摘要
Abstract
Equitable financing is a fundamental prerequisite for ensuring fairness at the starting point in medical assistance systems.Based on provincial panel data from 2013 to 2023,this study employs inequality measurement indicators,including the Gini coefficient and concentration index,along with their decomposition methods,to systematically assess the equity of medical assistance financing in China and analyze its underlying mechanisms.The findings reveal three key insights:First,China's medical assistance financing exhibits horizontal inequity with a clear"pro-rich"bias,with disparities in local fiscal capacity being the primary contributing factor to regional funding inequality.Second,although central fiscal transfers help alleviate regional funding imbalances,their redistributive effect remains limited.Third,the weakening of central fiscal responsibility and the insufficient emphasis on pro-poor indicators in allocation formulas constrain the redistributive efficacy of central government funding.Dynamic trend analysis further indicates that during the critical poverty alleviation period(2018-2020),the strengthened role of central government in medical assistance financing significantly enhanced equity.However,this progress showed signs of reversal in the post-poverty-eradication period,undermining the sustainability of equity improvements.Based on these findings,this study proposes several policy recommendations:rationally delineating funding responsibilities between central and local governments,improving the intergovernmental transfer payment system,and effectively leveraging the role of the third distribution to promote greater equity in medical assistance financing.关键词
医疗救助/筹资水平/横向公平/财政分权Key words
medical assistance/financing equity/regional inequality/fiscal decentralization
