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我国自2003年试点与实施新农合制度以来,已经取得诸多成果,其筹资和受益的区域差异性作为核心问题之一,一直备受关注。本文以地级市的指标数据为基础,将全国划分为三大地带间、带内省际间和省内市际间三个级次,利用泰尔指数二阶嵌套分解方法进行测算。结果表明,带内省际间差异是造成新农合不均等化的主要原因,2013年对筹资不均等贡献率高达70.74%,其次为省内市际间差异,影响最小的是三大地带间差异。因此,我国需要从区域经济发展策略、财政支出结构调整、基层医疗卫生服务资源和财政补贴等方面进一步完善新农合制度。
Since 2003, when piloting and implementing the NCMS system in our country, many achievements have been made. As one of the core issues, the regional differences in its funding and benefits have drawn great attention. Based on the index data of prefecture-level cities, this paper divides the country into three levels: the three major zones, the provincial-level inter-provincial and the provincial-level inter-city levels, and uses the Theil index second-order nested decomposition method to calculate. The results show that in-band disparity among provinces is the main reason for the unequalization of NCMS. In 2013, the contribution rate to non-uniform financing was as high as 70.74%, followed by inter-city and inter-provincial discrepancies, with the least impact being among the three major inter- difference. Therefore, our country needs to further improve the NCMS system from the aspects of the regional economic development strategy, the adjustment of the fiscal expenditure structure, the grass-roots medical and health service resources and the financial subsidies.