城市医疗救助试点自2005年初开始在全国范围内实施,其筹资与给付结构呈现很大的地区不平等性。第一,人均筹资水平的基尼系数高达0.881,处于极其不平等的状态,我国东部地区不平等程度最大;对于这一不平等,省际差异的贡献率为55.45%,省内各区县之间的差异贡献了38.35%。第二,人均给付水平总的基尼系数为0.652,也呈现极其不平等的状态,而东中西三大地区之间的差异对这一不平等状态的贡献较大。第三,对医疗救助人均筹资和人均给付水平的基尼系数的分解结果显示,省级和中央政府的转移支付没有产生拉平效应,未能对公共服务水平公平的实现发挥应有的作用。因此,健全医疗救助的公共财政体系是进一步努力的方向,其中最为关键的是实现转移支付的制度化。 Since the beginning of 2005, pilot cities for medical assistance have been implemented throughout the country, and their funding and payment structures have shown great regional inequality. First, the Gini coefficient per capita raised as high as 0.881, in an extremely unequal state, with the greatest degree of inequality in the eastern part of China. For this inequality, the contribution rate of inter-provincial disparity was 55.45%. Between the districts and counties in the province The difference contributed 38.35%. Second, the overall Gini coefficient per capita was 0.652, which also showed extremely unequal status. However, the differences between the three eastern, central and eastern regions contributed more to this inequality. Thirdly, the decomposition of the Gini coefficient of per capita financing and per capita payment of medical aid shows that the transfer payments of the provincial and central governments have not produced the smoothing effect and have failed to play their due role in the fair realization of public service levels. Therefore, improve the public financial system of medical aid is the direction of further efforts, of which the most crucial is the institutionalization of transfer payments.