中国和国际卫生总费用核算指标口径的比较研究

卫生总费用已成为国内外开展卫生政策分析和评价的重要工具.目前,我国公布的是筹资来源法的核算结果(政府卫生支出、社会卫生支出和居民个人现金卫生支出),国际上公布的是筹资机构法的核算结果(广义政府卫生支出和私人部门卫生支出).为避免国内外开展政策分析时因引用数据带来的偏差,需要对我国和国际卫生总费用分类方法和指标口径进行比较研究.文章描述了国际卫生总费用(筹资机构法)核算指标分类口径,梳理了我国卫生总费用(筹资来源法)核算指标分类口径,并对国内外卫生总费用核算指标进行了对比衔接,最后利用主要指标对卫生政策进行了简要分析评价.     

基于卫生总费用核算结果的卫生政策分析框架

从政策分析框架的概念出发,针对卫生总费用核算结果涉及的卫生资金来源、使用、用途和产生的结果等政策分析的主要问题,提出了福利经济学的政策分析准则,并从收益分配公平、成本分配公平、配置效率和技术效率的维度,对相关政策分析问题进行了组织和梳理,建立了基于卫生总费用核算结果的卫生政策分析的基本框架。     

我国和国际卫生总费用核算指标口径的比较研究

卫生总费用已成为国内外开展卫生政策分析和评价的重要工具。目前,我国公布的是筹资来源法的核算结果(政府卫生支出、社会卫生支出和居民个人现金卫生支出),国际上公布的是筹资机构法的核算结果(广义政府卫生支出和私人部门卫生支出)。为避免国内外开展政策分析时因引用数据带来的偏差,需要对我国和国际卫生总费用分类方法和指标口径进行比较研究。文章描述了国际卫生总费用(筹资机构法)核算指标分类口径,梳理了我国卫生总费用(筹资来源法)核算指标分类口径,并对国内外卫生总费用核算指标进行了对比衔接,最后利用主要指标对卫生政策进行了简要分析评价。     

2020年中国卫生总费用核算结果与分析

目的:核算2020年中国卫生总费用,分析"十三五"时期中国卫生筹资取得的成绩,总结当前中国卫生筹资面临的主要问题,提出完善卫生筹资体系的政策建议.方法:采用来源法和机构法核算卫生费用,采用时间序列的指标分析法分析中国卫生总费用变化情况.结果:2020年中国卫生总费用为72175.00亿元,占GDP比重为7.12％,人均...     

山东省卫生总费用的基本特征及未来展望

在深化医药卫生体制改革的当前,利用省级卫生总费用核算结果开展卫生筹资政策评价研究具有重要的现实意义。文章利用1998-2011年山东省卫生总费用的核算结果,总结山东省卫生总费用基本特征,观察政策对山东省卫生筹资带来的新变化,并对未来卫生筹资情况进行展望,以促进卫生事业更快更好发展。     

中国卫生总费用分配流向核算指标体系及测算方法研究

卫生总费用核算要反映全社会卫生资金的筹集、分配和使用的资金运动全过程,为此,要从卫生资金的筹集来源、分配流向和使用耗费三个层次建立完整的核算体系。卫生总费用分配流向核算是反映从全社会筹集的卫生资金,在各种分配和补偿政策作用下,流向卫生服务各领域和服务项目的资金量,为分析、评价和调整卫生资金分配和补偿政策提供依     

2011年中国卫生总费用核算结果与分析

目的:通过卫生总费用核算结果,分析医改以来中国卫生筹资特征与变化趋势。方法:参考国民经济核算制度,卫生部卫生发展研究中心建立了卫生费用核算制度,分初步核算和最终核算采用专门的方法测算卫生总费用,并对初步核算方法可行性进行验证。结果:初步核算具有很高的准确度,可用于卫生政策分析与决策,从而显著提高了卫生总费用政策时效性。最终核算结果显示,2011年中国卫生总费用为24 345.91亿元,占GDP比重为5.15%,其中政府卫生支出比重超过30%,个人卫生支出占比下降到35%以下。结论:医改以来政府卫生投入力度明显加大,投入重点向基本医疗保险和基层卫生机构倾斜,符合医改文件提出的要求;居民个人现金卫生支出比重持续下降,卫生筹资结构明显改善。     

1997年安徽省卫生总费用测算与分析

卫生总费用是卫生经济宏观分析的一个重要的经济范畴。研究卫生总费用的目的是反映、分析与评价卫生资金的筹集、分配与使用 ,以及资金使用的效率、效果和社会影响。卫生总费用的研究在卫生筹资战略、卫生资源配置、制订卫生经济政策以及卫生社会与经济效益综合评价等方面都具有重要的理论与实践意义。本文在过去研究的基础上 ,通过筹资来源法对1997年安徽省卫生总费用进行了测算 ,并作如下分析评价。1　卫生总费用筹资水平1997年安徽省卫生总费用为 986 2 45 .6 3万元 ,人均卫生费用为 16 1.44元 ,卫生总费用占国内生产总值 (GDP)比重为3…     

中国卫生总费用分配流向研究报告

本文作者以经济合作与发展组织(OECD)和世界银行1993年发展报告撰稿人提供的卫生总费用定义、口径和指标体系为指导,以我国国民经济统计、卫生统计和卫生财务报表的指标体系为核算依据,按照卫生总费用分配流向,测算了从1978年到1994年中国卫生总费用(1995年中国卫生总费用是预测值),对测算结果进行了初步的分析评价,提出有关政策建议。     

上海市卫生总费用现状分析

目标:分析上海市卫生费用的筹资来源,并进行国内外比较。资料与方法:在国家卫生总费用核算框架的指导下,参考国际卫生总费用核算经验,应用上海市卫生总费用核算研究资料,进行描述性分析和比较。结果:2001—2007年上海市卫生总费用占GDP的比重介于3.84%～3.98%,卫生总费用年均增长12.98%,基本与上海市生产总值增长相协调。上海市卫生总费用的构成状况总体呈"一升一降一平稳"的态势,2007年政府、社会和个人卫生支出分别占卫生总费用的20.47%、57.34%和22.19%。个人现金卫生支出比例的下降并不代表群众不存在"看病贵"问题,其背后仍隐含不少问题。建议:适当提高卫生总费用占GDP的比例,加大政府卫生投入力度,建立长效的卫生投入机制,新增卫生投入重点投向基层医疗卫生服务体系和公共卫生体系,将个人现金卫生支出的比例控制在合理的范围内。     

运用综合指数法进行孕产妇保健费用投入额度测算

公共卫生是政府具备的一项基本职能,该文从我国现状出发,探索更适宜的公共卫生政府投入的方式方法.采用综合指数法对孕产妇保健费用投入额度进行了测算.发现高投入带来高产出,同时避免了日后更多的追加费用投入,并且综合指数法适用于单项目的投入费用预算及项目资金在地区间的分配.建议政府应坚持预防为主的方针,转变政府职能,代表人民购买卫生.     

Triangulating health expenditure estimates from different data sources in developing countries

This article deals with the accuracy of statistical records used for political decision making and international comparative analysis. In developing countries, even major macroeconomic indicators can include data inadequacies and methodological differences in data generation between statistical agencies. Existing data show that total health expenditure as a percentage of GDP is about 50% lower in Pakistan than in other low-income countries (LIC). To determine whether these results reflect the actual situation in Pakistan or whether they are due to statistical error, Pakistan produced National Health Accounts (NHA) for the first time in 2009 to assess health spending in 2005-6. Improved NHA estimates are also being made for 2007-8, which will be based on the following: public expenditure data published with time lags; survey results for 2007-8; and multivariate analyses of data from 2010 and 2011 surveys on health-specific out-of-pocket (OOP) expenditure, healthcare providers, non-profit institutions and census data on autonomous bodies and large hospitals. Since these data are not yet available, a best estimate of health expenditure has to be made to support policy decision making and to provide a point of comparison for future NHA results. Health expenditure data are available from different data sources and estimates have been made by applying different methods, leading to a range of health spending estimates. As a result of this diversity of estimates and data, each with its own inaccuracies or gaps, there was a clear need to triangulate the available information and to identify a best possible estimate. This article compares estimates of household health expenditure from different sources, such as the Household Integrated Economic Survey, the Family Budget Survey and National Accounts (NA). The analysis shows that health expenditure figures for Pakistan have been underestimated by both WHO and the NHA. An adjusted estimate shows OOP spending to be twice as high as previously thought. Previous per capita total health expenditure estimates ranged from $US16 to $US19. The revised estimate showed per capita total health expenditure to be $US33, based on NA data. This puts Pakistan in a different position in international comparisons, with health expenditure exceeding the level of India ($US32.5) and the average of all LIC ($US24.5). Methodological differences in estimating expenditure and the multiple and conflicting estimates might cause stakeholders to make potentially adverse or even erroneous policy decisions on the allocation of resources. Because policy makers make decisions based on the estimates provided, the provision of a best estimate, made following a review of the advantages and limitations of existing sources and methods, is key.     

基于健康产出的卫生总费用与GDP的关系研究

目的:为我国卫生事业的发展中卫生总费用指标的评价提供参考。方法:选用国内外通用性更好的卫生总费用占GDP比重、广义政府卫生支出占GDP比重两个卫生费用指标,以及出生时的期望寿命、婴儿死亡率、新生儿死亡率、5岁以下儿童死亡率4个健康产出指标,分析不同GDP水平下,卫生费用指标处于何种水平时,会与"优"的健康产出有关。数据来源于世界银行和世界卫生组织官方网站,覆盖214个国家、1995—2012年的数据。结果:不同人均GDP水平下,卫生费用指标与人均GDP之间的散点分布有不同的规律,结合了健康产出也是如此。不同人均GDP水平下,卫生费用指标取值不一定越高,健康产出越好。建议:在GDP不断发展的过程中,动态的进行相关研究。影响卫生费用和健康产出的因素更多更复杂,可以根据数据的可得性纳入更多的影响因素进入研究。人均GDP区间划分可以更细,但不宜过细。不能一味要求卫生总费用各项指标持续增长,同时要考虑社会、居民的承受能力以及投入产出。一套标准不可能适用于所有国家和地区的卫生总费用投入的评价,要根据本国的实际特点做出分析。对于卫生工作的考核,要充分考虑到卫生事业发展的最终目的是要改善居民的健康水平而非增加投入。     

Government,politics and health policy: A quantitative analysis of 30 European countries

RationalePublic health policies are often dependent on political decision-making, but little is known of the impact of different forms of government on countries’ health policies. In this exploratory study we studied the association between a wide range of process and outcome indicators of health policy and four groups of political factors (levels of democracy, e.g. voice and accountability; political representation, e.g. voter turnout; distribution of power, e.g. constraints on the executive; and quality of government, e.g. absence of corruption) in contemporary Europe.Data and methodsData on 15 aspects of government and 18 indicators of health policy as well as on potential confounders were extracted from harmonized international data sources, covering 30 European countries and the years 1990–2010. In a first step, multivariate regression analysis was used to relate cumulative measures of government to indicators of health policy, and in a second step panel regression with country fixed effects was used to relate changes in selected measures of government to changes in indicators of health policy.ResultsIn multivariate regression analyses, measures of quality of democracy and quality of government had many positive associations with process and outcome indicators of health policy, while measures of distribution of power and political representation had few and inconsistent associations. Associations for quality of democracy were robust against more extensive control for confounding variables, including tests in panel regressions with country fixed effects, but associations for quality of government were not.ConclusionsIn this period in Europe, the predominant political influence on health policy has been the rise of levels of democracy in countries in the Central & Eastern part of the region. In contrast to other areas of public policy, health policy does not appear to be strongly influenced by institutional features of democracy determining the distribution of power, nor by aspects of political representation. The effect of quality of government on health policy warrants more study.     

What do health authorities think of population based health outcome indicators?

OBJECTIVES: To determine the role of population based indicators of health outcome in local health outcome assessments; the constraints of using such indicators; how they could be made more useful; and whether health authorities had developed their own indicators of health outcome. DESIGN: A structured telephone interview with representatives of 91 of the 100 English health authorities. RESULTS: Interviewees, asked to give details on two clinical areas in which population health outcome assessments had been of most value, nominated 147 examples in over 30 clinical areas. They chose 50 (34%) of the examples because of an outlying national indicator, and 20 (14%) because of local variations in a national indicator. The main perceived constraints in the use of population based indicators of health outcome were: data validity and timeliness; the attributability of these health outcomes to the quality of health care; the difficulties of changing clinical behavior; and organisational change within health authorities. To make these indicators more useful interviewees wanted an increased use of process indicators as proxies for health outcome, indicator trend data, and indicator comparisons of districts with similar population structures. Some recent publications have started to consider some of these issues. 27 (30%) health authorities had developed their own indicators, mostly provider based process indicators. 10 of these used their own indicators to manage the performance of local provider units. CONCLUSIONS: Population based indicators of health outcome had an important role in prompting districts to undertake population health outcome assessments. Health authorities also used these indicators to examine local variations in health outcome. They helped to highlight areas for further investigation, initiated data validation, and enabled the monitoring of changes to services. Comparative population based indicators of health outcome may have an increasing part to play in assessing the performance of health authorities.     

State health expenditure accounts: Minnesota's perspective

Minnesota's approach to the development and use of State health expenditure accounts (SHEAs) was developed to assist State policymakers with decisions regarding health care reform. The accounts are based on an annual survey of third-party payers and summary Medicaid and Medicare data. Summary data are presented along with a discussion of data collection methodology, estimation, and dissemination. Minnesota's experience demonstrates that the ability of States to conduct detailed analysis of health care spending and to use these estimates to change State policy, inform national policy debate, conduct impact analysis, educate policymakers, and monitor market trends.     

中国卫生总费用筹资来源与各领域分配流向矩阵分析

该项研究利用筹资来源与分配流向矩阵核算方法，测算了1990－1995年中国卫生总费用；并用矩阵分析法分析同期各筹资渠道在各分配领域中的卫生支出变动情况。     

医疗服务质量和费用关系的国际研究综述

医疗服务质量和费用是卫生保健系统经常面临的两个互相竞争的关键要素。医疗费用的不断上涨是否带来质量的提升是不同卫生保健系统共同关注的问题,解决该问题的核心在于了解医疗服务质量和费用之间的关系。本文通过对国外有关质量和费用关系的理论与实践研究进行综述,基于Donabedian结构—过程—结果三维度质量框架进行归纳分析,尝试对目前该主题的研究进展进行系统梳理和展示。研究结果显示,现有研究的分析单位一般基于地区、服务提供者、病人等水平;不同研究所用到的质量指标差异较大;较多研究关注结果质量和费用的关系,而对于结构质量和过程质量与费用关系的研究尚不足;多数研究基于住院环境下,较少研究关注门诊环境,缺乏二者对比的研究。基于现有证据,尚无法对医疗服务质量和费用的关系得出一致的结论,但不同研究所用到的质量指标、数据与方法或局限性等仍值得未来的研究借鉴,以便于更客观合理的对质量和费用关系进行探讨。     

中国31个省（市、自治区）聚类研究：基于卫生发展的视角

筛选影响区域发展的社会经济人口和卫生发展相关指标,采用系统聚类法中的Q型聚类,从卫生发展的视角对中国31个省份进行分类。研究分析呈现了3类、6类或8类聚类情况下的不同结果,并利用地图予以标记。