我国卫生总费用现状分析及影响因素研究——基于主成分回归分析法

[目的]分析2005-2020年我国卫生总费用现状及影响因素,并提供建议。[方法]利用统计描述和时间趋势法分析现状,运用主成分回归分析法分析影响我国卫生总费用的多种因素。[结果]2005-2020年我国卫生总费用持续增长,卫生费用结构明显优化;65岁及以上人口所占比重(0.3281)等人口老龄化因素成为驱动卫生总费用增长的重要因素;人均GDP(0.3213)等经济因素对卫生总费用的增长影响较为显著;卫生服务供给及利用也是卫生总费用增长不可忽视的因素。[结论]我国卫生总费用受多种因素的影响,其中人口老龄化已经成为促进卫生总费用增长的重要载体,同时不可忽视卫生服务供给与利用因素对卫生总费用的影响,政府要综合多种因素,制定切合实际的政策措施,有效控制我国卫生总费用的过快增长。     

卫生总费用和医疗费用影响因素研究现状

随着经济增长、人口老龄化、疾病模式的改变，人们对卫生服务需要迅速增加，卫生总费用和医疗费用增长较快，这是目前许多国家和地区共同面临的重要问题。然而，要解决这个问题，首先必须找出影响卫生总费用的主要因素，     

基于主成分分析的我国人均卫生费用研究

文章运用主成分分析法研究相关评价指标,对我国人均卫生费用的影响因素进行评价研究.研究表明,我国人均卫生总费用与人口总数、人均GDP、政府卫生支出的比例、卫生人力、卫生设施、居民生活水平等因素有很大的关系,在此基础上提出控制卫生总费用不合理增长的对策和建议.     

利用SPSS进行主成分回归分析

目的：利用SPSS8．0进行主成分回归分析。方法：利用SPSS8．0的Linear Regression,Factor,Analysis,Compute Variable和Bivariate Correciations等过程,结合主成分回归分析的基本原理,介绍整个主要成分回归分析的步骤,结果：用一个实例,描述SPSS8．0各种过程的操作和主成分回归整个计算过程,并且确定“最佳”方程。结论：介绍多重共线性的各种诊断指标,主成分回归分析的优点和注意事项,利用SPSS进行主成分回归分析能达到简便,快捷和准确的统计效果。     

中国卫生总费用发展变化趋势及其影响因素

本文分析1978～1998年20年间 ,中国卫生总费用的发展变化趋势 ,认为医疗卫生保健消费的收入弹性反映社会对医疗卫生费用的承受能力 ,其中城镇居民人均医疗消费水平、农村居民人均医疗消费水平、国有经济单位负担的职工人均医疗消费水平、人均卫生事业费四项指标对卫生总费用的影响最大。因此 ,21世纪中国卫生总费用增长的主要潜力是政府对卫生投入的增加和国有经济单位对职工医疗卫生卫生费的负担水平的提高 ,而居民个人医疗消费负担水平的开发潜力较弱。     

以主成分回归分析方法探讨人均卫生费用影响因素的研究

目的：分析影响人均卫生费用的因素,建立了影响人均卫生费用的数学模型,从而指导医疗保险和卫生体制改革。方法：本研究利用29个国家的卫生经济资料,进行多元线性回归和主成分回归统计分析。用回代法建立了影响人均卫生费用的数学模型。结果：发现多元回归分析存在严重的共线性现象,改以主成分回归分析,用主成分回归方法建立的方程有效地避免了共线性问题,在统计和实际意义的解释上更合理。得出的5个主成分分别为：Fact1主成分为住院费用和基础卫生费用,Fact2主成分为卫生人力资源,Fact3主成分为住院时间,Fact4主成分为药物和仪器检查费用,Fact5是人口寿命因素。主成分Fact1的标准化回归系数最大,其次是主成分Fact5,然后依次是Fact2、Fact4、Fact3。标化系数的大小表明,人口的预期寿命和卫生人力供需资源对人均卫生费用的贡献率超过了药费和检查费。结论：1住院费用等是构成欧、美、亚等29个国家卫生费用的主体,为控制人均卫生费用,应主要从控制住院费用入手;2预期寿命长和卫生人力资源比较丰富的国家其人均卫生费用的标准应高于医院服务利用相同的国家。随着我国人均期望寿命的逐渐延长和人口老龄化,我国人均卫生费用的增长是必然的;3单纯用多元线性回归的方法分析卫生经济资料,结果不一定可靠,提示在卫生经济研究中,在各指标有相关的情况下,宜采用主成分回归分析的方法。     

卫生总费用影响因素的岭回归分析

本文对湖南省１４个地（州）市卫生总费用和人匀卫生总费用的影响因素进行了分析,为了消除自变量间的多重共线性,使用了岭回归分析方法。结果表明主要影响因素有ＧＤＰ、人口数、国有单位职工人数及人均国内生产总值、财政收入占国内生产总值的比重、卫生事业费占卫生总费用的比重。     

主成分回归在学龄儿童体脂率研究中的应用

利用主成分回归方法消除在学龄儿童体脂率研究中形态指标之间的共线性作用。使得儿童体脂率与年龄,性别及形态指标的关系得以正确解释。方法：采用主成分回归分析的方法,并与多元逐频回归结果进行比较。结果消除了多元回归分析中由于共线性产生的参数估值不稳定性及结果中不好解释的现象。     

卫生总费用与卫生资源配置研究

卫生费用在机构间的分配状况反映了卫生资源的配置效率,本研究利用机构法卫生费用核算结果,分别描述了卫生费用在城乡之间、医疗机构与公共卫生机构之间以及不同医疗机构之间的配置状况,并时经常性卫生费用、基本建设投入的机构流向进行了初步分析.针对卫生资源配置中存在的问题,从引导资金合理流动的角度提出了相关建议.     

中国农村贫困地区卫生总费用时间序列系统分析

本文运用宏观卫生经济核算的方法，按照卫生总费用分配流向，整理测算了1978－1993年中国农村贫困地区卫生总费用时间序列的数据并对测算结果进行了政策分析。测算结果发现，贫困的农村地区卫生发展迟缓，与全国平均水平比较，差距在明显扩大；贫困地区在人均国内生产总值水平只有全国平均水平的30％的情况下，投了4．6％的国内生产总值发展卫生保健服务。即使如此，贫困地区居民医疗消费的实际支付能力与当地医疗机构的收费额度相比较，差距日益扩大。在现有支付能力下，贫困农民根本不可能从医疗机构得到基本的卫生保健服务。一方面，是贫困农民医疗需求不足；另一方面，贫困地区医疗机构供给相对有余，效率低下人浮于事。在我国贫困地区卫生费用对农民人均纯收入的多少竟然缺乏弹性，说明贫困地区温饱问题尚未解决。因此，很难指望贫困农民在温饱与健康的选择中，放弃温饱而选择健康。作者认为，农村居民基本卫生服务的实现程度，农村居民大病住院医疗的保障程度，是农村贫困地区卫生行政的主要责任。     

政府卫生支出健康效率测算及分析

目的：测算和分析中国1990年、2000年和2010年政府卫生支出的健康效率及其影响因素。方法：运用DEA和Tobit测算政府卫生支出的健康效率,评估效率值的影响因素。结果：政府卫生支出的健康生产效率在波动中有所提高,不同年度处于前沿面的省份基本一致,远离前沿面的省份存在较大差别;该效率在各区域间的差异较显著,东部地区政府卫生支出的健康生产效率高于中、西部地区;财政分权与政府卫生支出健康效率存在显著负相关关系。结论：财政分权制度的改革与完善是提高政府卫生支出健康效率的重要途径。     

National health expenditures: a global analysis.

As part of the background research to the World development report 1993: investing in health, an effort was made to estimate public, private and total expenditures on health for all countries of the world. Estimates could be found for public spending for most countries, but for private expenditure in many fewer countries. Regressions were used to predict the missing values of regional and global estimates. These econometric exercises were also used to relate expenditure to measures of health status. In 1990 the world spent an estimated US$ 1.7 trillion (1.7 x 10(12) on health, or $1.9 trillion (1.9 x 10(12)) in dollars adjusted for higher purchasing power in poorer countries. This amount was about 60% public and 40% private in origin. However, as incomes rise, public health expenditure tends to displace private spending and to account for the increasing share of incomes devoted to health.     

The concentration of health care expenditures, revisited

In two previous publications, we described the distribution of health care expenditures among the civilian, noninstitutionalized U.S. population, specifically in terms of the share of aggregate expenditures accounted for by the top spenders in the distribution. Our focus revealed considerably skewed distribution, with a relatively small proportion of the population accounting for a large share of expenditures. In this paper we update our previous tabulations (last computed using data more than a decade old) with new data from the 1996 Medical Expenditure Panel Survey (MEPS). Our findings show that the skewed concentration of health care expenditures has remained very stable; 5 percent of the population accounts for the majority of health expenditures.     

The impact of public voluntary health insurance on private health expenditures in Vietnam

As a financing mechanism with the potential to raise additional funds for health services, whilst improving access to services amongst the poor, non-profit health insurance has become increasingly attractive to health policy-makers. Using data from a household survey in Vietnam, out of pocket health expenditure are compared between members and eligible non-members of the government-implemented voluntary health insurance scheme. Expenditures are analysed for individuals who sought care during their most recent illness. Using an endogenous dummy variable model to control for bias resulting from self-selection into the scheme, we find that health insurance reduces average out-of-pocket expenditures by approximately 200%. Whilst income inelastic, health expenditures are found to be significantly influenced by an individuals level of income, irrespective of insurance status. Despite this, insurance reduces expenditures significantly more for the poor than for the rich.     

An income-weighted international average for comparative analysis of health expenditures

Data from 17 countries across 28 years are used to estimate an international health expenditure function based on real per capita GNP. Actual and expected spending levels are compared for 24 countries. Between 1960 and 1987, it has been rare for health expenditure in any country to be more than +/- 20 per cent from the projected value. The norm is for spending to rise at 1.5 times the growth rate of GDP. Two countries appear to display significant anomalies. Spending in the United Kingdom is consistently 15-25 per cent below normal for all years, and Danish expenditure has declined from 7 to 6 per cent of GDP since 1975.     

Impact and attribute of each obesity-related cardiovascular risk factor in combination with abdominal obesity on total health expenditures in adult Japanese National Health insurance beneficiaries: The Ibaraki Prefectural health study

Background

The aim of this study was to examine the attribution of each cardiovascular risk factor in combination with abdominal obesity (AO) on Japanese health expenditures.