我国政府卫生投入的特点与评价

基于文献综述与现场调查及相关数据的分析,对近年来我国政府财政卫生投入的基本模式与绩效等方面进行了比较系统的分析.阐述了我国政府卫生投入的特点及问题,分析了政府卫生投入的增长速度和绩效评价,并提出建立政府卫生投入的新理念、建立稳定与可持续的财政卫生投入机制、拓展政府卫生筹资能力以保障财政卫生投入、构建一种卫生改革的利益均衡的机制、强化卫生部门治理和建立政府问责机制和加强财政卫生投入的监督与评估六项改善政府卫生投入的建议.

Abstract：

Literature review, field survey and data analysis were called into play in this paper for systematic analysis of the basic models and performance of government health spending in China. The paper covered features and problems in China's health spendings and analyzed the growth rate and performance appraisal of such spendings. Recommendations for improved government health spendings include such six aspects as forming a consensus for building a new concept on government spendings, building a stable and sustainable health input mechanism for public finance, expanding government health financing capacity for assured health spendings, building a mechanism of balanced interests in health reform, intensifying health governance and government accountability mechanism, as well as reinforcing the supervision and assessment of government health spending.     

不同举办主体社区卫生机构妇幼保健现状分析

目的通过对不同举办主体社区卫生服务机构的财政投入、房屋来源以及人才队伍建设等方面的比较,了解不同举办类型机构的投入状况.方法 从全国社区卫生服务体系建设重点联系城市中,分层随机抽取南京等6个城市,收集社区卫生服务中心的定量数据;在部分城市,通过查阅文件、深入访谈及专题小组座谈,收集定性资料.结果 在财政投入及房屋来源方面,政府直接举办和政府所属医疗机构举办的机构状况较好;社会团体或个人举办的机构,发展支撑条件较差,P=0.00.结论 应坚持政府主导、社会参与的社区卫生服务发展原则,对不同举办主体的社区卫生服务机构一视同仁,将工作重点放在完善政策措施、落实经费补偿、加强绩效考核与服务监管等方面,充分发挥非政府举办的社区卫生服务机构的作用.

Abstract：

Objective To study the financial inputs into community health School of Medicine and Health Management, TONGJI Medical College of HUAZHONG[service (CHS) institutions by entities of different ownerships, by comparison of their investment, housing and human resources for policy recommendations.Methods Choose 6 cities in the East, Central and West of China through stratified random sampling. Collect data by literature review, in-depth interview, focus group discussion and questionnaire survey. Analyze quantitative data through EPI data 3.02 and SPSS 13.0.Results The institutions owned by the government and hospitals were advantageous in financial investment and housing; institutions under social organizations or individuals were inferior with development supports (P=0.00). Conclusion The community health service principle of government dominance and social involvement should be advocated, with equal opportunities for community service providers of various ownership. Emphasis should be placed on betterment of policies and measures, specific budget subsidy, as well as performance appraisal and service supervision. These measures aim at encouraging non-government providers to play greater role in community health service.     

上海市公共卫生体系建设发展现状与展望

2003年非典疫情后,公共卫生受到政府和公众前所未有的关注和重视.上海市先后实施完成了第一轮和第二轮的"加强公共卫生体系建设三年行动计划",并将启动实施第三轮行动计划,通过实施前两轮行动计划,上海市公共卫生体系框架逐步得到完善,城市公共卫生安全日益得到保障,市民主要健康状况和指标也不断得到改善和提高.本文在分析公共卫生概念和公共卫生体系范畴的基础上,回顾了上海近10年来公共卫生体系发展状况,并结合上海这个国际化特大型城市的特点,分析未来上海公共卫生体系可能面临的问题和挑战,提出体系发展方向和策略.

Abstract：

The government and general public has paid unprecedented attention to the public health after the outbreak of SARS in 2003. Based on the first and the second round of Three-year Action Plan for Public Health System Construction, the public health system in Shanghai has been gradually improved. The city's public health security has been increasingly consolidated and people's main health status and indicators have been constantly improved. Nowadays, the third round of Three-year Action Plan will be started. This paper will review the development of public health system in Shanghai in recent ten years, analyze the possible problems and challenges in the future and put forward the development direction and strategy of the system.     

湖北省6家公立医院的经济运行现状分析

目的 了解湖北省公立医院的经济运行现状,分析其对公立医院公益性的影响.方法 采用现场调查的方法收集数据,结合相关统计资料对湖北省公立医院的经济运行现状进行分析.结果 湖北省公立医院的财务收支不断增加并趋于平衡;政府财政补助有限,90%以上的公立医院收入来源于医疗收入和药品收入;公立医院人均业务收入呈逐年增长的趋势;湖北省公立医院的资产负债率相对较高.结论 宏观经济体制和卫生政策的变革、经济利益的诱导阻碍了公立医院公益性的实现.完善公立医院的财政补偿机制,规范公立医院的财务管理机制.

Abstract：

Objective To understand the current economical operation of public hospitals in Hubei province and its effect on their public welfare performance. Methods To collect data in field survey and to analyze the current economic situation of such hospitals in the province based on relevant statistics.Results Financial revenue and expenditure of these hospitals keep rising and achieving a balance in general; for the insufficient government financial subsidy, 90% of the revenue of such hospitals come from their medical services and drugs sold; the per capita revenue of these public hospitals maintains a yearly rising trend; their asset-liability ratio was relatively high. Conclusions The public welfare performance of these hospitals tends to be impeded by the reform on the macro economic system and health policy changes, on top of the attraction of economic interests. Improving the government subsidy mechanism for public hospitals and standardizing the financial management mechanism of public hospitals.     

民营医院履行社会责任的实践探索

介绍了我院作为改制后的民营医院,在医院文化建设方面,通过创建爱康医院家的文化,树立爱康价值观,构建和谐的医院工作环境;在管理体制改革方面,实施管办分离,成立了支持系统和运营系统,通过先进的管理方法改进医疗服务质量;在回报社会方面,通过积极救助弱势群体、积极承担公共卫生服务、热心慈善等,付出真诚的爱心,切实履行社会责任.

Abstract：

The paper introduced the organization culture building of a private hospital, in creating the Aikang hospital as your home culture and Aikang values for building a harmonious workplace for the hospital. The management system reform features the separation between regulations and management,building of the supporting system and operating system, for better quality of care with advanced management practice. The social rewards feature great efforts in supporting the disadvantageous population, and undertaking public health service and charity activities. These care and love to the community help the hospital to fulfill its social responsibilities.     

基于可及性视角的我国医药卫生资源区域分布差异研究

目的 通过对我国医药卫生资源区域空间分布的研究,以期为政府优化配置卫生资源提供政策依据.方法 将我国划分为3大经济和地理区域,选取6类医药卫生资源指标,依据2009年国家公布的31个省区的相关统计数据,应用变异系数、基尼系数、泰尔指数评价我国医药卫生资源区域空间分布的差异性.结果 每万人口生物制药企业拥有量区域间的分布差异最大,而医疗机构床位数的配置分布差异相对最小.生物制药企业和三级医院万人口拥有量的区域间极差排在前2位.东部地区是6项资源在3大地理区域间或区域内的差异贡献的最大者,经济相对落后地区是形成执业(助理)医师、床位、三级医院和药品生产企业分布区域内差异的主要贡献者,而经济发达地区对地区政府人均医疗卫生支出和生物制药企业区域间分布差异的贡献最大.总体上,经济发展水平高的地区,其人口资源拥有率也相对更高.但是,两者之间并不完全呈正比关系.结论 6类资源在我国区域间的分布均未表现出"相对合理"的状态.为更好地满足地区人群的卫生需求,政府应加大对经济不发达的西部地区生物制药产业和三级医院建设的投入,提高经济发达地区资源的有效利用和防止低水平重复建设,持续关注人均医药卫生的支出比例和执业医师的数量与质量.

Abstract：

Objective Analyzing the regional distribution discrepancy of medical and health resources in China,with the purpose of providing the government with policy making evidences for optimizing medical and health resource allocation.Results Dividing China into three regions based on regional economic development and geographic setting,and selecting 6 indicators for medical and health resources.On the basis of the statistics of 31 provinces released by the state in 2009,analyzing the interprovincial disparities of the distribution of these six resources,by means of the coefficient of variation,Gini coefficient and Theil index.Methods The largest inter-regional allocation disparity is found in the number of biopharmaceutical manufacturing companies per ten thousand population.And the smallest discrepancy is found in the number of hospital beds among these regions.The top two extreme differences of resource possession per ten thousand population between the maximum and the minmum region are the number of biopharmaceutical manufacturing companies and tertiary hospitals.The eastern region is the largest contributor to the discrepancy of allocation for the six resources within and between regions.The less developed regions contribute the most inter-regional discrepancy for the allocation of medical practitioners(their assistants included),hospital beds,tertiary hospitals and pharmaceutical companies.And the developed regions contribute the most inter-regional discrepancy of medical finance support from local governments and the most of the allocation of biopharmaceutical manufacturing companies.In general,regions of higher development enjoy greater possession of the SIX resources per population in such regions. But these two are not always in direct proportion. Condnsion Regional distribution disparity of the six resources is not yet"reasonable" in China.To better meet the health needs of the population in various regions,the government is expected to increase its financial support for building biopharmaceutical manufacturing companies and tertiary hospitals in the less developed western regions,to better use resources of developed regions,and to keep off investments at low level and repetition.The government is also recommended to pay attention to the proportion of government health finance output and the quality and quantity of medical practitioners.     

深圳市公立医院法人治理改革探索

分析了目前公立医院体制机制方面存在的问题,按照"政事分开、管办分开、医药分开、营利性与非营利性分开"的改革原则,制定了公立医院法人治理改革实施路径.一是建立公立医院管理委员会,统筹政府办医保障职能;建立公立医院管理机构,提高举办医院的行政管理水平;转变卫生行政部门职能,形成多元化办医格局.二是建立分级决策机制、自主经营制度及多元监管制度,解决政事分开问题.三是研究制定公立医院章程,促进公立医院向法定机构转变,通过法制化巩固法人治理改革成果.

Abstract：

Analysis of setbacks found in the existing system and mechanism of public hospitals. Based on the health reform principles of "Separation of administration and management, Separation of administration and operation, Separation of prescribing and dispensing, and Separation of for-profit hospitals and nonprofit hospitals", the authors named the following roadmap for public hospital governance reform. First, set up a management committee for each public hospital to coordinate the government function for medical service; set up a public hospital authority to upgrade the management level of these hospitals; transform functionality of health authorities to encourage diversity in medical service providers. Second, establish the tiered decision making mechanism, autonomous operation system and diversified supervision system, to separate administration and management. Third, formulate articles of association for hospitals to encourage their evolution to legal entities, consolidating the government reforms by legal means.     

Analysis of Developing Public Health Service Sector with Private Finance Initiative in Guangxi

In Guangxi Public Health Service Sector （GPHSS）, because lack of budget, it has caused a number of problems, such as weakened public health service in rural areas, poor professional quality of medical personnel in public health units at village and township levels, current urban public health service could not meet the health demand for urban residents. This paper is a secondary research. Through analysis of the financial problem and both of the advantages and disadvantages of using the Private Finance Initiative （PFI）, it intend to demonstrate that using the PFI could be considered as a good way for the Guangxi government.     

公立医院筹资补偿机制的探讨

"为群众提供安全、有效、方便、价廉的医疗卫生服务"是<公立医院改革试点指导意见>提出的公立医院医疗卫生服务的总体目标,这一目标的实现仅靠改革公立医院内部运行机制是很难奏效的.公立医院的投入机制、区域医疗卫生服务体系的布局、医院所在地的经济与产业状况、医疗保障(险)的支付额度与支付审批程序等众多因素直接影响医院的投入与产出.本文从我国医院的投入补偿机制入手,分析了医院投入与产出的特征,提出建立基于公益性绩效的公立医院投入补偿的观点,为进一步完善公立医院的管理体制、形成以公益性为导向的公立医院运行机制提供参考依据.

Abstract：

Access of safe, effective, convenient and affordable medical and health care services to the people is set as the goal of public hospitals health services as stated in the "Guidelines for Public Hospitals Pilot Reform". Such a goal, however, can hardly be achieved by mechanism changes within the public hospitals. The input and output of public hospitals rely critically on such factors as the input mechanism, regional pattern of healthcare system, the economic and industrial conditions of the region,payment quota and payment approval procedures of medical insurance. This paper set off from the input compensation mechanism of public hospitals in China and analyzed the input and output characteristics of the hospitals. Furthermore, the paper proposed to establish an input compensation mechanism based on public welfare performance for such hospitals. This provided further reference for improving the management of public hospitals and building a public welfare-oriented operation mechanism of public hospitals.     

基于社会治理视角的公立医院社会评价策略及研究框架构建

社会治理是基于对社会管理过程中权力格局分析与判断,在政府、市场、社会与公民基本关系明确定位的前提下倡导的新型公共管理模式.社会评价是基于社会治理理论的一种有效实现载体和手段,由于其对公众利益和责任表达、解决突出社会矛盾问题具针对性和优越性,已得到普遍促进和应用.在基于社会治理理论开展公立医院管理改革情景分析的基础上,阐述了国内外社会治理及社会评价理论、内涵与进展,以及对相关社会领域社会评价治理路径及实践探索进行梳理分析,提出了在医疗服务管理领域探讨和开发其公立医院社会评价策略及研究框架构建,为探索建立公立医院社会管理制度以及政策制定提供依据.

Abstract：

Social governance is a novel form of public administration made based on the analysis and judgment for the power pattern in the course of social administration, a model advocated in the premise of a clearly positioned relationship among the government, marketplace, society and citizens.Social evaluation is an effective carrier and means leveraging the social governance theory, which has found extensive and outstanding use in such issues as expression of public interests and responsibilities,and in tackling sharp social problems. The authors called into play the scenario analysis based on public hospital management reforms with the social governance theory. In addition, they explored social governance at home and abroad as well as the theories, meaning and progress of social evaluation, and analyzed the pathways and probes in social evaluation and governance in the fields in question. On such basis, the paper proposed to explore and develop the social evaluation strategies and study framework for public hospitals in terms of healthcare management, aiming at building the social governance system and policies for public hospitals.     

美国卫生费用上涨和控制及对我国的启示

长期以来,美国卫生费用总量与人均水平居世界首位并保持了较高的增长速度,对于该国政治、经济、社会与人民生活等产生了严重影响。美国卫生费用居高不下的主要原因包括对重点人群和疾病的费用控制措施不力、卫生体制过于复杂导致管理成本过高、人力成本和服务价格过高等。在过去40多年里,虽然美国根据限制、整合和竞争等原则采取了诸多费用控制措施,但收效不大。借鉴美国的相关经验教训并结合我国实际情况,本文的主要建议包括:(1)重视完善的卫生体制在费用控制中的重要作用;(2)在医药卫生体制改革中不宜过分提倡市场化;(3)政府在卫生费用控制中应发挥关键性作用并充分发挥医疗保险机构和医疗服务提供者的作用;(4)在支付方式改革上应重视归纳总结与宏观管理,避免支付方式复杂化;(5)对于医疗机构的横向合并应持审慎态度。     

北京市外来就医与购药对卫生总费用核算平衡的影响

目的：揭示外来就医与外来购药费用对北京市卫生总费用核算平衡的影响程度。方法：外来就医数据以北京市卫生局公共卫生信息中心年报和部分医院内部信息化统计结果为主,外来购药费用的收集采用抽样调查的方法。结果：2011年,北京市外来就医、购药费用313．60亿元,占卫生总费用来源法与机构法核算结果总差异的77．23％。来源法大于机构法核算结果且差异较大的黑龙江和吉林两省居民均在北京有较大比例的就医或购药行为。结论：北京市医疗系统承担了大量外地来京患者的医疗服务;药品零售机构药品销售费用中包含较高比例的外来消费,名优企业贡献突出;外来就医与外来购药是影响卫生总费用核算平衡的主要原因。建议：北京市卫生资源配置要充分考虑外来就医和购药因素;增加中央转移支付,缩小地区医疗资源差距;对外来就医、购药的研究应充分利用现有数据,并适当结合现场调查。     

Recortes,austeridad y salud. Informe SESPAS 2014

Since 2009, the economic recession has led to cuts in spending on social welfare policy and in health care. The most important risks to health depend on negative changes in social determinants. Notable among these determinants are unemployment and the large proportion of people at risk of poverty, which affects 30% of children younger than 14 years. Social inequalities have increased significantly, much more than health inequalities, probably because the value of retirement pensions has been maintained until now. Most of the population is fairly satisfied with the public health system, although it is under considerable pressure. Mortality statistics have not been affected so far, but there has been an increase in mood disorders and mental health problems. Health services utilization has decreased and the number of publicly prescribed drugs has fallen dramatically. This restriction accounts for much of the decrease in public spending on health, since the hospital care budget has not decreased, despite the fall in primary care and public health spending. The crisis could encourage community health and the inclusion of health in all policies. It is the responsibility of professionals and public health institutions monitoring the trend in health problems and their determinants to avoid irreversible situations as far as possible.     

Government health expenditure,out-of-pocket payment and social inequality: A cross-national analysis of China and OECD countries

This study aims to assess the association between Chinese out-of-pocket payments and government health spending, investigating their variation ratio in the context of OECD countries. Aggregated time-series data of 37 countries (from China and official OECD members) were collected from the World Bank Open Data source and analyzed using the multiple linear regression models. Benchmarking approach was applied to evaluate the causes of healthcare expenditure rise per capita. The results showed that China's government health expenditure was positively associated with out-of-pocket payment rise, with a higher variation score of 42.70%. The association was statistically significant at 5%. Likewise, the association between government expenditure and out-of-pocket payment in the OECD countries was positively significant at 1%, and their variation score was 2.41%. Health financing in OECD countries showed higher stability and equity than that in China. Policy implications for China is to reduce the distributional disparity of government health funds by tax adjustments in health services, universal health coverage, the removal of social health insurance disparities, and a single health payment method.     

国际卫生系统绩效评价框架的特点及启示

卫生系统绩效改进是各国卫生事业发展的优先事项。通过总结世界卫生组织、经济合作与发展组织、世界银行等国际组织,以及英国、美国、荷兰等典型国家的卫生系统绩效评价框架特点,为我国开展相关工作提供参考。卫生系统绩效评价框架的构建多参考投入产出模型和健康决定因素模型。卫生系统绩效评价框架呈现多元化、综合化发展趋势,且随着卫生发展阶段的不同而不断更新完善。各国卫生系统绩效评价框架有其自身特点,但也存在一定的规律性。卫生系统绩效评价框架应及时反映本国卫生发展的变化和国际理念的更新;完善数据信息系统,建立公开透明的卫生系统绩效评价动态监测机制;充分发挥卫生系统绩效评价的工具作用,有效推进卫生体系改革。     

A scoping review of the implementation of health in all policies at the local level

ObjectivesHealth in All Policies (HiAP) is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP implementation can involve engagement from multiple levels of government; however, factors contributing or hindering HiAP implementation at the local level are largely unexplored. Local is defined as the city or municipal level, wherein government is uniquely positioned to provide leadership for health and where many social determinants of health operate. This paper presents the results of a scoping review on local HiAP implementation.MethodsPeer reviewed articles and grey literature were systematically searched using the Arksey and O’Malley framework. Characteristics of articles were then categorized, tallied and described.Results23 scholarly articles and four government documents were identified, ranging in publication year from 2002 to 2016 and originating from 14 countries primarily from North America and Europe. A wide range of themes emerged relating to HiAP implementation locally including: funding, shared vision, national leadership, ownership and accountability, local leadership and dedicated staff, Health Impact Assessment, and indicators.ConclusionCommon themes were found in the literature regarding HiAP implementation locally. However, to better clarify these factors to contribute to theory development on HiAP implementation, further research is needed that specifically investigates the facilitators and barriers of HiAP locally within their political and policy context.     

Determining factors of catastrophic health spending in Bogota,Colombia

This study tests whether the low-income population in Bogota not insured under the General Social Security Health System is able to economically handle unexpected health problems or not. It used data from the Health Services Use and Expenditure Study conducted in Colombia in 2001, for which each household recorded its monthly out-of-pocket health expenditure during the year and the household income was measured as the sum of each member’s contribution to the household. Payment capacity or available income and catastrophic health spending were based on the latest methodology proposed by the World Health Organization (WHO) in 2005. A probit model was adjusted to determine the factors that significantly influence the likelihood of a household having catastrophic health spending. The percentage of households with catastrophic health spending in Bogota was 4.9%; incidence was higher in low-income households where none of the members were affiliated to social security, where there had been an in-patient event, and where the heads of household were over 60 years of age. There is no statistical evidence for rejecting the hypothesis under study, which states that low-income households that have no health insurance are more likely to have catastrophic health spending than higher-income households with health insurance.     

The effect of structural adjustment on health conditions in Latin America and the Caribbean, 1980-2000]

OBJECTIVE: To assess the impact of structural adjustment on health indicators in Latin America and the Caribbean during 1980-2000. METHODS: This was an ecological study. Public spending and per capita gross domestic product (pcGDP) figures were obtained from the World Bank, and life expectancy (LE) and infant mortality (IM) figures were obtained from the World Health Organization. Structural adjustment (government downsizing) was assessed by looking at the change in the amount of spending taken up by the government (or the reduction in public spending) in Latin American and Caribbean countries during 1980-1990. Changes in health indicators were measured in terms of the percentage variation in LE and IM. The variations found in Latin America and the Caribbean were compared to those seen in different groups of countries in other parts of the world during 1980-2000. Pearson's chi squared test was used to explore the associations between the decrease in public spending and health indicators. In order to estimate the health effects of such changes, a multivariate linear regression model was created, with adjustments for pcGDP. RESULTS: A deceleration in the rise of LE and in the decline of IM in Latin America and the Caribbean was noted, especially over the period from 1980 through 1990. Significant associations were observed between health indicators and the change in public spending in all groups of countries included in the study. When adjustments were introduced into the multiple regression model, the only associations that remained were seen in Latin America and the Caribbean. CONCLUSIONS: In the decade of 1980, adjustments in macroeconomic policies had a negative effect on social indicators, specifically those that had to do with health conditions in Latin America and the Caribbean. Such an effect lasted throughout the following decade.     

农村居民健康教育与健康促进探索：宁夏经验

目的：运用可行干预措施,帮助农民群众掌握基本健康知识,提高健康水平和生活质量。方法：开展基线调查,了解农民基本健康知识和行为。结果：宁夏农民健康教育普及率、核心信息知晓率、健康行为形成率不断提高,传染病、慢性病、地方病等疾病发病率逐年下降。结论：开展农民健康教育与健康促进行动是一项投入少,产出高的社会工程,需要多部门合作,广大农民参与,建立长效的工作机制,不断提高农民群众的健康意识和健康水平。