不同健康产出水平下卫生总费用与健康产出对应关系研究
|
摘要
[目的]在持续的卫生总费用投入下,一些发达国家和经济发达地区出现了卫生总费用与健康产出指标不对应的情况,即健康产出指标由迅速增长转为缓慢增长甚至停止增长。试图从卫生总费用与健康产出指标对应关系上找出问题原因。[方法]选择全国和上海作为2个不同健康水平样本,建立两个样本的卫生总费用与健康产出指标关系模型。将卫生总费用作为应变量,婴儿死亡率、孕产妇死亡率和平均预期寿命等健康产出指标作为自变量,采用逐步回归方法,按自变量对应变量的贡献率大小,建立卫生总费用最优回归模型。[结果]全国健康产出水平相对较低但健康产出水平提升较快,其卫生总费用与健康产出指标相互对应。卫生总费用与婴儿死亡率、孕产妇死亡率和平均预期寿命等三大健康产出指标紧密相关。只要增加卫生总费用就可以获得三大健康产出指标的提升。其提升顺序分别是:平均预期寿命、婴儿死亡率和孕产妇死亡率。上海健康产出水平相对较高但健康产出水平提升缓慢,其卫生总费用只与平均预期寿命相关,与婴儿死亡率和孕产妇死亡率两大健康产出指标不相关。[结论]应重视卫生总费用与健康产出指标的对应关系,不同区域(健康水平)的卫生总费用投入应分类施策。重视同一区域内不同人群健康水平差异对卫生总费用与健康产出对应关系的影响,加强对高健康产出地区低收入(低健康水平)人群中与婴儿死亡率和孕产妇死亡率指标相关的卫生总费用投入。
Objective Under putting into continuous total expenditure on health,some developed countries and economically developed regions have shown that total health expenditure does not correspond to health output indicators,that is,health output indicators change from rapid growth to slow growth or even stop growth. This study tries to find the cause of the problem from correspondence between total health expenditure and health output indicators. Methods Shanghai Municipality and the whole nation were selected as two samples of different health levels,and a model of the relationship between total health expenditure and health output indicators was established for two samples. Took total health expenditure as the dependent variable,health output indicators such as infant mortality,maternal mortality and average life expectancy were used as independent variables,and stepwise regression method was adopted. According to contribution rate of independent variables to dependent variable,the optimal regression model of total health expenditure was established. Results The national health output level was relatively low but health output level increased rapidly,and total health expenditure and health output indicators correspond to each other. Total health costs were closely related to three health output indicators,including infant mortality,maternal mortality and average life expectancy. As long as total health expenditure was increased,three major health output indicators could be promoted. The order of promotion was that average life expectancy,infant mortality and maternal mortality. Shanghai's health output level was relatively high but health output level rose slowly. Its total health expenditure was only related to average life expectancy,and it was not related to two major health output indicators of infant and maternal mortality. Conclusions It is recommended to pay attention to corresponding relationship between total health expenditure and health output indicators. The policy of total health expenditure for different regions( health level) should be classified and applied. Pay more attention to impact of differences in health levels on the relationship between total health expenditure and health output,and strengthen the input on total health expenditure to infant mortality and maternal mortality in low-income( low-health) populations of high-health-producing regions.
Objective Under putting into continuous total expenditure on health,some developed countries and economically developed regions have shown that total health expenditure does not correspond to health output indicators,that is,health output indicators change from rapid growth to slow growth or even stop growth. This study tries to find the cause of the problem from correspondence between total health expenditure and health output indicators. Methods Shanghai Municipality and the whole nation were selected as two samples of different health levels,and a model of the relationship between total health expenditure and health output indicators was established for two samples. Took total health expenditure as the dependent variable,health output indicators such as infant mortality,maternal mortality and average life expectancy were used as independent variables,and stepwise regression method was adopted. According to contribution rate of independent variables to dependent variable,the optimal regression model of total health expenditure was established. Results The national health output level was relatively low but health output level increased rapidly,and total health expenditure and health output indicators correspond to each other. Total health costs were closely related to three health output indicators,including infant mortality,maternal mortality and average life expectancy. As long as total health expenditure was increased,three major health output indicators could be promoted. The order of promotion was that average life expectancy,infant mortality and maternal mortality. Shanghai's health output level was relatively high but health output level rose slowly. Its total health expenditure was only related to average life expectancy,and it was not related to two major health output indicators of infant and maternal mortality. Conclusions It is recommended to pay attention to corresponding relationship between total health expenditure and health output indicators. The policy of total health expenditure for different regions( health level) should be classified and applied. Pay more attention to impact of differences in health levels on the relationship between total health expenditure and health output,and strengthen the input on total health expenditure to infant mortality and maternal mortality in low-income( low-health) populations of high-health-producing regions.
引文
[1]刘巧,李丽清.我国卫生总费用发展趋势与未来展望[J].中国全科医学,2017,20(7):859-864.
[2] AUERBACH,KRIMGOLD.收入地位与健康[M].北京:中国建筑工业出版社,2002.
[3]满晓玮,蒋艳,赵丽颖,等.基于健康产出的卫生总费用与GDP的关系研究[J].中国卫生政策研究,2016,9(7):66-73.
[4]满晓玮,蒋艳,赵丽颖,等.卫生总费用与GDP和健康产出关系研究综述[J].中国卫生经济,2016,35(4):45-49.
[5]中共中央办公厅,国务院办公厅.“健康中国2030”规划纲要[EB/OL].(2016-10-25)https://baike. so. com/doc/24468687-25312554. html.
[6]中共上海市委上海市人民政府.“健康上海2030”规划纲要[EB/OL].(2017-09-27). http://shzw. eastday. com/shzw/G/20170928/u1a13307052. html.
[7]王杰杰.公共卫生支出对居民健康的影响的实证研究[J].经济管理,2017,3(11):309-310.
[8]李华,俞卫.政府卫生支出对中国农村居民健康的影响[J].中国社会科学,2013,(10)204-213.
[9]郭玉玲,刘钦普.中国医疗卫生发展水平区域差异综合评价[J].中国卫生统计,2016,33(2):251-253.
[10]郑文升,蒋华雄,艾红如,等.中国基础医疗卫生资源供给水平的区域差异[J].地理研究,2015,34(11):2035-2048.
[2] AUERBACH,KRIMGOLD.收入地位与健康[M].北京:中国建筑工业出版社,2002.
[3]满晓玮,蒋艳,赵丽颖,等.基于健康产出的卫生总费用与GDP的关系研究[J].中国卫生政策研究,2016,9(7):66-73.
[4]满晓玮,蒋艳,赵丽颖,等.卫生总费用与GDP和健康产出关系研究综述[J].中国卫生经济,2016,35(4):45-49.
[5]中共中央办公厅,国务院办公厅.“健康中国2030”规划纲要[EB/OL].(2016-10-25)https://baike. so. com/doc/24468687-25312554. html.
[6]中共上海市委上海市人民政府.“健康上海2030”规划纲要[EB/OL].(2017-09-27). http://shzw. eastday. com/shzw/G/20170928/u1a13307052. html.
[7]王杰杰.公共卫生支出对居民健康的影响的实证研究[J].经济管理,2017,3(11):309-310.
[8]李华,俞卫.政府卫生支出对中国农村居民健康的影响[J].中国社会科学,2013,(10)204-213.
[9]郭玉玲,刘钦普.中国医疗卫生发展水平区域差异综合评价[J].中国卫生统计,2016,33(2):251-253.
[10]郑文升,蒋华雄,艾红如,等.中国基础医疗卫生资源供给水平的区域差异[J].地理研究,2015,34(11):2035-2048.