A Study On The Causes Of The Medical Expenditure Gap Between Urban And Rural

Since the reform and opening up,China’s medical and health care has developed rapidly,and the demand for medical and health care services of residents has increased,and medical expenditures have also risen.However,due to the historical legacy of the urban-rural dichotomy in China,there is not only an income gap between urban and rural areas,but also differences in medical resources and medical services,which brings about differences in medical expenditures of urban and rural residents and further affects their health.In the context of promoting the equalization of basic public services between urban and rural areas,this paper examines the formation mechanism of the urban-rural medical expenditure gap based on the theory of equal opportunity and the theory of feasible ability,and on this basis,analyzes the current situation and causes of the urbanrural medical expenditure gap from two aspects: inequality of opportunity and inequality of outcome,and designs countermeasure suggestions to alleviate the inequality of access to medical resources and narrow the urban-rural medical expenditure gap.Based on the dual perspectives of equality of opportunity and equality of outcome,this paper examines the current situation of urban-rural medical expenditure gap based on dissecting the formation mechanism of urban-rural medical expenditure gap,relying on CFPS 2014-2018 micro data,using inequality indicators and ex ante parametric method to measure the inequality of outcome and inequality of opportunity of urban-rural medical expenditure,respectively.On this basis,Oaxaca-Blinder and Shapley value decomposition are used to explore the causes of the urban-rural medical expenditure gap,and the Heckman two-step method is used to carry out robustness tests.The findings of this paper are fourfold as follows.First,the inequality of medical expenditure outcomes generally tends to decline,and the inequality of medical expenditure outcomes between urban and rural areas has been alleviated.The inequality of total medical expenditure outcomes between urban and rural areas decreased from 0.2897 in 2014 to 0.2325 in 2018,accounting for a decrease from50.7% to 31.9%;the inequality of out-of-pocket medical expenditure outcomes between urban and rural areas decreased from 0.2520 in 2014 to 0.1696 in 2018,accounting for a decrease from 33.4% to 25.4%.Urban-rural inequality in health care expenditure outcomes still accounts for more than 25% of overall inequality,and inequality in health care expenditure outcomes within urban areas is greater than that in rural areas,with urban areas facing greater inequality in outcomes than rural areas.Second,both the absolute and relative amounts of inequality in medical expenditure opportunities show a small upward trend,and inequality in medical expenditure opportunities between urban and rural areas has expanded.The absolute amount of inequality of opportunity in total medical expenditure rose from 0.1690 in 2014 to 0.1738 in 2018,and the relative amount rose from 21.5% to 23.9%;the absolute amount of inequality of opportunity in out-of-pocket medical expenditure rose from 0.1071 in 2014 to 0.1157 in 2018,and the relative amount rose from 14.2% to 17.3%.The relative amount of inequality between urban and rural health care expenditure outcomes exceeds 8%.The inequality of opportunity within urban areas is greater than that in rural areas,and urban areas face greater inequality of opportunity compared to rural areas.Third,the characteristic effect of inequality in urban and rural health care expenditure outcomes is on the rise,implying that the contribution of unexplained factors is decreasing.The contribution of the characteristic effect to the inequality in the outcome of total urban and rural medical expenditures increased from 44.6% in 2014 to 66.6% in2018,and the contribution of the characteristic effect to the inequality in the outcome of out-of-pocket medical expenditures increased from 46.4% in 2014 to 73.18% in 2018.More than 45% of urban-rural inequality in health care expenditure outcomes can be explained by urban-rural attributes,health insurance,and health care resources.The contribution of medical insurance changed from positive to negative,implying that medical insurance performed the function of regulating the inequality of urban-rural medical expenditure outcomes.Fourth,the contribution of urban-rural attributes and medical insurance factors in the inequality of urban-rural medical expenditure opportunities tends to decrease.The contribution of urban-rural attributes to the inequality of opportunity in total medical expenditures decreases from 46.38% in 2014 to 39.56% in 2018,and the contribution to the inequality of opportunity in out-of-pocket medical expenditures decreases from 41.14%in 2014 to 36.71% in 2018.Medicare’s contribution to inequality of opportunity in total health care expenditures decreased from 46.45% in 2014 to 44.24% in 2018.More than35% of the inequality of opportunity in out-of-pocket health care expenditures is explained by urban-rural attributes,and more than 39% is explained by health insurance.Based on the above empirical findings,this paper focuses on designing corresponding countermeasure suggestions in terms of alleviating the unequal access to urban and rural medical resources and narrowing the gap between urban and rural medical expenditures.First,optimize the allocation of urban and rural medical resources.Increase the investment in rural medical resources,improve rural medical service facilities and personnel training,and promote equal opportunities of urban and rural medical resources.Second,steadily improve the medical insurance treatment for residents.Gradually expand the scope of medical insurance payment,steadily increase the medical insurance payment limit,and play the role of charitable medical assistance to ease the medical burden of rural residents.Finally,improve primary medical services.Promote graded treatment,balance the allocation of primary medical resources,and improve the efficiency and level of primary medical services.