农村医疗救助项目的管理成本与效率

Management Costs and Efficiencies of Rural Medical Financial Assistance Programs

农村医疗救助项目资金流程复杂,救助实施过程涉及众多政府职能部门、医疗服务机构、村庄自治组织、农户和个人。这些利益相关者之间协调难度大,项目运行成本高。文章用案例分析表明,虽然世界银行在华贷款卫生Ⅷ项目的管理制度设计精密,但救助基金总量不足,管理经费欠缺,各方参与机构自行设法分散成本。这就不免使制度在实践中变形,甚至带来项目效率降低的后果。因此,中央和省级政府有必要重点加大对贫困县医疗救助专项资金的转移支付。同时,鼓励基层管理机构探索简便易行的制度,并且对这一公共开支项目展开追踪监测。

Financial programs for rural medical assistance are complicated in their implementation, for they involve numerous actors, including various government departments, health service providers, self-governing village organizations, rural households, and individuals. The coordination among these stakeholders is difficult, and operational costs of these programs are rather high. This paper shows that a considerable number of management offices tried to pass some management costs on to other participating institutions due to the shortage of program funds and management outlays. This led to various distortions of the management system in practice and reduced the effectiveness of the programs. Therefore,it is necessary for both central and provincial governments to intensify the transfer of medical financial assistance funds to poor counties. At the same time, institutional innovation should be encouraged in order to create a simpler and more effective management system. In addition, these programs should be constantly monitored with the Public Expenditure Tracking Survey.