新医改背景下云南省医疗卫生财政支出绩效评价研究

发布时间：2018-04-27 08:05

本文选题：新医改 + 医疗卫生　；参考：《云南财经大学》2017年硕士论文

【摘要】：我国的经济建设取得了举世瞩目的成就,各领域的改革开放继续深化。在医疗卫生领域,国务院于2009年提出深化医药卫生体制改革的决定,基本医疗卫生的可及性和医疗服务水平不断提高,医疗保障制度不断完善,医疗卫生支出规模也越来越大,政府在医疗卫生事业发展中的引导作用愈发明显。为进一步推动医疗卫生事业发展,各地不断增加对医疗卫生领域的投入,以云南省为例,在财政支出占GDP的比重不断下降的情况下,医疗卫生费用的支出在不断增长,充分推动云南医疗卫生事业发展的同时极大地减轻了全省城乡居民的医疗负担。但是医疗卫生领域从资源的配置效率到管理制度都依然存在诸多问题,为提高医疗资源配置效率、体现医疗卫生公共服务的公平性,充分满足城乡居民医疗卫生服务需求,本文云南省医疗卫生改革进行绩效评价研究。基于云南省及各市2008-2015年的医疗卫生数据样本,效率绩效选用数据包络分析法(DEA)研究发现云南省各州市间的医疗卫生财政支出效率差异较大,时间上的波动性也较大;规模绩效采用因子分析法分析法结果显示云南省医疗卫生财政支出在绝对规模上逐年增加,但是其占省财政支出和GDP比重是下降的;公平性绩效运用泰尔指数法分析发现医疗卫生资源配置的公平性比医疗卫生财政支出的公平性好,同时医疗卫生财政支出公平性呈现地域上的差异。在实证分析结果的基础上,结合云南省实际情况,本文建议从以下三个方面提升云南省医疗卫生支出绩效:1.提升规模绩效:界定政府在医疗卫生领域职责,加大财政资金的支持力度;合理规划医疗卫生的支出名目,保证资金的充足性;科学构建医疗卫生财政支出结构,提升财政支出规模效率;2.提升效率绩效:完善财税机制,提高医疗卫生财政支出使用力;重视绩效考核,加大政府对医疗卫生财政支出的关注度;完善信息化建设,提升医疗卫生组织的服务效率;增强监管力度,强化邻域医疗卫生的立体考核;3.提升公平性绩效:以立体考核为基础完善财政转移支付制度,平衡医疗卫生财政支出区域差距;扩大医疗卫生人才队伍,缩小医疗卫生软资源的地区差异;完善基层医疗卫生基础设施建设,扩大医疗卫生的承载力;强化基层医疗卫生均等化意识,开放民众利益诉求渠道。
[Abstract]:China's economic construction has made remarkable achievements, the reform and opening up in various fields continue to deepen. In the field of medical and health care, the State Council put forward a decision in 2009 to deepen the reform of the medical and health system. The accessibility of basic medical care and the level of medical services have been continuously improved, the medical security system has been continuously improved, and the scale of medical and health expenditure has become larger and larger. The guiding role of the government in the development of medical and health care is becoming more and more obvious. In order to further promote the development of medical and health services, various localities have continuously increased their investment in the field of medical and health care. Taking Yunnan Province as an example, the expenditure on medical and health expenses is increasing continuously while the proportion of financial expenditure in GDP is declining. While fully promoting the development of medical and health services in Yunnan Province, the medical burden of urban and rural residents in the province has been greatly alleviated at the same time. However, there are still many problems in the field of health care from the efficiency of resource allocation to the management system. In order to improve the efficiency of medical resources allocation, reflect the fairness of medical and health public services, and fully meet the needs of urban and rural residents for medical and health services. This paper studies the performance evaluation of medical and health reform in Yunnan Province. Based on the sample of medical and health data from 2008 to 2015 in Yunnan Province and other cities, the data Envelopment Analysis method (DEAA) is used to study the efficiency performance. It is found that there are great differences in the efficiency of medical and health financial expenditure among different cities in Yunnan Province, and the fluctuation in time is also great. The results of scale performance analysis showed that the medical and health financial expenditure of Yunnan Province increased year by year in absolute scale, but its proportion in provincial financial expenditure and GDP decreased. The fairness performance is analyzed by Tyr index method. It is found that the fairness of the allocation of medical and health resources is better than the fairness of the medical and health financial expenditure, and the fairness of the medical and health financial expenditure is different in different regions. On the basis of the results of empirical analysis, combined with the actual situation in Yunnan Province, this paper proposes to improve the performance of health expenditure in Yunnan Province from the following three aspects: 1. Enhance scale performance: define the responsibility of the government in the field of medical and health care, increase the support of financial funds; rationally plan the medical and health expenditure items to ensure the adequacy of funds; construct the structure of medical and health financial expenditure scientifically, Improving the efficiency of fiscal expenditure. Improve the efficiency performance: improve the fiscal and taxation mechanism, improve the ability to use medical and health financial expenditure; pay attention to performance appraisal, increase the government's attention to the medical and health financial expenditure; perfect the information construction, improve the service efficiency of the medical and health organization; Strengthen the supervision, strengthen the neighborhood medical and health stereoscopic assessment. Improve fairness performance: improve the financial transfer payment system based on three-dimensional assessment, balance the regional gap of medical and health financial expenditure, expand the medical and health personnel team, reduce the regional differences of medical and health soft resources; We should improve the construction of basic medical and health infrastructure, expand the carrying capacity of medical and health care, strengthen the awareness of equalization of medical and health care at the grass-roots level, and open up channels for the interests of the people.
【学位授予单位】：云南财经大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F812.45

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