The Reform of Medical Care System and Health Equity for the Elderly Population in China：A study in Zhejiang

健康公平是全民医保的理论基础，也是医疗保障制度改革追求的目标。本文从“弱者优先”的健康公平理论出发，以浙江为例，以质化研究与量化研究相结合的方式，分析了医疗保障制度改革对老年人群健康公平的影响。基于结构方程的非递归路径模型分析显示，职工医保和城居医保制度提高了老年参保者的医疗服务利用水平，从而增进了健康公平，但新农合的参保老人与未参保老人在医疗服务利用和健康结果方面均未呈现显著差异，原因是其保障待遇过低和制度设计缺陷。质化研究进一步显示，在医疗服务输送过程中几类弱势老年人群的健康结果公平尚未得到充分保障。因此，要强化健康公平的理念，使基本医疗保险由机会公平转向健康结果公平，加快构建全民医保和失能老人长期照护体系。

Health equity is the theoretical basis for universal health insurance and the target of medical care system reform.From the perspective of “vulnerable groupfirst” health equity theory, this article takes Zhejiang province as an example, and adopts a mixedmethod approach to explore effects of the reform of medical care system on health equity for elderly people.The analysis of SEMbased nonrecursive model demonstrates an improvement of health equity for policy holders of the Basic Medical Insurance for Employee and the Urban Basic Medical Insurance for Residents as a result of an increasing usage of health care.Yet, there is little difference in terms of the usage of medical care and health condition between the elderly insured by the New Rural Cooperative Medical System and those without health insurance.This is resulted from the lowlevel benefits of the insurance policy and defective policy design.A qualitative analysis further discovers the insufficient protection for outcomebased health equity for several types of vulnerable elderly groups in the process of health care delivery.Finally, this study advocates “health equity for vulnerable groups”, a transition from emphasizing opportunity equity to outcome equity, and the construction of universal health insurance and longterm care system for the disabled elderly.

刘晓婷 黄洪

国家社科基金青年项目“老年人群基本医疗保险待遇差距研究”（14CSH056）、国家社科基金重大项目“人口老龄化与长寿风险管理的理论和政策研究”（13&ZD163）

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