中国自付费用的空间溢出是什么驱动的？
What has driven the spatial spillover of China's out-of-pocket payments?
机构信息
School of Public Health, Jilin University, Changchun City, Jilin Province, China.
School of Management, Changchun University of Chinese Medicine, No. 1035, Bo Shuo Road, Jing Yue District, Changchun City, 130117, Jilin Province, China.
出版信息
BMC Health Serv Res. 2019 Aug 30;19(1):610. doi: 10.1186/s12913-019-4451-0.
BACKGROUND
Even though China launched a series of measures to alleviate several financial burdens (including health insurance scheme, increased government investment, and so on), the economic burden of health expenditure has still not been alleviated. Out-of-pocket payments (OPPs) show not only a time correlation but also some degree of spatial correlation. The aims of the current study were thus to identify the spatial cluster of OPPs, to investigate the main factors affecting variation, and to explore the spatial spillover sources of China's OPP.
METHODS
Global and local spatial autocorrelation tests were validated to identify the spatial cluster of OPPs using the panel data of 31 provinces in China from 2005 to 2016. The Spatial Durbin Model, established in this paper, measured the spatial spillover effect of OPPs and analyzed the possible spillover sources (demand, supply, and socio-economic factors.
RESULTS
OPPs were found to have a significant and positive spatial correlation. The results of the Spatial Durbin Model showed the direct and indirect effects of demand, supply, and socio- economic factors on China's OPPs. Among the demand factors, the direct and indirect correlation (elasticity) coefficients were positive. Among the supply factors, the direct and indirect effects of the share of primary health beds on residents' OPPs were negative. The ratio of health technicians in hospitals to those in primary health institutions on per capital OPPs had a significant indirect effect. Among the socio-economic factors, the direct effects of GDP, government health expenditure, and urbanization on OPPs were found to be positive. There were no significant indirect effects of socio-economic factors on OPPs.
CONCLUSION
This paper finds that China's OPPs are not randomly distributed but, overall, present a positive spatial cluster, even though a series of measures have been launched to promote health equity. Socio-economic factors and those associated with demand were found to be the main influences of variation in OPPs, while demand was seen to be the driver of the positive spatial spillover of OPPs, whereby effective supply could inhibit these positive spillover effects.
背景
尽管中国出台了一系列缓解多重财政负担（包括医疗保险计划、增加政府投资等）的措施，但医疗支出的经济负担仍未得到缓解。自付费用（OPP）不仅表现出时间相关性，还有一定程度的空间相关性。因此，本研究旨在识别 OPP 的空间集聚，探讨影响变异的主要因素，并探索中国 OPP 的空间溢出来源。
方法
使用 2005 年至 2016 年中国 31 个省份的面板数据，通过全局和局部空间自相关检验来识别 OPP 的空间集聚。本文建立的空间杜宾模型衡量了 OPP 的空间溢出效应，并分析了可能的溢出来源（需求、供应和社会经济因素）。
结果
发现 OPP 具有显著的正空间相关性。空间杜宾模型的结果表明，需求、供应和社会经济因素对中国 OPP 有直接和间接的影响。在需求因素中，直接和间接相关（弹性）系数为正。在供应因素中，基层卫生床位比例对居民 OPP 的直接和间接影响为负。医院卫生技术人员与基层卫生机构卫生技术人员之比对人均 OPP 有显著的间接影响。在社会经济因素中，发现 GDP、政府卫生支出和城市化对 OPP 的直接影响为正。社会经济因素对 OPP 没有显著的间接影响。
结论
本文发现，尽管中国出台了一系列促进卫生公平的措施，但中国的 OPP 并非随机分布，而是整体上呈现出正空间集聚。社会经济因素和与需求相关的因素是 OPP 变化的主要影响因素，而需求是 OPP 积极空间溢出的驱动力，有效的供应可以抑制这些积极的溢出效应。
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