我国公共卫生筹资改革措施评价

我国公共卫生筹资改革有两个明显特点：一是政府经费补助相对减少，二是对公共卫生服务实行有偿服务，改变了公共卫生机构的筹资结构。在1980年实行筹资改革以前，公共卫生机构的一切支出全部由政府经费补偿；在实行改革之后的90年代中期，政府经费占机构总收入的比例下降到30％－50％，仅能补偿人员工资，有偿收入所占比例相应地增加到50％－70％，以市场为导向的公共卫生筹资虽能提高机构的经济活力与生产效率，但同时也暴露出一些问题。经济激励机制导致了不必要卫生服务的过度提供与必要卫生服务的提供不足。有偿服务减少了人们对具有正外部效应的预防保健服务的需求和利用，政府经费不足导致了公共产品的供给不足。以往的实践证明：政府在公共卫生筹资中的作用减弱可导致社会资源利用的低效率；实行有偿服务会抑制人群对这些服务的需求，增加疾病发生的危险性；以市场为导向的公共卫生筹资改革不能作为一项政策选择，一旦采用这类政策，就会造成许多不良后果。

Evaluation on health financing reform for public health in China

There are two chareteristics in health finaning reform for public health in China that induced change of financing structure of public health institutions, one is relative declining of government subsidy, the other is charge for public health service. Before 1980, all expenditures of public health institutions were compensated by govemment subsidy. But by the middle of 1990' s, the proportion of government subsidy to total income dropped down to 30% ~ 50%, which only covered the salary of staff, while the proportion of revenue by charge went up to 50% ~ 70%. Although market-oriented financing for public health improves the viability and efficiency of institutions, it also reveals some serious problems. Economic incentives lead to surplus delivery of unnecessary health services and insufficient provision of essential health services. Charge for service decreaes the demand and utilization of preventive health service that has got positive impact on people, and lack of expenses subsidized by government results in lack of supply of public health products. Past experiences demonstrate that it brings about low efficiency of utilization of social resources that government is losing its role in health financing for public health. Charge for service restrains the demand for service of population, and increases the risk of disease. Market oriented health financing for public health is not a right choice for policy maker. When adopted, it will lead to a lot of ill side effects.