医改以来省级卫生总费用比较分析

Comparative analysis of changes in provincial health expenditure since China health system reform in 2009

目的:通过省级卫生总费用核算结果,分析2009年医药卫生体制改革以来我国卫生筹资的变化趋势与特征,为完善卫生筹资政策提供参考和依据。方法:选取2009—2012年全国20个省份的卫生总费用核算数据进行纵向和横向对比分析。结果:20个省份中,卫生总费用增幅最大的是安徽(82.97%),政府卫生支出增幅最大的是宁夏(108.71%)。2012年社会卫生支出占卫生总费用比重超过40%的省份全部位于东部地区。个人卫生支出占卫生总费用比重在40%以上的地区减少至5个。结论:各地区卫生总费用均保持增长趋势,但在地区经济水平匹配程度方面存在差异;筹资结构明显优化,但地区间筹资特点不同,部分省份个人卫生支出占卫生总费用比重的压力仍然较大。建议:在提高筹资水平的前提下,注重调整筹资结构,发挥公共筹资的作用,降低居民个人卫生支出负担。

Objective： To analyze the characteristics of health financing at the provincial level according to the total health expenditure since China health system reform began in 2009 and provide evidence for improving health fi- nancing policy. Methods： 20 provinces were chosen and vertical and horizontal Comparative approach was used to an- alyze the data. Results：Total health expenditure increased for all regions, of which the biggest rate was Anhui prov- ince, about 82.97%, while the largest increasing for government health care expenditure was Ningxia province, a- bout 108.71%. In 2012, the provinces with social health expenditure share of total above 40% were allocated in the east region, and the number of provinces with out-of pocket payment share of total above 40% reduces to 5. Conclu- sion： Total health expenditure grew in all regions, but there were differences in the degree that this spending matched the economic level; The financing structure was optimized, but the characteristic of regional financing was different. Some provinces were under huge pressure to reduce out-of pocket payments. Suggestions： Under the premise of im- proving the funding level, financing structure adjustment must be focused, and public funding should play a bigger role and out-of pocket payments should be reduced.