政府卫生投入分析和政策建议

本文从卫生总投入结构及其变化趋势、政府卫生支出预测和影响因素、政府卫生投入的地区和机构差异等方面，对政府卫生投入现状进行了评价和分析，并提出了完善政府卫生投入政策的建议。     

我国政府卫生投入效率研究

以我国18个省市的政府卫生投入作为决策单元,分别从经费投入、人员投入和资本投入3个方面选择投入指标,从医疗卫生机构的服务效率与服务数量两个方面选择产出指标,应用数据包络分析方法研究我国政府卫生投入效率,进而对我国政府卫生投入产出情况进行分析。结果表明,整体上我国政府卫生投入效率较高,但是有的省市实际投入较少,还有一些省市存在一定的资源浪费和资源配置不尽合理等情况,可以通过有针对性地增加政府卫生投入,优化资源配置,提高医疗卫生服务的质量等措施,提高我国的医疗卫生水平。     

新医改背景下政府卫生投入的现状分析及路径选择

《中共中央、国务院关于深化医药卫生体制改革的意见》明确提出了我国将建立政府主导的多元卫生投入机制的卫生体制改革方向。文章从政府卫生投入的总体现状与国际比较、政府卫生投入存在的主要问题、新医改背景下政府卫生投入的路径选择和政府不同卫生投入路径的制度创新与政策建议等四个方面进行探讨。     

卫生服务系统投入问题及目标研究(上)

目前,政府在对卫生服务系统的投入中存在各级政府支出责任划分不合理、资金分配不合理、补偿模式缺乏激励性、资金落实不到位等许多待规范的问题。对此,围绕政府卫生投入目标策略,从投入主体、投入方向、投入模式和投入的落实这几个方面提出强化各级政府卫生投入的责任,在补偿重点如何进行转移支付,预算编制如何向绩效预算转变,完善政策的制定和监督机制等方面提出建议。     

关于加强政府卫生投入与控制医药费用的探讨

医药卫生体制改革关乎国民健康、经济发展和社会稳定。政府卫生投入有利于促进人群健康及健康公平。医药费用上涨过快是政府和城乡居民共同关心的热点话题。该文通过研究政府卫生投入与医药费用控制关系,探索如何增加和改变政府卫生投入总量、结构和方式,抑制医药费用的过快增长,从投入与控制两个方面提出对策建议。     

基于结构方程模型的政府卫生投入绩效评价研究

利用结构方程模型,评价全国各省市2002-2008年的政府卫生投入绩效。结果显示：政府卫生投入绩效总体供给不足;东、中、西部地区政府卫生投入绩效递减;地区间的政府卫生投入绩效差异呈现缩小的局面;政府卫生投入绩效逐年提高;现阶段,增加投入是提高政府卫生投入绩效的关键。     

我国政府对公共卫生投入的状况分析

我国的卫生事业是政府实行一定福利政策的社会公益事业。政府对卫生经费的投入 ,无疑是主渠道。政府在卫生领域的定位应当是为全体人民提供公共产品和公共服务 ,但不是包办一切 ,重点放在基本公共卫生、防疫、防灾和维护环境上。政府对卫生投入的多少直接反映出政府对卫生部门的重视程度。本文根据现有的资料 ,从公共卫生、农村、防疫与卫生保健机构、公立医疗机构等五个方面对政府的投入状况作以下综述。一、政府的总体投入状况卫生投入有广义和狭义之分。广义的卫生投入 ,不仅应包含政府、社会和个人对卫生服务活动的直接资金支出 ,而且应…     

医疗卫生产业化与提高政府卫生投入适宜性的关系

政府卫生投入不足,以及政府卫生投入方式上存在的诸多问题,直接导致了我国医疗卫生系统的绩效低下.政府应坚持卫生投入主导地位,并在此基础上,运用产业化发展思路,改进卫生投入方式,提高卫生投入适宜性,进而推动卫生产业的全面发展.     

加强政府卫生财政投入机制研究

当前我国卫生服务公平性下降，群众看病难、看病贵反映强烈，卫生体制改革势在必行，而投入机制研究是关键。文章从我国卫生投入主体、结构、数量、方式等方面概要分析了我国政府卫生财政投入的现状与问题，并从财政投入主体、方向、规模、保障机制等方面对政府卫生财政投入提出了相应建议。     

农村贫困地区政府卫生投入分析

本文对青海省门源等２６个国家级贫困县政府卫生投入进行了分析,发现青海、甘肃等４省国家级贫困县政府卫生投入虽有随时间增加的趋势,但政府卫生投入占财政支出的比例无明显增长,与人均政府卫生投入尚有下降趋势;当地人口、出生、死亡、人均收入与政府卫生投入、人均政府卫生投入、政府卫生投入占财政支出的比例关系密切。在现实条件下,作者认为农村贫困地区卫生事业的发展出路在于加强管理,提高卫生投入效率。同时也要加强当地的经济建设,提高居民的收入水平,更好地促进卫生事业投入水平的提高     

Health education and primary health care in Costa Rica: the role of the health assistant

Health status indicators for the population of Costa Rica comparedfavorably in the 1980s to those of more developed nations. Morbidityand mortality had been lowered, and health status differentialsbetween population subgroups had been narrowed. By 1984, mostof the objectives set by the World Health Organization had beenexceeded. These outcomes have been attributed to the successof a national primary health care program and to the role ofthe health assistant/asistente de salud in the operation ofthis program. This article examines the approach taken in achieving theseoutcomes. Of particular interest is the role of the health assistantas health educator in attaining the health promotion and diseaseprevention goals of the primary care program. Contemporary challenges which may diminish the role of the healthassistant and the possible consequences of this for public healthare considered, as is a recent government experiment which affordsa potential response to these issues. The latter, a new modelfor the organization and delivery of health services, featuresa partnership between government and a private sector providergroup. This arrangement retains the traditional role of thehealth assistant in primary care and enhances the health educationfunction of the health assistant. Under pressure and in transition, the health sector in CostaRica is striving to safeguard the admirable achievements ithas attained and to plan for further advances. It is clear thatunder present circumstances difficult choices must be made.One hopes that in the trade-offs made, those elements of theprimary health care program which have been essential to thisnation's success are not assigned a lower priority.     

Historical analysis of the development of health care facilities in Kerala State, India

Kerala's development experience has been distinguished by the primacy of the social sectors. Traditionally, education and health accounted for the greatest shares of the state government's expenditure. Health sector spending continued to grow even after 1980 when generally the fiscal deficit in the state budget was growing and government was looking for ways to control expenditure. But growth in the number of beds and institutions in the public sector had slowed down by the mid-1980s. From 1986-1996, growth in the private sector surpassed that in the public sector by a wide margin. Public sector spending reveals that in recent years, expansion has been limited to revenue expenditure rather than capital, and salaries at the cost of supplies. Many developments outside health, such as growing literacy, increasing household incomes and population ageing (leading to increased numbers of people with chronic afflictions), probably fueled the demand for health care already created by the increased access to health facilities. Since the government institutions could not grow in number and quality at a rate that would have satisfied this demand, health sector development in Kerala after the mid-1980s has been dominated by the private sector. Expansion in private facilities in health has been closely linked to developments in the government health sector. Public institutions play by far the dominant role in training personnel. They have also sensitized people to the need for timely health interventions and thus helped to create demand. At this point in time, the government must take the lead in quality maintenance and setting of standards. Current legislation, which has brought government health institutions under local government control, can perhaps facilitate this change by helping to improve standards in public institutions.     

辽宁省政府卫生支出研究

政府卫生支出是卫生总费用的重要组成部分,是保障每个公民平等、公平享受医疗卫生产品和服务的重要手段。2009年新一轮医药卫生体制改革以来,辽宁省各级政府卫生投入资金规模逐年增长。文章分析了辽宁省政府卫生支出的规模以及资金分配的基本状况,反映当地政府卫生投入工作所取得的成绩和存在的不足,探讨在政府卫生投入稳步提升的同时,提高政府卫生资源配置的合理性和公平性。     

对中泰两国政府卫生投入差异的思考

泰国和中国有相似的社会人口学状况和卫生服务提供体系,也同样面临卫生资源配置不平衡问题和推进全面医保的挑战。两国人均卫生总费用水平相似,但中国政府卫生支出占卫生费用比例及占财政支出比例均明显低于泰国;泰国政府卫生筹资职责主要由中央政府承担,而中国则在相当程度上依赖地方政府。通过对政府卫生支出总额和结构分析,发现中国卫生事业发展主要与地方经济有关,这一关联也导致了地区间资源分布的差异。     

GENERAL BUDGET SUPPORT: HAS IT BENEFITED THE HEALTH SECTOR?

There has been recent controversy about whether aid directed specifically to health has caused recipient governments to reallocate their own funds to non‐health areas. At the same time, general budget support (GBS) has been increasing. GBS allows governments to set their own priorities, but little is known about how these additional resources are subsequently used. This paper uses cross‐country panel data to assess the impact of GBS programmes on health spending in low‐income and middle‐income countries, using dynamic panel techniques to estimate unbiased coefficients in the presence of serial correlation. We found no clear evidence that GBS had any impact, positive or negative, on government health spending derived from domestic sources. GBS also had no observed impact on total government health spending from all sources (external as well as domestic). In contrast, health‐specific aid was associated with a decline in health expenditures from domestic sources, but there was not a full substitution effect. That is, despite this observed fungibility, health‐specific aid still increases total government health spending from all sources. Finally, increases in total government expenditure led to substantial increases in domestic government health expenditures. Copyright © 2012 John Wiley & Sons, Ltd.     

Decentralisation and health services delivery in Tanzania: Analysis of decision space in planning,allocation, and use of financial resources

While decentralisation of health systems has been on the policy agenda in low‐income and middle‐income countries since the 1970s, many studies have focused on understanding who has more decision‐making powers but less attention is paid to understand what those powers encompass. Using the decision space approach, this study aimed to understand the amount of decision‐making space transferred from the central government to institutions at the periphery in the decentralised health system in Tanzania. The findings of this study indicated that the decentralisation process in Tanzania has provided authorities with a range of decision‐making space. In the areas of priority setting and planning, district health authorities had moderate decision space. However, in the financial resource allocation and expenditure of funds from the central government, the districts had narrow decision‐making space. The districts, nevertheless, had wider decision‐making space in mobilising and using locally generated financial resources. However, the ability of the districts to allocate and use locally generated resources was constrained by bureaucratic procedures of the central government. The study concludes that decentralisation by devolution which is being promoted in the policy documents in Tanzania is yet to be realised at the district and local levels. The study recommends that the central government should provide more space to the decentralised district health systems to incorporate locally defined priorities in the district health plans.     

On a hiding to nothing? assessing the corporate governance of hospital and health services in New Zealand 1993–1998

In New Zealand the governance of public sector hospital and health services has changed significantly over the past decade. For most of the century hospitals had been funded by central government grants but run by locally elected boards. In 1989 a reforming Labour government restructured health services along managerialist lines, including changing governance structures so that some area health board members were government appointments, with the balance elected by the community. More market oriented reform under a new National government abolished this arrangement and introduced (1993) a corporate approach to the management of hospitals and related services. The hospitals were established as limited liability companies under the Companies Act. This was an explicitly corporate model and, although there was some modification of arrangements following the election of a more politically moderate centre-right coalition government in 1996, the corporate model was largely retained. Although significant changes occurred again after the election of a Labour government in 1999, the corporate governance experience in New Zealand health services is one from which lessons can, nevertheless, be learnt. This paper examines aspects of the performance and process of corporate governance arrangements for public sector health services in New Zealand, 1993-1998.     

A cautious approach to privatization in Papua New Guinea

Health services in Papua New Guinea have historically been providedpredominantly by the public sector, in close partnership withthe churches, which are largely subsidized by government andconsequently tend to be considered as part of the public healthsector. There is a small, but growing private health sectorabout which little is known and which until recently had developedwithout involvement by the government. Indeed, little interestwas shown by health officials, apart from the occasional animosityof hospital staff to in-patients of private doctors, until thelate 1980s when attention was brought to the high levels ofattrition of doctors from the public to the private sector.Budgetary constraints felt by the health sector in 1986, asa result of a change in governmental policy, emphasized theneed to improve the financial information available to enablepolicy makers to optimize the use of the limited resources andseek alternative financing sources. One alternative, which hassince been the suject of greater interest, has been the potentialfor sharing the responsibility for health care provision withthe private sector. This paper draws together what is knownabout the private health care sector in Papua New Guinea anddiscusses the implications of private sector growth for furtherhealth planning and policy formulation.     

沈阳市2006-2007年社区卫生服务站财务收入状况分析

目的了解沈阳市2006—2007年上半年社区卫生服务中心财务收入情况。方法在沈阳市10个区全部73个社区卫生服务中心进行问卷调查。结果2006年沈阳市平均每个社区卫生服务中心业务收入为445．18万元．占总收入的77．79％。2007年上半年为362．71万元,占总收入的73．81％,两年来业务收入高于全国均值,但其比例低于全国均值：2006年沈阳市平均每个社区卫生服务中心财政补助为93．96万元．低于全国均值,平均每个社区卫生服务中心财政补助占总收入的比例为16．42％,与全国水平相当,2007年上半年。为64.39万元,高于全国均值53．51万元,所占比例为17．75％,高于全国同期比例13．80％。结论沈阳市社区卫生服务正在逐渐改变“以药养医”的收入补偿模式．转变“重医轻防”的发展思路．走向正规化、合理化和科学化。沈阳市政府2007年比2006年加大了对社区卫生服务财政补助的力度．投入力度高于全国平均水平。但财政补助地区间严重不平衡,各级政府要调整财政支出结构．并根据地区发展的不平衡。建立稳定的社区卫生服务筹资和投入机制．