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目的:通过对全面实行省直管县财政体制以及该体制下省级财政转移支付制度的典型调查,实证分析其对全民基本医疗保险筹资均等化的促进效应。方法:采集2008—2012年浙江省6个不同经济类型市(县)所在统筹地区城乡基本医保筹资水平的数据资料,综合运用差异系数、泰尔指数及基尼系数法测评省级财政转移支付前后基本医保筹资水平均等化程度及促进效应。结果:2008—2012年,每年省级财政转移支付后基本医保间、基本医保内人均筹资水平的泰尔指数及基尼系数均小于转移支付前的;转移支付前后基本医保间的筹资不均等程度大于基本医保内;基本医保间、基本医保内及总的泰尔指数、基尼系数转移支付前后整体上均呈现逐年下降趋势;省级转移支付对城乡基本医保筹资均等化的调节效应呈现逐年增大态势,其对新型农村合作医疗的调节效应均大于城镇居民基本医保。结论:该省直管县财政体制及其转移支付制度有效促进了全民基本医保人均筹资水平的均等化进程。建议该省应进一步激活和发挥省直管县财政体制优势,探寻并科学建立该体制下省级公共财政,对不同经济类型区域及城乡全民基本医保间有效持续动态的差别化筹资机制和转移支付制度设计。
OBJECTIVE: Empirical analysis of the promotion effect on the equalization of universal basic medical insurance funding through the full implementation of a typical survey of the provincial financial system and provincial financial transfer payment system under the system. Methods: The data of basic medical insurance of urban and rural areas in the co-ordinating areas where 6 different economic types cities (counties) in Zhejiang Province from 2008 to 2012 were collected were collected. The difference coefficient, the Theil index and the Gini coefficient method were used to evaluate the basic data before and after the provincial financial transfer payment Medical insurance funding level of equalization and promotion effect. Results: From 2008 to 2012, the Thier index and the Gini coefficient of basic health insurance and basic medical insurance per capita after the provincial fiscal transfer were less than those before transfer payment. The degree of funding inequality between basic medical insurance before and after transfer payment was greater than The basic Medicare, basic Medicare and the total Theil index, Gini coefficient before and after the transfer payment showed a downward trend year by year; provincial transfer payments on the urban and rural basic medical insurance equalization of the adjustment effect showed a trend of increasing year by year , Its regulation effects on the new rural cooperative medical system are greater than the basic medical insurance for urban residents. Conclusion: The financial system of the directly administered counties in the province and its transfer payment system have effectively promoted the equalization of per capita funding levels for universal health care. It is suggested that the province should further activate and give play to the advantages of the province’s direct financial system, explore and scientifically set up provincial-level public finance under this system, differentiated financing mechanisms and transfer payments for effective sustainable development of basic medical insurance for all types of people in different economic types and between urban and rural areas, System Design.