2009年中国卫生总费用测算结果与分析

"十一五"期间,我国卫生总费用总体水平稳步提高,卫生总费用年平均增长速度快于国民经济增长,卫生总费用占国内生产总值比重达到历史最高水平。政府卫生支出和社会卫生支出占卫生总费用比重逐年提高,居民个人现金卫生支出所占比重逐年降低,达到世界卫生组织在《亚太地区卫生筹资战略2010-2015》中提出的实施全民覆盖的监测和评价标准。文章对居民个人现金卫生支出所占卫生总费用比重逐年降低的主要原因作了分析和总结,对近年来居民个人现金卫生支出所占比重下降趋缓的原因进行了初步探讨,并对如何进一步降低居民个人现金卫生支出所占比重提出了建议。     

2004年中国卫生总费用测算结果与卫生筹资分析

概要描述2004年我国卫生总费用测算结果。2004年卫生总费用增速缓慢,政府卫生投入比例稳中有升,社会卫生支出比重持续回升,居民个人现金卫生支出所占比重保持近2年的下降趋势。还就卫生筹资面临的主要问题和挑战,从公平性角度对我国及部分地区卫生资金筹集和卫生服务利用进行分析评价,并讨论与借鉴世界卫生组织提出的卫生筹资政策目标和卫生筹资策略。     

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…     

2007年中国卫生总费用分析与预测

为反映我国卫生总费用现状特点以及未来一段时期卫生总费用筹资结构的变化,对2007年卫生费用进行了核算和分析,并在历史数据基础上,结合未来政策预期,对卫生费用筹资总额和三类卫生筹资来源分别进行预测.研究表明,在我国医药卫生体制改革方向和政策导向下,我国卫生费用筹资结构将逐步优化,政府和社会筹资比重将逐渐加大,而居民个人现金卫生支出比重将持续下降,预计2014年将基本形成"三四三制"的筹资结构.     

基于ARIMA模型的中国卫生总费用预测分析

卫生总费用是研究和评价卫生改革与发展政策的重要工具.文章利用1978至2007年卫生总费用占GDP比重的历史数据,采用ARIMA(1,1,6)模型进行拟合,在模型进行检验适用的前提下对2010年的卫生总费用占GDP比重进行预测,结果发现2010年我国卫生总费用占GDP比重为4.73%,仍低于世界卫生组织规定的最低标准5%,提出加大公共卫生投入,扩大健康保障制度覆盖面来适度提高卫生总费用占GDP重,实现卫生资源配置优化.     

医改以来省级卫生总费用比较分析

目的：通过省级卫生总费用核算结果,分析2009年医药卫生体制改革以来我国卫生筹资的变化趋势与特征,为完善卫生筹资政策提供参考和依据。方法：选取2009—2012年全国20个省份的卫生总费用核算数据进行纵向和横向对比分析。结果：20个省份中,卫生总费用增幅最大的是安徽（82.97%）,政府卫生支出增幅最大的是宁夏（108.71%）。2012年社会卫生支出占卫生总费用比重超过40%的省份全部位于东部地区。个人卫生支出占卫生总费用比重在40%以上的地区减少至5个。结论：各地区卫生总费用均保持增长趋势,但在地区经济水平匹配程度方面存在差异;筹资结构明显优化,但地区间筹资特点不同,部分省份个人卫生支出占卫生总费用比重的压力仍然较大。建议：在提高筹资水平的前提下,注重调整筹资结构,发挥公共筹资的作用,降低居民个人卫生支出负担。     

山东省卫生总费用核算与预测

目的：对山东省卫生总费用进行核算与预测,为建立卫生筹资策略和机制提供依据。方法：资料主要来源于1998—2009年山东省卫生财务、卫生统计和社会经济统计资料。运用筹资来源法对山东省卫生筹资进行系统测算,并开展国内外比较研究;运用指数平滑法,预测山东省卫生总费用未来发展趋势。结果：（1）1998—2009年,山东省卫生总费用从195.71亿元增加到1163.20亿元,人均卫生总费用从221.44元增加到1228.26元,卫生总费用占GDP的比例从2.79%增加到3.43%;（2）1998—2009年,按照国内口径,政府卫生支出和社会卫生支出占卫生总费用的比重分别从15.67%和28.93%增加到21.84%和36.85%,个人卫生支出比重从55.40%降低到41.31%;按照国际口径,广义政府卫生支出占卫生总费用的比重从36.95%增加到45.62%,私人卫生支出比重从63.05%降低到54.38%;（3）2015年和2020年,预测卫生总费用占GDP的比重分别达到4.01%和4.25%,个人卫生支出占卫生总费用比重分别降低至37.02%和35.47%。结论：（1）山东省卫生筹资水平较低;（2）山东省卫生筹资构成向着好的方向变化,但卫生筹资构成仍不合理,公共筹资不足、个人筹资较高。建议：努力筹集足够的卫生资金,提高卫生总费用占GDP的比重;加大政府卫生投入,降低个人筹资比例。     

甘肃省卫生总费用筹资水平及结构分析

目的：运用筹资来源法对2003—2012年甘肃省卫生总费用进行测算,初步了解甘肃省卫生总费用筹资水平及结构,从宏观上分析政府、社会和个人筹资负担,为甘肃省制定和调整卫生政策提供科学的参考依据。方法根据研究目的,运用筹资来源法,查阅相关统计年鉴及统计公报,得到相关指标,建立相应的数据库,应用 Ex-cel、SPSS 19.0等软件对数据进行统计和分析。结果2003—2012年甘肃省卫生总费和人均卫生总费用呈逐年增加趋势,平均增长速度分别为21.02%和21.20%。2003—2012年政府卫生支出占卫生总费用比重由22.40%上升至37.97%;社会卫生支出所占比重有较小波动,总体上有所增加,2012年达到25.62%;个人卫生支出所占比重由2003年的53.85%降至2012年的36.41%。结论甘肃省卫生筹资水平不断提高,但人均卫生总费用偏低;卫生筹资结构有待完善,应建立长效的政府卫生投入机制;同时甘肃省应深化卫生总费用核算等工作。     

2010年安徽省卫生总费用核算结果与分析

目标:通过对卫生总费用的筹资水平、筹资结构及分配状况的研究与分析,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:2010年安徽省政府、社会和居民个人卫生支出分别占卫生总费用的比重分别为29.71％、35.69％和34.60％.建议:合理配置卫生资源,完善各类社会医疗保障制度,加强基层医疗服务体系建设,合理调整政府对卫生的投入结构.     

2022年中国卫生总费用核算结果与分析

目的：核算2022年我国卫生总费用,分析“十三五”以来卫生筹资主要变化趋势,总结当前卫生筹资面临的主要问题和挑战,提出政策建议。方法：基于来源法、机构法及卫生费用核算体系2011的核算结果,分析我国卫生总费用及经常性卫生费用变化情况。结果：2022年,我国卫生总费用为85 327.49亿元,占GDP比重为7.05%,人均卫生总费用为6 044.09元;其中,个人卫生支出占卫生总费用比重降至26.89%,政府卫生支出占比升至28.17%,社会卫生支出占比降至44.94%,筹资结构继续优化。结论：我国卫生费用总规模持续增长,但卫生筹资系统韧性有待加强,需加快健全多层次医疗保障体系,提升筹资保障水平与人民群众获得感,优化卫生资金配置,提升卫生费用的效率效能。     

2005年中国卫生总费用测算结果与基本卫生服务筹资

概要描述了2005年我国卫生总费用的测算结果。2005年卫生总费用增速缓慢,政府卫生投入比例稳中有升,社会卫生支出比例持续回升,居民个人现金卫生支出所占比例保持近几年的下降趋势。还介绍了国内外卫生总费用口径和进行国际比较应注意的问题,并提供了按国际口径测算的我国卫生总费用结果。最后对我国基本卫生服务筹资机制与筹资模式进行探讨,提出我国基本卫生服务筹资应以税收筹资模式为主,依托现有卫生体系构建城镇居民的基本卫生保健制度。     

Future directions for the national health accounts

Over the past 15 years, the Health Care Financing Administration (HCFA) has engaged in ongoing efforts to improve the methodology and data collection processes used to develop the national health accounts (NHA) estimates of national health expenditures (NHE). In March 1998, HCFA initiated a third conference to explore possible improvements or useful extensions to the current NHA projects. This article summarizes the issues discussed at the conference, provides an overview of three commissioned papers on future directions for the NHA that were presented, and summarizes suggestions made by participants regarding future directions for the accounts.     

我国卫生筹资系统的历史沿革与分析

文章结合卫生费核算数据描述了我国卫生筹资系统的演化过程,并对其原因和存在的问题进行了讨论,在此基础上结合医药卫生体制改革政策,对未来一段时期我国卫生筹资系统的发展进行了展望。     

National health accounts: lessons from the U.S. experience

The national health accounts (NHA) are the framework within which type of services and sources of funding for health care expenditures are measured. NHA, devised to portray the structure of health care delivery and financing in the United States, provide essential information necessary for the formulation of public health policy and for international comparison. In this article, the authors describe the importance of the NHA nationally and internationally, and provide a blueprint of the definitions, sources, and methods used to create this system of NHA in the United States.     

Innovation and participation for healthy public policy: the first National Health Assembly in Thailand

Aim This paper aims to describe and disseminate the process and initial outcomes of the first National Health Assembly (NHA) in Thailand, as an innovative example of health policy making. Setting The first NHA, held in December 2008 in Bangkok, brought together over 1500 people from government agencies, academia, civil society, health professionals and the private sector to discuss key health issues and produce resolutions to guide policy making. It adapted the approach used at the World Health Assembly of the World Health Organization. Method Findings are derived from a literature review, document analysis, and the views and experiences of the authors, two of whom contributed to the organization of the NHA and two of whom were invited external observers. Results Fourteen agenda items were discussed and resolutions passed. Potential early impacts on policy making have included an increase in the 2010 public budget for Thailand’s universal health coverage scheme as total public expenditure has decreased; cabinet endorsement of proposed Strategies for Universal Access to Medicines for Thai People; and establishment of National Commissions on Health Impact Assessment and Trade and Health. Discussion The NHA was successful in bringing together various actors and sectors involved in the social production of health, including groups often marginalized in policy making. It provides an innovative model of how governments may be able to increase public participation and intersectoral collaboration that could be adapted in other contexts. Significant challenges remain in ensuring full participation of interested groups and in implementing, and monitoring the impact of, the resolutions passed.     

医院卫生费用核算方法学研究

根据卫生费用核算的基本理论和方法,提出了医院卫生费用核算的基本概念,对在我国实行医院卫生费用核算的口径进行界定．并建立了符合我国实际情况的核算指标体系,讨论了实际操作中的数据收集方法和测算具体方法,对在我国建立医院卫生费用核算系统具有方法学指导意义。     

健康公平性概述

健康公平性在国际上得到广泛关注,各国把消除健康不公平作为卫生改革与发展的主要目标。本文就健康公平性的内涵进行梳理,为我国健康公平性内涵和测量研究提供参考。     

Health financing in Malawi: Evidence from National Health Accounts

Background  

National health accounts provide useful information to understand the functioning of a health financing system. This article attempts to present a profile of the health system financing in Malawi using data from NHA. It specifically attempts to document the health financing situation in the country and proposes recommendations relevant for developing a comprehensive health financing policy and strategic plan.     

A review of health resource tracking in developing countries

Timely, reliable and complete information on financial resources in the health sector is critical for sound policy making and planning, particularly in developing countries where resources are both scarce and unpredictable. Health resource tracking has a long history and has seen renewed interest more recently as pressure has mounted to improve accountability for the attainment of the health Millennium Development Goals. We review the methods used to track health resources and recent experiences of their application, with a view to identifying the major challenges that must be overcome if data availability and reliability are to improve. At the country level, there have been important advances in the refinement of the National Health Accounts (NHA) methodology, which is now regarded as the international standard. Significant efforts have also been put into the development of methods to track disease-specific expenditures. However, NHA as a framework can do little to address the underlying problem of weak government public expenditure management and information systems that provide much of the raw data. The experience of institutionalizing NHA suggests progress has been uneven and there is a potential for stand-alone disease accounts to make the situation worse by undermining capacity and confusing technicians. Global level tracking of donor assistance to health relies to a large extent on the OECD's Creditor Reporting System. Despite improvements in its coverage and reliability, the demand for estimates of aid to control of specific diseases is resulting in multiple, uncoordinated data requests to donor agencies, placing additional workload on the providers of information. The emergence of budget support aid modalities poses a methodological challenge to health resource tracking, as such support is difficult to attribute to any particular sector or health programme. Attention should focus on improving underlying financial and information systems at the country level, which will facilitate more reliable and timely reporting of NHA estimates. Effective implementation of a framework to make donors more accountable to recipient countries and the international community will improve the availability of financial data on their activities.     

安徽省阜阳市卫生总费用测算报告

中国卫生总费用核算体系,应该包括地市级卫生总费用核算。以安徽省阜阳市为试点,讨论如何在现有方法的基础上,克服部分资料来源的困难,探索一种适合地市级卫生总费用测算的方法,并提供阜阳市卫生总费用的初步测算结果,为当地卫生部门服务。