我国医疗机构卫生总费用增长预测与发展阶段分析

Prediction and stage analysis on increase in total health expenditure of medical institutions in China

目的预测我国卫生总费用的增长趋势,分析各类医疗机构卫生总费用的发展阶段。方法收集我国1990-2015年卫生总费用序列数据,使用SPSS的曲线估计拟合logistic函数模型。结果预测到2020年前后,我国卫生总费用增长出现拐点,由凹增函数变为凸增函数。在2009年之前我国卫生总费用处于渐增期;2009-2030年处于快增期;从2030年以后,进入缓增期。城市医院的增长拐点预计发生在2010年左右,快速增长期在2000-2021年,持续22年;县医院的增长拐点预计发生在2026年左右,快速增长期在2016-2036年,持续21年;卫生院的增长拐点预计发生在2019年左右,快速增长期发在2006-2032年,持续27年。结论流向各类医疗机构的卫生总费用极不平衡,城市医院率先进入快速增长期,卫生院紧随其后,而县医院最晚进入。提示卫生政策制定者应遵循卫生总费用发展变化规律,根据各级医疗机构费用发展阶段制定不同的政策。

Objective To predict the increase in total health expenditure(THE) and to analyze changing stage of THE for various medical institutions in China. Methods We collected national data on THE from 1990 through 2015 and analyzed the data using logistic function curve fitting with SPSS software. Results The analysis results indicated that an inflection point in the curve for China′s THE increase from concave to convex increasing function would occur around 2020. China′s THE increased gradually before 2009 but has been increased rapidly since 2009 and could remain in a rapid increase till2030. We estimated that China ′s THE would increase slowly after 2030. For urban medical institutions in China, the inflection point for THE increase occurred around 2010 and there would be a 22-year period(2000 – 2021) of rapid increase in THE;for medical institutions at county level, the inflection point for THE increase would occur around 2026 and there would be a 21-year period(2016 – 2036) of rapid increase in THE;and for medical institutions at township level, the inflection point for THE increase would occur around 2019 and there would be a 27-year period(2006 – 2032) of rapid increase in THE. Conclusion The increase in total health expenditure is greatly unbanlanced among medical institutions at different levels in China, with a rapid total health expenditure increase first among medical institutions at municipal level,then among those at township level, and lastly among those at county level. The study results suggest that decision makers should develop different policies based on changes and stages in the variation of total health expenditure for medical institutions at different administration level.