McPake B
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, U.K.
Soc Sci Med. 1993 Jun;36(11):1397-405. doi: 10.1016/0277-9536(93)90382-e.
Literature suggests that in theory, the efficiency of user charges for health services is related to the level of externality, the price elasticity of demand, the proportion of total costs which are private access costs, and the level of the government budget constraint. Theoretical models predict that price elasticity of demand for health services is likely to be higher for lower income groups and that user charges are therefore unlikely to promote equity, or reduce the discrepancies between the utilisation rates of the rich and poor, 'ceteris paribus'. Empirical evidence tends to confirm the latter prediction but to suggest that user charges in many countries provide the scope for welfare gains for the majority. Unfortunately, this scope is seldom exploited in practice. It is argued that many countries have little choice but to try to exploit the potential for majority gains, but that more emphasis should be placed on ensuring quality improvements than on superficial financial measures of success.
文献表明，理论上，医疗卫生服务使用者付费的效率与外部性水平、需求价格弹性、私人就诊成本占总成本的比例以及政府预算约束水平有关。理论模型预测，在其他条件相同的情况下，低收入群体对医疗卫生服务的需求价格弹性可能更高，因此使用者付费不太可能促进公平，或缩小贫富之间的利用率差异。实证证据倾向于证实后一种预测，但也表明许多国家的使用者付费为大多数人带来了福利增加的空间。不幸的是，这种空间在实践中很少被利用。有人认为，许多国家别无选择，只能尝试利用多数人受益的潜力，但应更加强调确保质量提升，而非表面的财务成功指标。
