我国艾滋病防治资金的筹集、分配和利用研究

发布时间：2018-05-08 07:07

本文选题：艾滋病 + 资金　；参考：《山东大学》2008年博士论文

【摘要】： 背景艾滋病的流行已成为一个严重影响人类健康和全球社会经济发展的公共卫生危机问题,艾滋病对人类健康已经造成的危害和潜在的威胁是史无前例的。联合国在其发布的《人类发展报告2005》中断言:“艾滋病造成了人类发展史上最为严重的倒退”。世界各国艾滋病流行态势及防治经验表明,预防和控制艾滋病是一项刻不容缓、复杂而长期的艰巨任务。与艾滋病防治工作所需要的资金数量相比,资金不足是一个全球性的问题。根据联合国艾滋病规划署(UNAIDS)的测算,目前全球艾滋病防治国际合作资金每年约有100亿美元,而实际需要则高达每年200—230亿美元。中国政府高度重视艾滋病防治工作,不断加大艾滋病预防和控制力度,资金投入也迅速增长。2006年1月29日,国务院颁布《艾滋病防治条例》。《条例》明确了“以政府投入为主,分级承担、多渠道筹资”的筹资机制,规定“县级以上地方人民政府按照本级政府的职责,负责艾滋病预防、控制、监督工作所需资金”,“中央财政对在艾滋病流行严重地区和贫困地区实施的艾滋病防治重大项目给予补助”,“国家鼓励和支持开展艾滋病防治工作的国际合作与交流”。为此,中央财政设立了艾滋病防治专项资金,并且已经列入年度中央财政预算。该资金主要用于中央有关部门开展防治工作和对重点疫区和经济困难地区进行补助。从艾滋病防治资金来源构成看,目前我国艾滋病防治资金的主要来源为政府财政投入。它具有资金数量大、稳定性强、可持续性强的特点,对整个艾滋病防治工作的开展发挥着主导作用。此外,国际合作项目资金数量仅次于政府投入,其来源相对稳定,对艾滋病防治工作起着重要的补充作用。近年来,随着国内艾滋病防治资金的迅速增长,对艾滋病筹资问题的学术关注也逐渐增强。综合国内关于艾滋病筹资的研究结果,可以做出以下结论: 1)目前各级地方政府尚未完全承担起艾滋病防治工作筹资的职责; 2)中央财政转移支付资金在各省的分配体现了补助“艾滋病流行严重地区”的原则,但是没有体现补助“贫困地区”的原则。由于受到数据可得性的影响,已有研究内容还比较局限,并且研究对象局限在国家或省级层面。但是艾滋病各项防治工作的落实主要是在县级,而已有的研究和结论主要是在国家级和省间层面上做出的,目前尚缺少在省内、特别是县级层面点对艾滋病筹资问题的研究,而这样的研究对于评价艾滋病筹资政策的执行情况和指导决策具有重要的应用价值。另外,艾滋病防治工作的投入产出情况、艾滋病项目资金的实际使用状况和效率是决策者关心的一个重要问题,目前国内文献还没有提供这样的研究信息。本研究的主要目的是通过分析我国艾滋病防治资金的筹集、分配和利用状况,揭示县级政府在艾滋病筹资中的职责履行情况,中央财政资金在县级分配的合理性,以及影响艾滋病资金利用效率的因素,为我国艾滋病筹资决策和项目管理提供参考信息。研究方法本研究以定量研究为主并结合案例分析。根据研究目的,分别选取并收集四川省181个县(市、区)2004—2006连续三年的疫情、资金筹集和分配数据,中原七省(安徽、河北、河南、山东、山西和陕西省)72个艾滋病项目县2005-2007连续三年的疫情、资金使用及产出数据作为研究对象。数据的分析方法包括描述性统计分析、方差分析、Probit回归模型和线性回归模型。由于本研究全部数据均为面板数据结构(横断面时间序列数据),面板数据在进行统计分析时需要进行特殊的处理,这包括方差分析进行重复测量因素的校正,回归分析根据分析目的区分为组间效应模型和组内效应模型,组内效应模型又划分为固定效应模型和随机效应模型。数据的描述性统计分析和统计图表主要使用MS Excel软件,统计模型分析使用Stata 10软件。研究结果县级财政设立艾滋病专项资金的比例很低。2004年四川省181个县(县级市、区)中仅有16个县级财政(8.84%)设立了艾滋病专项资金,投入总额为48万元,投入最高者为10万元,最低者为0.2万元;2005年全省仅有28个县级财政(15.47%)设立了艾滋病专项资金,投入总额为157万元,投入最高者为20万元,最低者为0.3万元。县级财政是否设立艾滋病专项资金及资金的数量与HIV感染者人数和人均GDP没有关系。人口数对县级财政资金的影响作用具有统计学意义,人口数每增加10万,县级财政资金数量平均增加910元,其实际意义不大。并且人口数对县级财政资金数量的解释作用仅为4.5%。 HIV感染者人数、人口数和人均GDP三个变量对中央财政资金在县级的分配数量的影响作用均具有统计学意义,但是资金数量主要受疫情因素的影响,其它两个变量的影响作用较小。HIV感染者人数越多、人口数越多、人均GDP越高,县级获得中央财政资金的数量越多。中央财政资金在县级的配置体现了“重点支持高疫情地区”的原则,但没有体现“重点支持贫困地区”的原则。 2005年—2007年,中原七省艾滋病项目活动资金执行率逐年上升,2007年平均资金执行率达98.36%。多部门合作资金占总活动资金的比例逐年增加,2007年已接近总资金数量的一半。参与艾滋病防治工作的非政府组织主要包括工会、共青团、妇联、红十字会、计划生育委员会、相关学会和协会、学术机构(高校和研究院/所)、草根组织等。每项活动支持的资金额度从千元到数十万元不等,平均为1.5万元,学术机构和国际组织资金相对较高,草根组织资金较少。 VCT单位成本在各省之间和各周期间存在明显的差异,最高时为356.65元,最低时为30.25元。从项目第2周期开始,随着项目进展,各省的VCT单位成本均呈现逐渐下降的趋势。周期1各省平均VCT单位成本为100.24元,至周期6下降为61.63元,下降了38.52%。VCT单位成本随着项目累计资金投入数量的增长而下降,回归模型结果表明县均累计资金数量每增加10万元,VCT单位成本降低30%。 ART单位成本在各省和各周期间存在巨大差异,最低时为51.84元,最高时达到8601.06元。与VCT单位成本的变化趋势相反,随着项目进展,各省的ART单位成本总体上呈现逐渐上升的趋势。周期1各省平均ART单位成本为193.55元,至周期6上升为450.92元,上升了3.82倍。ART单位成本随着项目累计资金投入数量的增长而上升,回归模型结果表明县均累计资金数量每增加10万元,ART单位成本上升81%。中原七省的艾滋病防治项目预防干预工作取得了明显的效果。2007年与2005年相比,大众人群艾滋病知识知晓率提高了31个百分点,FSW艾滋病知识知晓率提高了32个百分点,FSW最近一次商业性行为安全套使用率提高了13个百分点。结论与政策建议市、县级地方财政没有承担起艾滋病筹资的应有职责。总体上讲,县级财政对艾滋病防治工作的投入严重不足,没有承担起艾滋病防治应有的筹资责任。建议采取有效措施使地方政府承担起艾滋病筹资的应有的职责。地方财政特别是县级财政对艾滋病防治资金的投入数量应该明文确定并予以量化。地方财政的投入应与地方政府的财政能力相适应,经济发达地方投入较多的资金,经济欠发达地方可以投入较少的资金。经济欠发达地区不足部分可通过中央财政和省财政的转移支付补足。中央财政资金在县级的配置体现了重点支援艾滋病流行严重地区的原则,但没有体现出对经济欠发达地区的重点支援。建议明确并公开上级财政资金分配方案,充分发挥财政转移支付职能。中央转移支付资金需要加大对欠发达地区转移支付的力度,使经济欠发达地区的防治资金得到必要的保证。中央财政和省财政资金在进行区域配置时应充分发挥财政转移支付职能,这不仅能起到平衡各地区艾滋病防治资金的作用,同时还可以促使地方政府发挥其在艾滋病防治筹资中的职能,调动地方政府对艾滋病防治工作的积极性和责任意识。在艾滋病项目执行过程中,应加强对各工作领域资金使用效率的测算并对其影响因素进行研究。根据测算和研究结果,适时调整资金在项目地区和工作领域的分配,以提高资金的使用效率。以VCT和ART为例,本文研究结果表明,VCT资金的使用效率随着项目进展和资金的持续投入而逐渐提高,从效率角度考虑,应保障VCT工作的持续投入。但是,由于艾滋病项目一般为持续数年的短期项目,在项目结束后,资金的持续性如何保证是决策部门应该考虑的问题;相反,ART资金的使用效率随着项目进展而逐渐下降,从效率的角度考虑,项目管理部门应根据对ART效率的测算数据,确定一个合理的效率界限值,对ART资金使用效率低于界限值的地区的ART资金做出适当的调整,将其ART资金调整为其它领域资金,或将其ART资金调整到其它效率高的地区使用。项目资金调整的前提是资金的可调整性,目前艾滋病项目资金的调整,包括资金在各工作领域的调整和在各项目地区的调整,均需要繁琐的审批手续,实际执行难度很大,这是项目管理机构和出资方应该关注的一个问题。
[Abstract]:background
The epidemic of AIDS has become a public health crisis which seriously affects human health and the global social and economic development. AIDS has caused unprecedented dangers and potential threats to human health. The United Nations in its release of human development report 2005>: "AIDS has caused the most human development history. The epidemic situation and control experience of all countries in the world show that the prevention and control of AIDS is an urgent, complex and long-term arduous task. The shortage of funds is a global problem compared with the amount of funds needed for AIDS prevention and control. According to the estimate of the United Nations Programme on AIDS (UNAIDS), At present, the Global Fund for international cooperation in AIDS prevention and treatment is about $10 billion a year, and the actual demand is as high as $200 to $23 billion per year.
The Chinese government attaches great importance to the prevention and control of AIDS and increases the efforts of AIDS prevention and control. The investment in AIDS has also increased rapidly in January 29th. The State Council promulgated < Regulations for the prevention and control of AIDS >. < Regulations >. The financing mechanism of "government input, hierarchical commitment and multi-channel financing" has been defined by the State Council, which stipulates "civil affairs at the county level and above". In accordance with the responsibilities of the government, the government is responsible for the prevention, control and supervision of AIDS, "the central finance gives subsidies to major AIDS prevention and control projects in the areas of AIDS epidemic and poor areas". "The State encourages and supports international cooperation and exchanges on AIDS prevention and treatment." The government has set up special funds for the prevention and control of AIDS, and has been included in the annual central financial budget. The fund is mainly used in the central departments concerned to carry out prevention and control work and to subsidize key epidemic areas and economically difficult areas.
From the source of AIDS prevention and control, the main source of AIDS prevention and control funds in China is the government financial input. It has the characteristics of large amount of funds, strong stability and strong sustainability. It plays a leading role in the development of the whole AIDS prevention and control work. In addition, the number of international cooperation projects is second only to the government investment. The source is relatively stable, which plays an important supplementary role in AIDS prevention and control.
In recent years, with the rapid growth of domestic AIDS prevention and control funds, the academic concern on AIDS financing has gradually increased. The results of comprehensive domestic research on AIDS financing can be made as follows:
1) at present, local governments at all levels have not yet fully assumed the responsibilities of raising funds for AIDS prevention and control.
2) the allocation of the central financial transfer payment in the provinces reflects the principle of subsidized "the epidemic area of AIDS epidemic", but it does not reflect the principle of subsidized "poor areas".
Due to the effect of data availability, the existing research content is limited, and the research object is limited to the national or provincial level. However, the implementation of the AIDS prevention and control work is mainly at the county level, while the existing research and conclusions are mainly made at the national and inter provincial levels, and are still lacking in the province, especially at the county level. The research on the problem of AIDS financing is of great value to the evaluation of the implementation of AIDS financing policy and the guidance and decision-making. In addition, the input and output of AIDS prevention and control work, the actual use and efficiency of AIDS project funds are an important issue for the decision-makers. The domestic literature has not provided such information.
The main purpose of this study is to analyze the financing, distribution and utilization of AIDS prevention and control in China, to reveal the performance of the duties of county-level governments in AIDS financing, the rationality of the distribution of central financial funds at the county level, and the factors affecting the efficiency of AIDS fund utilization, for the decision-making of AIDS financing and project management in China. Provide reference information.
research method
According to the purpose of this study, we selected and collected 181 counties (cities, districts) of Sichuan province (city, district) 2004 to 2006 consecutive three years of epidemic, fund and allocation of data, seven provinces of the Central Plains (Anhui, Hebei, Henan, Shandong, Shanxi and Shaanxi province) 72 AIDS counties 2005-2007 consecutive three years of epidemic situation, Gold use and output data are used as research objects.
Data analysis methods include descriptive statistical analysis, ANOVA analysis, Probit regression model and linear regression model. Because all the data are panel data structures (cross section time series data), panel data need special reasons for statistical analysis, which includes variance analysis for repeated measurement factors. The regression analysis is divided into the inter group effect model and the intra group effect model according to the analysis purpose, and the intra group effect model is divided into the fixed effect model and the random effect model.
Descriptive statistical analysis and statistical charts of data are mainly based on MS Excel software and statistical model analysis using Stata 10 software.
Research results
The proportion of AIDS special funds at county level was very low in 181 counties (county-level cities and districts) in Sichuan province (8.84%) of County Finance (8.84%) set up special funds for AIDS in 16 counties (8.84%), the total input was 480 thousand yuan, the highest was 100 thousand yuan and the lowest was 2 thousand yuan. In 2005, only 28 county finance (15.47%) set up AIDS special. The total investment is 1 million 570 thousand yuan, the highest input is 200 thousand yuan and the lowest is 3 thousand yuan. The number of AIDS special funds and funds at the county level is not related to the number of HIV infected persons and the per capita GDP. The influence of the population on the county financial funds is of unified significance, the population number is increased by 100 thousand, and the county financial capital is increased. The average increase in the amount of gold is 910 yuan, and its actual significance is not large. And the number of population is only 4.5%.
The number of HIV infection, the number of population and the three variables of per capita GDP have statistical significance on the distribution of central financial funds at the county level, but the amount of funds is mainly affected by the epidemic factors, the other two variables have less influence on the number of.HIV infected people, the more the population, the higher the per capita GDP, the county-level gain. The number of central financial funds is more. The allocation of central financial funds at the county level embodies the principle of "key support for high epidemic areas", but does not reflect the principle of "key support to poor areas".
From 2005 to 2007, the implementation rate of AIDS activities in the seven provinces of Central Plains increased year by year. The proportion of the average funds in 2007 increased with the proportion of 98.36%. multi sector cooperative funds, which was nearly half of the total funds in 2007. The non-governmental organizations involved in the AIDS prevention and control work included the trade unions, the Communist Youth League and the women's Federation. The Red Cross, the Family Planning Commission, the relevant societies and associations, academic institutions (universities and institutes / institutes), grassroots organizations, etc. each activity supports a range of funds ranging from 1000 yuan to hundreds of thousands of yuan, averaging 15 thousand yuan, relatively high funds for academic institutions and international organizations and less capital in grass-roots organizations.
VCT unit cost has obvious difference between each province and each cycle, the highest is 356.65 yuan and the lowest is 30.25 yuan. From the second period of the project, with the project progress, the cost of VCT unit in each province is decreasing gradually. The average cost of VCT unit of each province is 100.24 yuan, and the decrease of 61.63 yuan to 6 of the period is 61.63 yuan, down by 38.52. The unit cost of%.VCT decreased with the increase of the amount of funds invested in the project. The regression model showed that the total amount of capital in the county increased by 100 thousand yuan, and the cost of VCT unit reduced by 30%.
There is a huge difference between ART unit cost in all provinces and cycles, at the minimum of 51.84 yuan and up to 8601.06 yuan at the highest level. Contrary to the change trend of VCT unit cost, as the project progresses, the cost of ART unit in each province is on the rise. The average cost of ART unit in each province is 193.55 yuan, and to the cycle 6 is up to 450.92. Yuan, up 3.82 times.ART unit cost increases with the increase in the amount of capital investment in the project. The regression model results show that the total amount of funds in the county increases by 100 thousand yuan, and the cost of ART unit increases by 81%..
The prevention and intervention of AIDS prevention and control projects in the seven provinces of central China have achieved significant results in.2007 years compared with 2005, the awareness rate of AIDS knowledge in the mass population increased by 31 percentage points, and the awareness rate of FSW AIDS knowledge increased by 32 percentage points, and the use rate of the latest commercial behavior safety set in FSW was increased by 13 percentage points.
Conclusions and policy recommendations
Municipal, county and local finance did not assume the responsibility for AIDS financing. On the whole, the input of the county finance to AIDS prevention and control work is seriously inadequate, and there is no responsibility for the financing of AIDS prevention. It is suggested that effective measures be taken to make the local government undertake the due responsibility of AIDS financing. The investment in the funds for the prevention and control of AIDS should be clearly defined and quantified. The input of local finance should be adapted to the financial capacity of local governments, more funds are invested in the developed areas, less funds can be invested in underdeveloped areas, and the insufficient part of the underdeveloped areas can be passed through the central finance and the province's wealth. The transfer payment of the government is complemented.
The allocation of central financial funds at the county level embodies the principle of focusing on the serious AIDS epidemic areas, but does not reflect the key support for the underdeveloped areas. It is suggested that the financial transfer scheme should be made clear and open, and the financial transfer payment function should be fully played. The central transfer payment needs to increase the transfer of funds to the less developed areas. The efforts to transfer payment make the funds for the prevention and control of the underdeveloped areas necessary guarantee. The central financial and provincial financial funds should give full play to the financial transfer payment function in the regional allocation, which can not only balance the role of AIDS prevention and control funds in various regions, but also promote the local government to play its role in the prevention and control of AIDS. In the fund-raising function, we should mobilize local governments' initiative and sense of responsibility for AIDS prevention and control.
In the implementation of AIDS projects, we should strengthen the calculation of the efficiency of the use of funds in various work areas and study its influencing factors. According to the results of calculation and research, we should adjust the allocation of funds in the project area and work field in time so as to improve the efficiency of the use of funds. The results of this study show that the VCT funds are made by VCT and ART. With the progress of the project and the continuous investment of funds, the efficiency of the VCT should be ensured. However, since AIDS projects are generally a short-term project for several years, how to guarantee the sustainability of funds after the end of the project is a problem that the decision department should consider; on the contrary, the use of ART funds. Efficiency decreases gradually as the project progresses. From the efficiency point of view, the project management department should determine a reasonable limit of efficiency according to the measured data of ART efficiency, make appropriate adjustments to the ART funds in the area where the use efficiency of ART is lower than the limit value, and adjust its ART funds to other domain funds, or its ART capital. Gold is adjusted to other areas with high efficiency. The premise of the adjustment of the project funds is the readjustment of funds. At present, the adjustment of funds for AIDS projects, including the adjustment of funds in various work areas and the adjustment in each project area, requires tedious examination and approval procedures, and it is difficult to carry out the actual implementation. This is the project management organization and the capital contribution. A matter of concern.

【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2008
【分类号】：R184

【引证文献】