公共财政框架下农村卫生发展的政策选择

首先提出在财政投入不足的条件下,农村卫生发展走出了一条以市场筹资为主的发展路径,并对这一路径进行了利弊分析。指出以市场补偿为主的农村卫生发展方式所形成的“马太效应”使卫生资源配置和卫生发展水平的地区差距不断扩大,并将政府应承担的保证基本公共卫生服务供给的支出责任转嫁给卫生机构和民众。但是,这一路径在实践中也对政府公共部门和私人提供者的合作进行了有益的尝试;对公立卫生机构的工作流程管理、人力资源管理做出了有益的探索。提出对公共卫生服务可以采用政府购买并用项目管理的思路实现均等化提供,对基本医疗服务主要采用支持社会医疗保险的方式逐步实现相对均等化。

The Policy Decision of Rural Health Development in Public Finance Framework

Being shorten of government financing,the rural health service system had to financing by market mainly. The pros cons were analyzed of this mode. The pros of this mode were the feasibility of cooperating between public sector and private provider was attempted and the work process adaptation,the human resource management promotion in public health agencies was explored. The cons of this mode were the matthew effect of health resource allocation caused by market financing aggravated the inequality of health service among deferent regions,the government responsibilities on health service was transferred to the health agencies and the mass. In order to advance the equality of health service utilization,the government procurement and project management could be done in public health sphere,the negotiate ability of social medical insurance would be strengthened to limit the expense.