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目的:评价浙江省新型农村合作医疗(以下简称新农合)改善农村居民收入公平的能力。方法:应用GINI系数和洛伦兹曲线原理,分析筹资、医疗费用和新农合偿付对农村居民收入公平的影响。结果:(1)新农合筹资导致的GINI系数变化非常微弱,筹资后GINI系数只上升了1.7个百分点;(2)新农合偿付对发生医疗费用人群收入公平影响显著,作用力度为42.6%。其中,秀洲区最大,作用力度为45.5%;常山县最小,作用力度为7.6%;(3)不同的新农合偿付方案使其对在不同级别医院发生的住院费用偿付所带来的对GINI系数的影响作用也是不同的。结论:疾病经济负担明显加重了农村居民收入分布的不公平;新农合在改善上述不公平方面的作用已经有相当程度的体现。
Objective: To evaluate the ability of Zhejiang New Rural Cooperative Medical Scheme (NCMS) to improve the income equality of rural residents. Methods: Using GINI coefficient and Lorenz curve principle, the paper analyzes the impact of financing, medical expenses and NCMS reimbursement on income equality of rural residents. Results: (1) The change of GINI coefficient caused by NRCMS financing was very weak, and the GINI coefficient increased by only 1.7 percentage points after financing; (2) NRCMS payment had a significant impact on the income equality of people with medical expenses and the effect was 42.6% . Among them, the Xiuzhou District is the largest, with an effect intensity of 45.5%; Changshan County is the smallest, with a degree of intensity of 7.6%; (3) Different NRCMSs make it possible for different NRCMS reimbursement for hospitalization expenses incurred in different levels of hospitals The effect of GINI coefficient is also different. Conclusion: The economic burdens of diseases obviously aggravate the unfairness of rural residents’ income distribution. The role of NCMS in improving the above-mentioned unfairness has already been reflected to a considerable extent.