湖南省计划免疫成本和经费来源研究

Study on Financing of Expanded Program on Immunization in Hu'nan Province

目的了解计划免疫工作实际投入情况及经费来源,探讨规范开展计划免疫工作的合理成本,为争取政府投入提供依据。方法2004年对本省省级、6个市(州)、24个县(市、区)2003年的计划免疫工作经费投入现况进行调查,并按卫生部《计划免疫技术管理规程》要求规范开展工作进行合理成本测算。结果湖南省为每名儿童计划免疫总投入为194.36元,省、市、县、乡、村级投入分别为17.00元、5.58元、26.36元、84.65元、60.77元;全省平均投入每剂次12.96元。政府投入占省、市、县、乡、村级投入的比例分别为89.24%、54.50%、47.46%、27.56%、3.29%。市、县两级40%以上的计划免疫经费来源于创收,而乡、村级60%～70%的经费依赖创收。全省计划免疫的合理成本为每名儿童260.87元。平均每剂次合理成本为17.39元。结论计划免疫工作经费投入严重不足,在基层,政府投入不是主渠道,而是依赖创收;各级政府应该加大对计划免疫工作的经费投入,国家应用财政转移支付的方式统筹解决计划免疫经费,支持财政困难地区政府履行计划免疫责任。

OBJECTIVE To investigate the actual finacing situation and source of EPI work, try to find out the appropriate compensation of EPI in Hu＇nan and provide the gist for the governments＇ further support. METHOD A cross-sectional study was performed in the investigation covering 24 townships in 6 prefectures. The provincial CDC, 6 prefecture CDCs and 24 township CDCs have counted their work cost according to the Technical Regulations for EN Management established by the ministry of health. RESULTS The financing per child was 194.36 yuan. The cost, inprovincial level, prefecture level, county level, township level and village level was 17.00 yuan, 5.58 yuan, 26.36 yuan, 84.65 yuan and 60.77 yuan respectively. The cost per injection was 12.96 yuan. The government input constitutes of provincial level, prefecture level, county level, township level and village level was 89.24%, 54.50%, 47.46%, 27.56% and 3.29%. More than 40% of the cost in prefecture and county level were financed by the CDC themselves. About 60%-70% of the cost in township and village level were financed by the CDC themselves. The reasonable inpuffor EPI per child in Hunan is 260.87 yuan. The reasonable cost per injection is 17.39 yuan. CONCLUSIONS The EPI finance has a large gap to be filled. The main source of the financing was noi the grass-roots governments＇ compensations but CDCs＇ profitable activities. The governments at all levels should increase input for EPI work. Central and provincial governments should provide further support for EPI work in the poverty areas to ensure immunization service provides and the government＇s responsibility be actualized.