财政支出对城乡医疗卫生资源均衡配置的影响研究

发布时间：2018-04-26 17:41

本文选题：财政支出 + 城乡医疗卫生　；参考：《中国海洋大学》2014年硕士论文

【摘要】：医疗卫生资源在许多方面表现出巨大的城乡差异，如医疗资源占有、卫生筹资、健康消费、医疗保障等的城乡不均衡。城乡医疗卫生配置不均衡不仅影响到国民的健康，也会带来一系列社会问题。造成配置不均衡局面的根本原因就是资金分配问题，而在财政收入和支出规模不断扩大的背景下，医疗卫生资源配置的城乡差距并没有得到显著改善，这无疑暴露出财政卫生支出在城乡分配方面存在的问题。鉴于此，本文力图在分析医疗卫生资源均衡配置的财政机理的基础上，从医疗卫生经费结构的角度入手，运用时序分析的方法对我国城乡卫生医疗资源均衡配置问题进行系统的研究，以期为推动城乡医疗卫生资源均衡配置、提高财政支出精细化水平提供科学的政策建议。医疗卫生的准公共品属性为财政干预医疗卫生资源配置提供了必要前提条件。公共物品理论、福利经济学、最大最小理论和平均主义理论等都支持公共品均衡配置的观点，是财政均衡配置医疗卫生资源的理论依据。财政通过保障资源有效供给、控制城乡均衡配置和引导社会资本持续投入等层面实现上述目标。为支持城乡医疗卫生事业的不断改革和发展，中央财政不断提高投入水平，支持医疗卫生基础设施建设、提供卫生服务资金支持和保障国家基本药物制度施行。财政支持城乡医疗卫生事业发展卓有成效，公共医疗卫生资源稳步增加，城乡配置差距有效改善。但是由于我国医疗卫生资源按照城乡两条路径进行配置，财政支持城乡医疗卫生事业发展仍存在医疗卫生财政投入比例不足、个人医疗负担较大等问题。我国医疗卫生配置差距存在长期的积累效应，城乡配置在卫生经费、卫生床位、技术人员数量及服务水平等方面仍然处于非均衡状态。根据以上事实，论文利用泰尔指数法对我国城乡医疗卫生资源配置状况进行了测度，结果显示2006年之后我国城乡差距开始有明显改善，但目前城乡差距仍较大，我国距离实现城乡医疗卫生资源的均衡配置仍有较长的道路要走。且呈现城镇内部差距较小、农村内部差距较大的特点，要增加对农村地区的医疗卫生资源供给，改善农村就医环境。为探究财政支出对城乡医疗卫生资源配置差距的影响，论文从卫生经费结构的角度出发，利用状态空间模型法分析了财政卫生支出、个人卫生支出和社会卫生支出在缩小城乡医疗卫生资源配置差距中的不同作用。结果显示财政未能发挥主导性地位，反而是个人卫生支出的功效最大。医疗卫生资源按照流动性划分可以分为医疗卫生人员类的“软资源”和医疗机构床位类的“硬资源”，通过实证分析发现“硬资源”的城乡差距较易改善，而“软资源”类不易改善。经实证分析，我国城乡医疗卫生资源配置差距过大，财政支出占总经费比例较少的原因促进了这一差距的形成。为扭转目前这种存在较大差距的形势，财政从提高财政投入水平、统筹城乡医疗卫生资源配置，创建财政优惠条件、调整城乡医疗资源分配结构，变革财政投入重心、建立城乡医疗卫生帮扶机制，强化政府主导职能、建立医疗卫生多元投入体系，，重视农村卫生宣传、提高农村医疗卫生防御实力等五个方面进行科学地规划，努力实现城乡医疗卫生资源均衡配置。
[Abstract]:Medical and health resources have shown great differences in urban and rural areas in many aspects, such as medical resources, health financing, health consumption, medical security and so on. The imbalance of urban and rural medical and health allocation not only affects the health of the people, but also brings a series of social problems. The fundamental reason for the disequilibrium situation is capital. In the context of the expanding financial income and the scale of expenditure, the gap between urban and rural areas in the allocation of medical and health resources has not been significantly improved, which undoubtedly exposes the problems of the distribution of financial health expenditure in urban and rural areas. From the perspective of the structure of medical and health funds, this paper makes a systematic study on the balance allocation problem of urban and rural health care resources in China by means of time series analysis, in order to provide a scientific policy suggestion for promoting the balanced allocation of urban and rural medical and health resources and improving the fine level of financial expenditure.
The property of medical and health quasi public goods provides the necessary preconditions for financial intervention in medical and health resources allocation. Public goods theory, welfare economics, maximum minimum theory and equalitarianism theory support the equilibrium allocation of public goods, which is the theoretical basis of financial balanced allocation of medical health resources. In order to support the continuous reform and development of urban and rural medical and health undertakings, the central finance continuously improves the level of investment, supports the construction of medical and health infrastructure, provides support for health services and guarantees the implementation of the national basic drug system, in order to support the continuous reform and development of urban and rural medical and health services. Financial support is effective in the development of urban and rural medical and health services, public health resources are steadily increasing, and the gap between urban and rural areas is effectively improved. However, due to the allocation of medical and health resources in urban and rural areas in accordance with the two routes of urban and rural areas, the financial support for the development of urban and rural medical and health undertakings still has insufficient medical and health financial input, and the personal medical burden is negative. The gap between medical and health allocation in China has a long-term accumulation effect, and the allocation of urban and rural areas in health funds, health beds, the number of technicians and the level of service is still in a disequilibrium state.
According to the above facts, the paper uses the Tel index method to measure the distribution of medical and health resources in urban and rural areas in China. The results show that the gap between urban and rural areas in China has been obviously improved after 2006, but the gap between urban and rural areas is still large, and the distance between urban and rural medical and health resources is still a long way to go. In order to explore the effects of financial expenditure on the gap between urban and rural medical and health resources, the paper makes an analysis of the financial health by using the state space model method. Expenditure, personal health expenditure and social health expenditure have different roles in reducing the gap between urban and rural medical and health resources allocation. The results show that the financial failure to play a leading role is the most effective of personal health expenditure. The medical and health resources can be divided into "soft resources" and medical care personnel according to the mobility of medical and health personnel. Through the empirical analysis, we find that the gap between the urban and rural areas of "hard resources" is easier to improve, while the "soft resources" category is not easy to improve.
Through the empirical analysis, the gap between urban and rural medical and health resources is too large and the financial expenditure accounts for a small proportion of the total expenditure, which has promoted the formation of this gap. In order to reverse the current situation, the financial investment level, the allocation of urban and rural medical resources, the establishment of financial preferential conditions, and the adjustment of urban and rural areas are made. The distribution structure of medical resources, the reform of the focus of financial input, the establishment of urban and rural medical and health assistance mechanism, the strengthening of the government's leading function, the establishment of the multiple input system of medical and health, the emphasis on rural health publicity, and the improvement of the strength of the rural medical and health defense, are carried out scientifically in five aspects, and the balanced allocation of medical and health resources in urban and rural areas is achieved.

【学位授予单位】：中国海洋大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F812.45

【参考文献】