摘要
“看病难、看病贵”是我国居民面临的突出问题,而“看病难、看病贵”的根源在于医疗卫生资源配置公平性与效率性的缺乏,正如国务院发展研究中心课题组指出的,医改基本不成功表现在医疗卫生资源配置缺乏公平和效率两个方面。
卫生总费用的总量及其结构反映了一国或一个地区医疗卫生资源配置的基本状况,它是分析医疗卫生事业与国民经济、社会健康需求之间的关系,评价各项卫生政策的合理性与公平性、社会效益与经济效益的基本手段。本文以卫生总费用为研究对象,通过对卫生总费用的总量分析与结构分析,定性分析与定量分析,分析和评价我国卫生资源配置的现状,探求各种制约或扭曲医疗卫生资源配置公平与效率的因素,为即将推进的医疗卫生改革提出相关政策建议。全文包括五个部分:
第一部分,导言。本章首先简单介绍我国卫生总费用的基本情况,并对论文即将涉及的基本概念进行了清晰界定,最后梳理了国内外有关卫生总费用研究的文献。目前国内外关于卫生总费用的研究主要集中在五个方面:(1)卫生总费用核算;(2)卫生总费用的影响因素;(3)卫生总费用与GDP的关系;(4)卫生总费用配置公平;(5)卫生总费用配置效率。
第二部分,卫生总费用的弹性分析。本章重点了考察我国卫生总费用及其构成部分的收入弹性,通过对改革开放以来卫生总费用收入弹性的理论分析与实证分析,揭示了卫生总费用及其构成部分的动态特征以及与GDP的动态关系,并预测我国卫生总费用占GDP的比例将达到8%。此外,本章还通过卫生总费用的相关数据间接而巧妙地测算了医疗卫生服务需求的收入弹性与价格弹性,计量经济模型表明我国医疗卫生服务需求收入弹性和价格弹性都在0.36左右。这说明医疗卫生服务总体而言是必需品而不是奢侈品,政府需要在提供公共卫生服务和基本医疗服务方面承担更多的责任,此外,由于医疗卫生服务需求的价格弹性比较小,政府需要改善和加强对药品和医疗服务的价格管制。
第三部分,卫生总费用的结构分析。本章对我国卫生总费用的筹资结构和分配结构进行了深入分析:我国卫生总费用筹资结构的主要问题为政府在卫生筹资方面弱化了自身的责任,政府卫生支出在卫生总费用中的比重偏低,居民个人现金卫生在卫生总费用的比重过高,居民医疗卫生负担沉重;我国卫生总费用分配结构的主要问题为,医疗费用相对公共卫生费用过高,药品费用在卫生总费用中的比重过高,卫生总费用在各地区、人群之间分配不均衡。我国卫生总费用筹资结构和分配结构的不合理,既制约了医疗卫生资源配置的效率,也损害了医疗卫生资源配置的公平。
第四部分,卫生总费用与经济增长。本章运用经济增长核算的实证研究方法测算了由卫生总费用或健康投资累积而形成的人力资本对我国经济增长的贡献率,计量经济模型表明健康人力资本的产出弹性大约为0.24,处于物质资本产出弹性(0.52)和教育人力资本产出弹性(0.13)之间。这表明健康投资对经济增长的促进作用是非常明显的,加大对健康与教育的投资有利于加快人力资本的积累,进而推动和促进经济增长以及经济增长方式的转变。
第五部分,相关政策建议。通过对我国卫生总费用及其构成部分与GDP动态关系的研究,以及卫生总费用筹资结构与分配结构的分析,本章为正在推进的医疗卫生体制改革提出了相关政策建议,主要包括:(1)平衡政府、社会和个人在卫生筹资中的责任;(2)促进卫生资源在地区间、人群间更加均衡地分配;(3)完善公共卫生体系,形成合理的防治投入比例;(4)改善药品价格管制,控制药品费用的过快增长。
It has been an outstanding problem for people to see a doctor difficultly and expensively. A report from the State Council Development Research Center writes, the failure of health system reform lies in inequity and inefficiency of the allocation of health resources. The root of difficulty in seeing a doctor and the high cost of getting a treatment, lies in the same fact that the allocation of health resources lacks equity and efficiency.
The quantity and structure of the Total Health Expenditure (THE) shows how health resources are allocated in a country or an area .It helps us to analyze the relationship among the health cause, the national economy and the health demand, and assess the equity, effectiveness and efficiency of health policies. By means of quantitative and structural analysis, theoretic and empirical analysis, the paper analyzes and assesses the allocation of health resources in China. This paper consists of five parts:
PartⅠ: Introduction. At the beginning of the chapter, the paper briefly introduces the THE in China, and then defines the fundamental concepts that concerned. Finally, the paper makes a brief review of relevant studies on THE. These studies are divided into five groups categories, that is, the calculation of THE, influencing factors of THE, the dynamic relationship between THE and GDP, allocation equity of THE, and allocation efficiency of THE.
PartⅡ: Analyzing the elasticity of THE. First, the paper studies the basic characteristics of five time series, that is to say, THE, GDP, the public health expenditure, the social health expenditure, the out-of-pocket health payment. Second, the paper researches the dynamic relationship between THE and GDP since the reform and opening policy in the way of calculating the income elasticity of THE, and forecasts the proportion of THE in GDP reaches 8% in future years.
In addition, the paper calculates the price elasticity and income elasticity of medical service or healthcare, which can be regarded as a standard commodity for all Chinese people. According to the econometric model, the price elasticity and income elasticity of medical service both are about 0.36, which means healthcare is not a luxury but a necessity in China. Because of low price elasticity and income elasticity of medical service, Chinese government should undertake more responsibilities in providing the public health service and basic medical services, improve and strengthen the price regulation of medicines and medical services.
PartⅢ: Analyzing the structure of THE. The paper studies the financing structure and distribution structure of THE in China. For the financing structure of THE, the problems lie in that, because of government weakening the responsibilities in providing the public health service and basic medical services, the proportion of public health expenditure in THE is extremely low, while the proportion of out-of-pocket health payments in THE is excessively high. The structural problems of the distribution structure of THE in China can be summarized as follows. First, the proportion of medical expenses relative to public health expenditure is excessively high; second, the excessive increasing drug expenditure occupies such a big part in THE ; third, the distribution of THE among different areas and different groups is not balanced. At the end of this part, the paper concludes that, the structural problems of THE in China have not only restricted the allocation equity of health resources, but also the allocation efficiency of health resources.
PartⅣ:THE and economic growth. The paper calculates the output elasticity of the heath capital which formed by health expenditures or health investment.
According to the econometric model, the output elasticity of the heath capital equals to 0.24, which lies between the output elasticity of the material capital and education capital, the former is 0.52 and the latter 0.13. At the end of this part, the paper concludes that it is necessary for Chinese people to extend the investment of healthcare and education, which is helpful for us to speed up the accumulation of human capital, accelerate economic growth, as well as promote the transformation of economic growth mode.
PartⅤ: Relative policy suggestions. Based the above analysis of the dynamic relationship between THE and GDP, as well as the structural problems of THE, the paper brings up much constructive advice for the new health system reform. Firstly, the government, the society and the individual should undertake respective responsibilities for financing healthcare expenditures; secondly, promoting a much more fair distribution of health resources among different areas and different groups; thirdly, perfecting the public health system, and forming a rational proportion of investment between treatment and prevention; fourthly, improving and strengthening the price regulation of medicines and medical services, controlling the excessive increasing drug expenses.
引文
①参见,王少平:《宏观计量的若干前沿理论与应用》,南开大学出版社,2003 年,pp.137。
①参见王星:《非参数统计》,中国人民大学出版社,2005 年,pp.230。
②资料来源:http://www.itl.nist.gov/div898/handbook/pmd/section1/pmd14.htm
①数据来源:《非典影响财政收支》,新浪网,http://news.sina.com.cn/c/2003-06-29/1708288650s.shtml
①参见,《哥伦比亚百科全书(第六版)》,网络链接 http://www.bartleby.com/65/
②参见,李少冬:《发展发展非基本医疗服务 增强卫生事业活力》,《中华医院管理杂志》,2000(5)。
③参见,李少冬:《发展发展非基本医疗服务 增强卫生事业活力》,《中华医院管理杂志》,2000(5)。
①数据来源:《中国卫生统计提要(2007)》,卫生部网站,http://www.moh.gov.cn/open/2007tjts/P25.htm。
②参见,雷海潮、毛阿燕:《全国大型医用设备技术效率分析》,《医疗装备》,2002(1)。
③数据来源,刘国祥、赵郁馨等:《中国卫生总费用分配流向测算报告》,《中国卫生经济》,2001(2)。
④2005 年我国卫生总费用使用总额为 8659.91 亿元,其中药品费用为 4142.10 亿元,人均药品费用 129.34 元。数据来源,卫生部卫生经济研究所:《2006 中国卫生总费用研究报告》
②数据来源:《医院仍垄断药品销售 涨服务费就能降药费?》,新浪网,http://news.sina.com.cn/c/2006-11-01/073110376701s.shtml
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