目的:了解我国卫生筹资转型的主要特征和历史沿革。
方法:从各种来源收集数据,包括全球卫生支出数据库(GHED),中国卫生统计年鉴,国家卫生财政年度报告,中国卫生总费用研究报告,etal.进行了描述性统计和文献研究。
结果:自21世纪初以来,世界上大多数国家都经历了卫生筹资的转变,卫生筹资规模的扩大和公共筹资责任的强化。值得注意的是,我国卫生筹资转型呈现出鲜明的特点。首先,与全球平均水平相比,卫生筹资规模扩大得更快。2000年至2019年期间,人均卫生总费用按可比价格计算增长816.6%,大大超过全球其他国家的平均增长率(102.1%)。其次,为加强公共融资的责任作出了更大的努力。从2000年到2019年,自费卫生支出占卫生总支出的比重大幅下降30.6个百分点。这一下降幅度明显大于全球其他国家的平均下降幅度(5.6个百分点)。第三,政府卫生支出分配模式发生了重大转变,越来越重视“需求方补贴”,超过“供应方补贴”。在“供应方补贴”的范围内,用于医院的资金显着增加,超过了分配给初级医疗机构和公共卫生机构的资金。基于这些鲜明的特点,本文将中国卫生筹资转型扩展为三个维度:规模维度,结构尺寸和流动尺寸。使用全面的分析框架,中国卫生筹资转型的历史大致分为四个阶段:计划经济阶段,经济转型阶段,后非典阶段和新的卫生体制改革阶段。分析了与每个阶段相关的主要特征和进化逻辑。
结论:最重要的是,应在纵向“嵌入性”和横向“互补性”方面加强卫生筹资体系。此外,应强调卫生筹资过渡在维护隐性价值和减轻公共风险方面的重要性,并且需要一种平衡价值和风险的改进的双向权衡机制。此外,应全面考虑与卫生筹资过渡相关的道德原则,同时在政府实际治理模式内优化预算决策。最后,认识现代医学发展的全局性和深远影响,探索我国卫生筹资转型的长期战略和路径至关重要。
OBJECTIVE: To comprehend the main characteristics and historical evolution of health financing transition in
China.
METHODS: Data were collected from various sources, including the Global Health Expenditure Database (GHED),
China Health Statistics Yearbook, National Health Finance Annual Report,
China \' s Total Health Expenditure Research Report, et al. Descriptive statistics and literature study was conducted.
RESULTS: Since the beginning of the 21st century, most countries in the world had witnessed a transition of health financing, characterized by the expansion of health financing scale and the strengthening of public financing responsibility. Notably,
China \' s health financing transition exhibited distinctive features. Firstly, there had been a more rapid expansion in health financing scale compared with global averages. Between 2000 and 2019, total health expenditure per capita experienced a remarkable increase of 816.6% at comparable prices, significantly surpassing average growth rates observed among other countries worldwide (102.1%). Secondly, greater efforts had been made to strengthen the responsibilities of public financing. From 2000 to 2019, there was a substantial decrease of 30.6 percentage points in the proportion of out-of-pocket health expenditure as a share of total health expenditure. This decline was significantly larger than the average reduction observed among other countries worldwide (5.6 percentage points). Thirdly, there had been a significant shift in government health expenditure allocation patterns, with an increased emphasis on \"demand-side subsidies\" surpassing \"supply-side subsidies\". Within the realm of \"supply-side subsidies\", funding directed towards hospitals had notably increased and surpassed that allocated to primary healthcare institutions and public health institutions. Based on these distinctive characteristics, this paper expanded China \' s health financing transition into three dimensions: Scale dimension, structure dimension and flow dimension. Using a comprehensive analytical framework, the
history of
China \' s health financing transition was roughly divided into four stages: The planned economy stage, the economic transition stage, the post-SARS stage and the new health system reform stage. The main features and evolutionary logic associated with each stage were analyzed.
CONCLUSIONS: Above all, the health financing system should be enhanced in terms of vertical \"embeddedness\" and horizontal \"complementarity\". Moreover, the significance of health financing transition in preserving hidden value and mitigating public risk should be emphasized, and there is a need for an improved two-way trade-off mechanism that balances value and risk. Additionally, the ethical principles associated with health financing transition should be considered comprehensively, while optimizing budget decision-making within the government \' s actual governance model. Lastly, it is crucial to recognize the overall and profound impact of modern medicine development and explore long-term strategies and pathways for health financing transition in China.