辽宁省卫生总费用的政策分析

文章运用福利经济学的基本理论对辽宁省1990-2008年的卫生总费用进行了测算,从公平性角度对迁宁省卫生总费用占GDP比重、人均卫生费用、卫生总费用筹资构成、政府卫生投入水平和居民个人卫生投入水平进行了分析.     

不同健康产出水平下卫生总费用与健康产出对应关系研究

[目的]在持续的卫生总费用投入下,一些发达国家和经济发达地区出现了卫生总费用与健康产出指标不对应的情况,即健康产出指标由迅速增长转为缓慢增长甚至停止增长。试图从卫生总费用与健康产出指标对应关系上找出问题原因。[方法]选择全国和上海作为2个不同健康水平样本,建立两个样本的卫生总费用与健康产出指标关系模型。将卫生总费用作为应变量,婴儿死亡率、孕产妇死亡率和平均预期寿命等健康产出指标作为自变量,采用逐步回归方法,按自变量对应变量的贡献率大小,建立卫生总费用最优回归模型。[结果]全国健康产出水平相对较低但健康产出水平提升较快,其卫生总费用与健康产出指标相互对应。卫生总费用与婴儿死亡率、孕产妇死亡率和平均预期寿命等三大健康产出指标紧密相关。只要增加卫生总费用就可以获得三大健康产出指标的提升。其提升顺序分别是:平均预期寿命、婴儿死亡率和孕产妇死亡率。上海健康产出水平相对较高但健康产出水平提升缓慢,其卫生总费用只与平均预期寿命相关,与婴儿死亡率和孕产妇死亡率两大健康产出指标不相关。[结论]应重视卫生总费用与健康产出指标的对应关系,不同区域(健康水平)的卫生总费用投入应分类施策。重视同一区域内不同人群健康水平差异对卫生总费用与健康产出对应关系的影响,加强对高健康产出地区低收入(低健康水平)人群中与婴儿死亡率和孕产妇死亡率指标相关的卫生总费用投入。     

1994年各省市自治区卫生总费用经济分析

为了评价各省市区运用筹资来源法测算的卫生总费用数据的可靠性,为进一步开发实际使用法做准备,中国卫生总费用课题组运用机构收入法测算了1994年各省市区的人均卫生费用、卫生费用占国内生产总值的比重、人均卫生事业费、按人口平均职工医疗卫生费、人均医疗总费用、医疗费用占卫生总费用的比重、各省市区城乡人均医疗费用水平及其差距、基本医疗服务的保障程度、上级补助占医疗机构收入的比重、住院费用占医疗总费用的比重、劳务费用占医疗总费用的比重、农民人均医疗消费水平与乡村医疗收费水平比较等指标,并进行了卫生总费用计量经济分析。     

“十二五”时期广西卫生筹资状况分析

目的:通过对"十二五"时期广西卫生投入的充足性以及卫生筹资的公平性、效率性、可持续性状况进行分析,为改善广西卫生筹资结构提供参考依据。方法:对广西卫生筹资状况、卫生总费用机构流向构成、GDP和卫生总费用增长情况进行描述性统计分析,并与全国发展水平进行对比。结果:"十二五"时期,广西卫生总费用占GDP比重均超过5%,人均卫生总费用均低于全国水平;政府卫生支出与占卫生总费用比重均高于全国水平,社会卫生支出和个人卫生支出占卫生总费用比重均低于全国水平;卫生总费用流向医院比重超过50%,而流向公共卫生机构的比重呈逐年下降;卫生总费用年平均增长速度高于GDP的年平均增长速度,2014年政府卫生支出占财政支出的比重超过10%。结论:广西卫生筹资结构在不断优化,个人卫生负担有所减轻,但人均卫生总费用远低于全国水平,卫生费用支出总额离百姓的需求尚存在差距,影响卫生投入充足性;社会卫生支出不足,影响卫生筹资公平性;卫生筹资配置结构失衡,影响卫生筹资效率;卫生投入与经济发展协调性不足,影响卫生筹资可持续性。     

加大卫生总费用投入，减轻病人负担

我国社会投入卫生的资源总额不是太多需要控制,而是不够,且资源配置甚不合理,锦上添花的多,雪中送炭的少。弄清楚卫生总费用的概念卫生总费用是一个国家或独立关税区在一定时期（一年）内投入卫生发展的经济资源的货币表现,简称“卫生投入”。卫生总费用核算的主要指标包括：卫生总费用;人均卫生费用;卫生费用占国内生产总值的比重;政府卫生投入;社会卫生投入：居民现金卫生投等内容。卫生总费用分析和评价的主要指标通常用卫生费用占国内生产总值的比重、卫生总费用增长速度、卫生总费     

我国与发达国家医疗资源和卫生费用比较分析

目的:比较分析我国与7个发达国家医疗资源和卫生费用相关情况,以期对我国目前正在深化的医改工作提供有益借鉴。方法:通过数据分析、查阅文献等方法进行。结果:与7个发达国家相比,我国医疗资源总体水平较低,但人均医院床位数相对偏高;卫生总费用、卫生总费用和人均卫生费用增速均较快;卫生总费用占GDP比重偏低,且增速较慢;政府卫生总支出占卫生总费用比重提高较快。结论:我国应在继续加大卫生投入的基础上,调整医疗资源结构,转变卫生服务模式,健全相关机制,重视体制与科技创新,不断提升有限资源和资金使用绩效,最大限度地保障居民健康。     

山东省2010年卫生总费用筹资水平与结构分析

目的分析山东省卫生费用的筹资来源,讨论存在的问题并提出相应对策。方法对山东省2010年的卫生总费用进行了测算,即按照卫生资金的筹资渠道与筹资形式收集卫生总费用数据,采用筹资来源法测算全社会卫生筹资总额,并与上年及全国水平进行比较。文中数据均以当年价格为基准,并未排除价格因素的影响,对于筹资结构分析中的相关指标采用的是统计学上的构成比。结果 2010年山东省卫生总费用较上年总体呈现增长趋势,筹资总额达1 345.30亿元,政府、社会、居民个人现金卫生支出分别占24.34%、36.94%、38.72%。2010年山东省卫生总费用占国内生产总值(grossdomestic prodact,GDP)比重和人均卫生总费用均低于全国水平。结论应适当提高卫生总费用占GDP的比例,加大政府和社会的卫生投入力度,降低居民个人现金卫生支出,建立合理的卫生筹资机制。     

新疆生产建设兵团农八师石河子垦区2011年卫生总费用核算结果与分析

[目的]对农八师卫生总费用的筹资水平、结构及分配状况进行描述性分析,为制定和评价卫生政策提供依据。[方法]运用卫生总费用的筹资来源法和机构流向法,进行描述性分析和比较。[结果]2011年八师卫生总费用19.09亿元,卫生总费用占GDP的比重为8.11%,人均卫生费用3,057.48元;政府卫生支出为6.47亿元,占总费用的33.89%,社会及居民个人卫生支出占总费用额比重分别为41.33%、27.48%;政府卫生支出占GDP的比重为2.75%,人均政府卫生支出1,036.15元;分配总额18.24亿元中,医疗机构占81.45%,公共卫生机构占4.62%。[结论]筹资水平尚可,筹资结构合理,卫生费用机构配置不甚合理,应合理配置卫生资源,加强基层医疗服务体系建设,合理调整各级政府对卫生的投入。     

黑龙江省卫生筹资状况分析

2010年,黑龙江省卫生费用筹资总额605.77亿元,比上年增加了25.64亿元;占GDP的比重为5.84％,高于全国同期水平;人均卫生费用1580.23元,高于全国水平.2001-2010年,黑龙江省人均卫生费用增长了4.70倍.按实际值计算,2010年黑龙江省卫生总费用首次呈现负增长;政府对卫生的投入力度逐年增强,但仍需进一步增加;政府应调整卫生领域的投资结构,更多关注基层医疗卫生机构支出和公共卫生支出.黑龙江省居民的疾病经济负担过重,完善社会医疗保障制度建设尤为重要.     

基于国际间比较的我国健康生产效率分析

目的:通过国际间比较反映我国卫生体系的投入产出水平,获得近年来我国卫生体系的健康生产效率绩效及其变化趋势,并提供促进健康生产效率的政策建议。方法:通过描述我国卫生投入和健康产出的国际排名及其变化趋势反映卫生体系的相对效率水平,并以人均卫生总费用作为投入指标、健康结局作为产出指标,使用数据包络分析和健康生产函数法构建前沿健康生产函数、中国的健康生产函数与边际健康生产函数。结果:近年来我国卫生体系的健康生产效率水平与相似卫生发展水平并处于生产前沿上的国家在65%~73%之间;随着卫生投入的增加,我国边际健康产出水平有所下降并不断趋于平缓。结论:我国当前的健康生产效率在国际上相对较高,但在卫生总费用快速增长的背景下,如何提高边际健康产出、提高卫生体系的健康生产效率是未来医药卫生体制改革的重点。     

卫生费用核算体系 2011扩展维度方法学研究：以资本形账户为例

目的：分析影响我国人均卫生费用的宏观影响因素。方法：采用2011-2014年我国各省（自治区、直辖市）人均卫生费用的数据，分别使用混合回归和固定效应模型分析我国人均卫生费用的宏观影响因素。结果：固定效应模型适用于分析人均卫生费用的宏观因素，人均地区生产总值和65以上老年占总人口比重影响人均卫生费用，且两者均与人均卫生费用呈正相关。结论：关注低收入的省（市、自治区）居民的健康需求以及积极推动医养结合。     

我国卫生保健相对价格对人均卫生费用的影响研究：基于ARDL模型的分析

目的:深入研究卫生保健商品或服务的相对价格对人均卫生费用的短期与长期影响。方法:基于1986—2009年宏观时间序列数据,在考虑人均GDP、政府卫生投入等因素前提下,采用自回归分布滞后模型(ARDL)与误差修正模型(ECM)进行分析。结果与结论:⑴卫生保健商品相对价格对于人均实际卫生费用的影响要明显大于卫生保健服务相对价格和政府卫生投入比例增长率的影响;⑵相对于其他消费品,卫生保健商品相对价格的持续下降会促使人均实际卫生费用增长率也呈现下降趋势;卫生保健服务相对价格的下降可能会刺激人们卫生保健服务需求,提高实际人均卫生费用的增长率;⑶政府卫生投入比例的上升会导致实际人均卫生费用增长率增加,产生明显的正向效应。     

我国人均卫生费用的主成分分析

目的:分析我国人均卫生费用的影响因素,去除线性回归中多变量相关问题带来的不利影响。方法:基于1990-2014年我国人均卫生费用,选取人均GDP、人均可支配收入、城镇化率、人口老龄化、婴儿死亡率、每千人口执业医师数和每千人口医疗卫生机构床位数作为解释变量,使用主成分分析模型研究解释变量如何影响我国人均卫生费用。结果:解释变量均显著影响人均卫生费用。其中,人均GDP、人均可支配收入、每千人口执业医师数和每千人口医疗卫生机构床位数正向影响人均卫生费用,婴儿死亡率、城镇化率和人口老龄化负向影响人均卫生费用。结论:我国人均卫生费用的影响因素并非是单一的。人均卫生费用的上涨是多个因素的共同结果。     

Health care expenditure and health outcome nexus: new evidence from the SAARC-ASEAN region

Background

The total health expenditure (as a percentage of GDP) and health outcomes in the region of South Asian Association for Regional Cooperation (SAARC) and Association for South East Asian Nations (ASEAN) are lower than that of the OECD region and the world. This study investigated the relationship between different types of healthcare expenditures (public, private and total) and three main health status outcomes - life expectancy at birth, crude death rate and infant mortality rate - in the region.

Methodology

Using the World Bank data set for 15 countries over a 20-year period (1995–2014), a panel data analysis was conducted where relevant fixed and random effect models were estimated to determine the effects of healthcare expenditure on health outcomes. The main variables studied were total health expenditure, public health expenditure, private health expenditure, GDP per capita, improved sanitation, life expectancy at birth, crude death rate and infant mortality rate.

Results

Total health expenditure, public health expenditure and private health expenditure significantly reduced infant mortality rates, and, the extent of effect of private health expenditure was greater than that of public health expenditure. Private health expenditure also had a significant role in reducing the crude death rate. Per capita income growth and improved sanitation facilities also had significant positive roles in improving population health in the region.

Conclusions

Health expenditure in the SAARC-ASEAN region should be increased as our results indicated that it improved the health status of the population in the region. Public sector health funds must be appropriately and efficiently used, and accountability and transparency regarding spending of public health funds should be ensured. Finally, government and private institutes should implement appropriate strategies to improve sanitation facilities.

     

卫生资源优化配置研究

该文应用卫生服务供需平衡法探讨卫生资源优化配置问题。卫生服务投入对卫生服务产出的影响可划分为两级,一是投入对利用的影响,二是投入对效果的影响。把投入、利用和效果的指标作为供需指标,如卫生服务利用指标有：居民年均就诊人次、计划免疫接种率、食品卫生监督监测覆盖率、卫生水普及率;卫生服务投入指标有：每千人口医生数、每千人口医院床位数、卫生总费用占GDP比例、卫生事业费占财政支出比例;卫生服务效果指标有：计划免疫目标疾病报告发病率、传染病发病率、婴儿死亡率、平均期望寿命。通过多元线性回归模型和重权模型计算结果提示需要加强卫生服务投入,尤其是加大财力投入。     

Health expenditure and growth dynamics in the SADC region: evidence from non-stationary panel data with cross section dependence and unobserved heterogeneity

This paper investigates the long run relationship between health care expenditure and economic growth, using panel data for 14 Southern African Development Community (SADC) member countries over the period 1995–2012. The non-stationarity and cointegration properties between health expenditure per capita and GDP per capita were examined, controlling for cross section dependence and heterogeneity between countries. Our results suggest that health expenditure and GDP per capita are non-stationary and cointegrated. These findings seem to confirm the notion that health expenditure is non-discretionary—health is a necessary good—in the SADC region. The estimated income elasticity is below unity but higher than what was obtained for the OECD regional grouping. The policy implication of our result is that adequate health care service provision should be a key objective of governmental intervention in the SADC region.     

中央转移支付对地方对政府卫生支出的影响机制及实证分析

利用30个省市2003-2014年面板数据研究了中央转移支付对于地方政府卫生支出的影响。实证结果表明,无论是比重指标还是人均指标,中央转移支付对地方政府卫生支出促进效应有限;人均转移支付指标促进效应要优于转移支付比重指标;转移支付的使用效果存在显著的地区差异;人均GDP、人均财政收入、政策冲击、每万人口医疗技术人员与老年人口抚养比均对地方政府卫生支出有显著促进效应,FDI水平对地方政府卫生支出有显著的阻滞效应。政策性建议是加强中央转移支付用于卫生支出使用的透明度管理,强化地方政府的问责机制;以效率和公平为政策导向谨慎调整中央转移支付内部结构;中央转移支付政策供给应当寻求精细化;中央转移支付政策要同其他政策配套实施。     

Pooling international health care expenditure data.

The purpose of this paper is twofold. The first is to analyse the statistical relationship between real health care expenditure per capita and aggregate income, public share in finance, age-dependency ratio and inflation. The second purpose deals with methodological problems involved in pooling health care expenditure data. The empirical work is based on pooled cross-sectional, time-series data for 22 OECD countries from 1972 to 1987. Public finance share and inflation were found to be associated with lower per capita health care expenditure. No consistent correlation was found between the age-dependency ratio and health care expenditure. Contrary to results of earlier studies, we found that health care expenditure does not appear to be income (GDP) elastic. However, the results do not appear to be robust to changes in the time periods and countries included.     

Shared ‘features’ in prices: Income and price elasticities for health care expenditures

The evidence found in most studies suggests a strong positive relationship between health care expenditure and gross domestic product. However, this evidence weakens with respect to the actual value of the income elasticity. There are two possible sources of these discrepancies, the use of arbitrary deflators and specification errors. We find that health PPP cannot be taken as a ‘universal’ price index. The problem is that its components do not move together. Nevertheless, we derive a ‘universal’ health price index from a dynamic system in which its components share both short and long run co-movements. The omission of relevant explanatory variables seems to be the main cause of the discrepancies. We confirm that there exists a strong positive relationship between per capita health care expenditure and per capita GDP. However we estimate a long run income elasticity at or around unity, although it is greater than unity for the countries with lower per capita income (Spain and Ireland). The results for income elasticity are the same regardless of whether health care expenditure is converted using the GDP PPP or the ‘universal’ health price index. The importance of non-income variables is also confirmed, in particular the relative price of health care. We find that relative price has a strong rationing effect on the quantity of health demanded and has no effect on the expenditures.     

State size as measured in terms of public spending and world health, 1990-2000

OBJECTIVE: To determine the relationship between state size (measured in terms of public spending) and public health indicators in a sample of countries representing all regions of the world and from 1990-2000. METHODS: An ecological study was performed using data on Central Government Spending (CGS) and per capita Gross National Product (GNP) obtained from the International Monetary Fund, and on life expectancy, maternal, and infant mortality, provided by the World Health Organization. A multiple linear regression model was fitted to estimate the effect of CGS on health, which also took into consideration per capita GNP and geographical region. RESULTS: CGS varied little over the study period, with convergence around an average of 28%, but within a relatively wide range (7.80-53.0%); the countries with the strongest economies (according to per capita GNP) had the highest levels of CGS. The influence of this factor was particularly relevant for the infant mortality rate (r = 0.40; beta = -1.327; EE = 0.237; t = -5.590; p < 0.001). Per capita GNP and geographic location were also associated with variations in health; health indicators tended to be worse for poorer countries in Africa and Asia. In the adjusted model, CGS was statistically significant with regard to infant and maternal mortality rates. CONCLUSION: The study suggests that state size (in terms of public spending) has an important influence upon health and particularly upon mortality. Although it is important to bear in mind the limitations of this study and the reduced time window used, these results should be taken into consideration in the current political and epidemiological debate.