2006.38-40.
140.任苒,张琳.中国农村贫困地区居民住院医疗服务需求及其影响因素分析[J].中国卫生经济,2002,21(12):1-3.
141.WHO.Who benefits and by how much Who benefits from health sector subsidies? Quantitative Techniques for Health Equity Analysis.Technical Note.12:1-9.
142.Christopher JL Murray,Felicia Knaul,Philip Musgrovc,Ke Xu,Kei Kawabata.Defining and measuring fairness in financial contribution to the health system,World Health Organization,GPE Discussion Paper Series.24.
143.Tin Tin Su,Boear Kouyate,Stefen Flessa.Catastrophic household expenditure for health Cal″e in a low-income society:a study from Nouna District.Burkina Faso.Bulletin of the WOrld Health Organization,2006,84:21-27.
144.杨红燕.建立农村医疗救助制度的若干难点分析[J].卫生经济研究,2005,5:20-22.
145.周恩泽,官波,范国富,等.镇江市医疗救助制度在维护医疗保障公平性中的作用[J].中国卫生经济,2004,23(9):34-35.
146.朱玲.对农牧人口医疗补助的公平性问题的调研[J].卫生经济研究,2006,:14-15.
147.朱玲.农村特困群体医疗救助效果研究[R].农村卫生政策应用研究课题完工报告汇编之二-农村特困医疗救助.北京:卫生部国外贷款办公室,2006.
148.李银河编译.[美]艾尔巴比.社会研究方法[M].成都:四川人民出版社,1987.
149.李颍琰,韩耀风,周文贞,等.农村合作医疗评价指标体系初探[J].中国卫生经济,2004,23(3):21-24.