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筹资公平是医疗救助制度实现起点公平的重要基础。基于2013—2023年省级面板数据，综合运用基尼系数、集中指数等不平等测度指标及分解方法，本研究系统测度了我国医疗救助的筹资公平性及其形成机制。实证结果表明：我国医疗救助筹资呈现显著的“亲富性”横向不公平特征，地方财政能力差异是区域筹资不平等的主要贡献因素；中央转移支付虽在一定程度上缓解了筹资的区域失衡，但其调节力度仍存在明显不足；中央财政筹资责任弱化及资金分配中扶弱性指标权重偏低，制约中央财政的调节效能。动态趋势显示，2018—2020年脱贫攻坚关键阶段，中央财政筹资责任的强化显著提升了其均衡效应，但全面脱贫后呈现回调态势，导致其公平性改善的可持续性不足。基于上述发现，本研究建议从合理划分筹资责任、完善转移支付制度、有效发挥第三次分配作用等方面进一步提升医疗救助的筹资公平性。

Equitable financing is a fundamental prerequisite for ensuring fairness at the starting point in medical assistance systems. Based on provincial panel data from 2013 to 2023, this study employs inequality measurement indicators, including the Gini coe fficient and concentration index, along with their decomposition methods, to systematically assess the equity of medical assistance financing in China and analyze its underlying mechanisms. The findings reveal three key insights: First, China's medical assistance financing exhibits horizontal inequity with a clear "pro-rich" bias, with disparities in local fiscal capacity being the primary contributing factor to regional funding inequality. Second, although central fiscal transfers help alleviate regional funding imbalances, their redistributive ef fect remains limited. Third, the weakening of central fiscal responsibility and the insu fficient emphasis on pro-poor indicators in allocation formulas constrain the redistributive e fficacy of central government funding. Dynamic trend analysis further indicates that during the critical poverty alleviation period(2018–2020), the strengthened role of central government in medical assistance financing significantly enhanced equity. However, this progress showed signs of reversal in the post-poverty-eradication period, undermining the sustainability of equity improvements.Based on these findings, this study proposes several policy recommendations: rationally delineating funding responsibilities between central and local governments, improving the intergovernmental transfer payment system, and effectively leveraging the role of the third distribution to promote greater equity in medical assistance financing.