我国预防接种工作筹资机制存在的问题及对策

Problems and Countermeasures on Fund-raising System of Expanded Program on Immunization in China

国家免疫规划工作是一种政府行为,是带有社会福利公益性的事业,但政府对免疫规划工作经费投入不足是长期未能解决的问题。根据有关调查数据,免疫规划工作实行分级财政负担的体制,政府财政投入不到免疫规划工作所需经费的1/3;免疫规划工作平均有近65%的投入来自创收,乡、村级预防接种工作的开展主要依靠创收。上述过分依靠分级财政和创收的筹资模式导致了免疫规划工作发展不平衡和服务的不公平,创收不仅加重了公众负担,而且降低了免疫规划工作质量,致使一些地区免疫规划工作出现滑坡。国务院颁布的《疫苗流通和预防接种管理条例》明确规定,各级政府有保证免疫规划工作经费的职责。为落实经费保障政策,各级政府要对免疫规划工作给予足够的投入,合理解决基层工作人员的预防接种报酬,中央和省级政府要加大对贫困地区预防接种工作的支持力度。

Objective National Immunization Program belongs to a government behavior with social welfare and public goods. But shortage of government input on national immunization program for a long-time limits future progress and places the program at risk of slipping backward. According to relevant study results, immunization program depends on fiscal decentralization and the government input accounts for less than 1/3 of total program financing. About 65 % financing of immunization program relies on cost-recovery （revenue）. Operation of immunization at township and village level depends on revenue mainly. The model of excessive fiscal decentralization and over-reliance on revenue results, in development unbalance and growing inequities in access to service. Revenue not only increases the parents, burden, but also decreases service quality. The probelem leads the immunization program to slip back. The Ordinance on the Management of Vaccine and Immunization confirms the responsibilities of the government at all levels financing for national immunization program. So the government at all levels should provide enough money for the program. Central and provincial governments should provide further support for EPI work in poor areas and ensure financing for immunization service providers instead of user fee.