关键词: 全民健康覆盖, 卫生保健费用, 卫生保健公平提供, 卫生政策

Abstract: Objective　To analyze the status and equity of health expenditure among urban and rural residents in the process of achieving universal health coverage，giving policy suggestions.Methods　From the results of National Health Services Survey in China，2013，data of Shandong Province were collected，involving a total of 33 060 individuals from 12 006 families（10 391 from 6 006 urban families，and 22 669 from 6 000 rural families）.Quinquepartite method was adopted to classify the annual household income.The status and equity of health expenditure of the participants were analyzed by residency place and level of income.Results　The rural families had lower median annual healthcare expenditure but higher median total cost per outpatient visit，and median total cost per hospitalization compared with the urban families（P<0.05）.The median total cost per hospitalization differed significantly between rural families by level of annual household income（P<0.05），but median annual healthcare expenditure and median total cost per outpatient visit did not（P>0.05）.The median total cost per outpatient visit did not vary significantly between the urban families by level of annual household income（P>0.05）.Higher median annual healthcare expenditure and median cost per hospitalization were positively associated with higher annual household income in the urban families（P<0.05）.From 2003 to 2016，the Engel coefficient of rural residents dropped from 41.81% to 29.76%，and that of urban residents was 27.58% in 2016.The ratio of annual health expenditure to income rose from 4.41% to 7.36% in rural residents while it dropped from 5.29% to 4.73% in urban residents during this period.The concentration curve of median annual rural household health expenditure almost coincided with the 45-degree line（CI=0.016 4），while that of median annual urban household health expenditure was below the egalitarian line（CI=0.092 1），the concentration curve of median annual urban and rural household health expenditure was below the 45-degree line（CI=0.039 0）.The concentration curves of median annual cost of outpatient expenditure of rural residents，urban residents and all the residents were all above the 45-degree line.The CI value of paying outpatient expenditure with cash was -0.064 2，-0.094 1，-0.393 3，respectively，for all the residents，rural residents and urban residents.The hospitalization expenditure of the urban and rural residents with high income occupied most of the total hospitalization expenditure（CI=0.013 0）.The concentration curve of the median total cost per outpatient visit in rural residents almost coincided with the 45-degree line（CI=-0.002 6）.The concentration curve of the median annual hospitalization expenditure of urban residents was below the egalitarian line on the whole（CI=0.047 1）.Conclusion　Compared with urban areas，the median household healthcare expenditure is lower and median outpatient/inpatient expenditure per capita is higher in rural areas. In general，the equity of health expenditure in rural residents is worse than that of urban residents. Moreover，low income rural residents are found with higher ratio of annual household healthcare expenditure to annual household income，and higher ratios of annual outpatient and inpatient expenditure per family member to annual household income. In order to achieve universal health coverage，rural residents，especially those with low income，should be placed into priority groups whose health coverage should be enhanced，and the affordability of healthcare should be increased by improving the healthcare financing strategies and health insurance systems，and strengthening the interventions for reducing disease risks in low-income and middle-income rural residents.

Key words: Universal health coverage, Health care costs, Health care rationing, Health policy