“环境”还是“努力”?——医疗服务利用不平等的夏普里值分解Circumstance or Effort?——The Shapley Value Decomposition of Inequality in Health Care Utilization
赵广川,马超,顾海,孙徐辉
摘要(Abstract)：
本文在Roemer机会平等理论的基础上,利用基于回归的夏普里值分解,对1991-2011年CHNS数据进行分析,详细考察了"环境""努力"以及它们内部各因素对医疗服务利用不平等的贡献及其变化趋势。从历年的均值来看,机会不平等约为0.067~0.488,占总不平等的11.56%~84.02%。具体的贡献率大小排序表明,除健康状况外,"环境"中户口(3.85%~5.61%)、工作状态(2.33%~4.47%)、教育(1.81%~2.67%)、收入(0.59%~1.48%)以及"努力"因素中的年龄(2.26%~4.11%)是影响医疗服务利用不平等最重要的因素。长期来看,健康状况、年龄的贡献有先升后降的趋势,工作状态的贡献在下降,而户口、教育和收入的贡献呈现一定的波动。
关键词(KeyWords)： 机会平等;基尼系数的子群分解;基于回归的夏普里值分解;医疗服务利用
基金项目(Foundation): 国家自然科学基金资助项目“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);; 江苏省自然科学基金项目“城乡医保统筹对农村老年居民医疗服务利用公平性的影响”(BK20150646)
作者(Author): 赵广川,马超,顾海,孙徐辉
DOI: 10.16513/j.cnki.cje.2015.03.005
参考文献(References)：
- 陈斌开,杨依山,许伟.2009.中国城镇居民劳动收入差距演变及其原因:1990—2005[J].经济研究,(12):30-42.
- 陈纯槿,李实.2013.城镇劳动力市场结构变迁与收入不平等:1989—2009[J].管理世界,(1):45-55.
- 陈璐,陈兴宝,夏妤.2007.上海郊区居民健康状况和医疗服务利用公平性研究[J].中国初级卫生保健,21(11):23-26.
- 高建民,周忠良.2007.互助医疗改善卫生服务公平性的效果评价[J].中国卫生经济,26(10):39-42.
- 雷晓燕,谭力,赵耀辉.2010.退休会影响健康吗?[J].经济学季刊,(4):1539-1558.
- 李建,范翠萍,冯芮华等.2014.湖南三县农村居民卫生服务利用公平性分析[J].中国农村卫生事业管理,34(3):245-247.
- 林相森,艾春荣.2009.对中国医疗服务利用不平等问题的实证检验[J].中国人口科学,(3):86-95.
- 刘广彬.2009.教育与居民健康:我国教育的健康收益实证研究[D].东北财经大学.
- 马超,顾海,韩建字.2014.我国健康服务利用的机会不平等研究——基于CHNS2009数据的实证分析[J].公共管理学报,(11):91-100.
- 毛璐,秦江梅,芮东升等.2013.东中西部城市卫生服务利用公平性比较:基于社区卫生综合改革典型城市居民健康询问调查[J].中国卫生经济,(11):54-56.
- 齐良书,李子奈.2011.与收入相关的健康和医疗服务利用流动性[J].经济研究,(9):83-95.
- 万广华.2006.经济发展与收入不均等:方法和证据[M].上海:上海三联书店,上海人民出版社.
- 魏众,古斯塔夫森.2005.中国居民医疗支出不公平性分析[J].经济研究,(12):126-134.
- 吴愈晓.2013.中国城乡居民的教育机会不平等及其演变(1978-2008)[J].中国社会科学,(3):4-22.
- 解垩.2009.与收入相关的健康及医疗服务利用不平等研究[J].经济研究,(2):92-105.
- 许东霞,秦江梅,唐景霞等.2012.新疆生产建设兵团门诊和住院服务公平性分析[J].中国卫生经济,31(3):55-56.
- 张晓波.2003.中国教育和医疗卫生中的不平等问题[J].经济学(季刊),(2):1-13.
- 赵郁馨,张毓辉,唐景霞等.2005.卫生服务利用公平性案例研究[J].中国卫生经济,24(7):5-7.
- Balia S,Jones A M.2011.Catching the habit:A study of inequality of opportunity in smoking-related mortality[J].Journal of the Royal Statistical Society-.Series A(Statistics in Society),174(1):175-194.
- Chen Z,Wan G,Lu M.2011.Inter-industry inequality:An important source of the urban income gap—Regression-based decomposition[J].Social Sciences in China,32(5):159-177.
- Cook B L,McGuire T G,Meara E,et al.2009.Adjusting for health status in nonlinear models of health care disparities[J].Health Services and Outcomes Research Methodology,9(1):1-21.
- Cook B L,McGuire T G,Lock K,et al.2010.Comparing methods of racial and ethnic disparities measurement across different settings of mental health care[J].Health Services Research,45(3):825-847.
- Daniels,N.1985.Just health care[M].Cambridge:Cambridge University Press.
- Daniels,N.1996.Justice,fair procedures,and the goals of medicine[J].Hastings Center Report,26(6):10-12.
- Dworkin R.1981a.What is equality?Part 1:Equality of welfare[J].Philosophy&Public Affairs,10(3):185-246.
- Dworkin R.1981b.What is equality?Part 2:Equality of welfare[J].Philosophy&Public Affairs,10(4):283-345.
- Ferreira F H G,Gignoux J.2011.The measurement of inequality of opportunity:Theory and an application to Latin America[J].Review of Income and Wealth,57(4):622-657.
- Fleurbaey M,Schokkaert E.2011.Equity in health and health care[J].Handbook of Health Economics,Amsterdam:North Holland,2:1003-1092.
- Garcia-Gomez P,Schokkaert E,Van Ourti T,et al.2014.Inequity in the face of death[J].Health Economics,coming soon.
- Grossman M.1972.The demand for health:A theoretical and empirical investigation[M]//National Bureau of Economic Research.New York:Columbia University Press.
- Jusot F,Tubeuf S,Trannoy A.2013.Circumstances and efforts:How important is their correlation for the measurement of inequality of opportunity in health?[J].Health Economics,22(12):1470-1495.
- Petrie D J,Tang K K.2008.A rethink on measuring health inequalities using the Gini coefficient[R].School of Economics Discussion Paper No.381.
- Pignataro G.2010.Measuring equality of opportunity by shapley value[J].Economics Bulletin,30(1):786-798.
- Roemer J E.1998.Equality of Opportunity[M].Cambridge:Cambridge University Press.
- Roemer J E,Trannoy A.2013.Equality of opportunity[R].Cowles Foundation Discussion Paper No.1921,Cowles Foundation for Research in Economics,Yale University.
- Rosa Dias P.2009.Inequality of opportunity in health:Evidence from a UK cohort study[J].Health Economics,18(9):1057-1074.
- Shorrocks A F.1999.Decomposition procedures for distributional analysis:A unified framework based on the Shapley value[R].Unpublished manuscript,Department of Economics,University of Essex.
- Trannoy A,Tubeuf S,Jusot F M.2010a.Inequality of opportunities in health in France:A first pass[J].Health Economics,19(8):921-938.
- Trannoy A,Tubeuf S,Jusot F M.2010b.Inequality of opportunities in health in Europe:Why so much difference across countries?[R].Health Econometrics and Data Group(HEDG)Working Papers.
- Van Doorslaer E,Clarke P,Savage E,et al.2008.Horizontal inequities in Australia's mixed public/private health care system[J].Health Policy,86(1):97-108.
- Wan G.2004.Accounting for income inequality in rural China:A regression-based approach[J].Journal of Comparative Economics,32(2):348-363.
- Wooldridge J M.2010.Introductory econometrics:A modern approach[M].4th ed.Beijing:Tsinghua University Press.
- Yang J,Huang X.Liu X.2014.An analysis of education inequality in China[J].International Journal of Educational Development,37:2-10.
- Zhang Y,Eriksson T.2010.Inequality of opportunity and income inequality in nine Chinese provinces,1989—2006[J].China Economic Review,21(4):607-616.
- Zheng B.2006.Measuring health inequality and health opportunity[C]//Unpublished Work,presented at the 2nd Meeting of the Society for the Study of Economic Inequality(ECINEQ).
- ①如本研究的表3计算所示。
- ①更多了解基于回归的夏普里值分解,请参考万广华(2006)。
- ①该数据来自《2013年中国卫生统计年鉴》及其计算。
- ①更详细讨论教育与健康之间的关系,请参考刘广彬2009年的博士论文《教育与居民健康:我国教育的健康收益实证研究》。
- ②限于篇幅,城镇样本和农村样本详细的分解结果未在文中展示。
- ①数据来自卫生部《2003—2007我国卫生发展情况简报》及第六次人口普查公布资料。