不同经济水平地区计划免服务成本的筹资现状分析

目的了解我国计划免疫筹资现况,为补偿政策的制定提供参考依据。方法运用卫生经济学成本核算的基本原理,采用现况调查的方法,选择东、中、西部3个省,对省、地区、县、乡、村五级计划免疫服务成本与筹资进行测算。结果省、地区、县、乡、村五级政府投入比例为6%~89%,呈逐级降低的趋势;与人均成本相比,人均财政缺口比例为12%~91%,县、乡、村三级普遍存在缺口,并且缺口比例较高。结论计划免疫的政府筹资主渠道作用弱化,政府对计划免疫的筹资责任未得到充分体现;政府在计划免疫筹资上的缺位,导致社会筹资成为计划免疫的主要筹资渠道。建议加强政府对计划免疫服务筹资责任,丰富筹资渠道,建立计划免疫的成本核算制度,并深入研究成本效率。

Financing Situation of Expanded Programme on Immunization in Areas at Different Economic Levels

Objective To know the financing of expanded Programme on Immunization (EPI) Provided by the government. Method This study used the cost accounting theory of health economy,compared EPI service cost and financing degree in different levels, three provinces,3 prefectures,9 counties,18 towns and 12 villages were selected from the western,central, and eastern regions,from three provinces in Guizhou,Heilongjiang and Zhejiang. Results The main results are shown below:The construct of financing showed that the proportion of government investment in the five levels were among 6%-89%,and decreased from the provincial to prefecture,county,town, and village level.Compared with the average cost for one child,the average governmental investment still has the funding insufficiency of 12%-91%.These data indicated that the government responsibility of financing for the EPI was weak,and social financing became the main channel in some areas.As a result,the governmental management was weakened and the ability of macro adjustment and control was restricted. Conclusions According to the result,some suggestions were put forward:1)Enhancing governmental financing responsibility on the EPI service.2)Developing more channels of financing for the EPI service.5)Establishing cost accounting system and further conducting cost-efficiency study.