上海区级疾病预防控制机构财政经费保障现状:对财政事权与支出责任划分的启示

Financial status of district level centers for disease control and prevention in Shanghai:enlightenment to the division of financial affairs and expenditure responsibilities

目的明确上海市各区疾病预防控制机构财政经费保障现状,分析区级疾病预防控制经费使用管理过程中存在的问题,对市、区疾病预防控制领域财政事权和支出责任划分改革提供经验借鉴。方法收集2016—2018年上海市16个区级疾病预防控制机构财务情况,通过现场调查明确经费使用管理问题。采用Spearman等级检验,分析各区财政经费承担情况与区级财政能力、区疾病预防控制机构业务绩效考核结果之间的相关关系。结果上海市16个区级疾病预防控制机构的基本支出和区级财政业务支出呈增长态势。历年区财政能力与区疾病预防控制机构基本支出间均存在正相关关系(P均小于0.01),并在2017年与区级财政业务经费间存在相关关系(r=0.647,P=0.007)。历年区疾病预防控制机构业务考核结果与机构基本支出间存在正相关关系(P均小于0.01),并在2017年与区级财政业务经费间存在相关关系(r=0.571,P=0.021)。区级经费存在下达时间较晚、执行效率较低等问题。结论结合国家对公共卫生领域财政事权和支出责任划分改革的要求,地方应根据区域财政能力和承担的疾病预防控制任务合理分配事权职责和支出责任,完善财政经费使用管理机制,对财政能力不足的区域给予转移支付,并注重对人员和机构运行经费的保障。

Objective To understand the current financial funding-guaranteeing situation status of district centers for disease control and prevention(CDC)in Shanghai,to identify and analyze the existing problems of using and managing the funds of district CDCs,and to offer experiences and lessons in the division of responsibilities for the reform of financial affair rights and expenditure responsibilities of district CDCs.Methods Annual financial status data from 2016 to 2018 in 16 district CDCs in Shanghai were collected.Opinions on the problems of fund management were clearly identified through site surveys.The relationship between the fund commitment as well as financial capability of various district CDCs and the results of business performance assessments of various district CDCs were analyzed.Results In Shanghai,the basic expenditures of 16 district CDCs and the financial affair expenditures of various districts were on the rise.Over the study period,the financial capability of each district was positively correlated with the annual basic expenditure of the CDC in that district(P<0.01 for all three years).Regional government financing capacity was significantly correlated with annual basic funds and was significantly correlated with the financial operational fund for that district in 2017(r=0.647,P=0.007).Meanwhile,the results of business performance assessment of each district CDC was positively correlated with the annual basic expenditure of the CDC in that district(P<0.01 for all three years)and was significantly correlated with the financial operational fund for that district in 2017(r=0.571,P=0.021).Late granting of funds,low efficiency in implementation and other problems existed in the use of financial operational funds for various districts.Conclusion In connection with the national requirements regarding the reform in the division of responsibilities for financial affair rights and expenditure responsibilities in the public health fields,local governments should reasonable distribute affair right and expenditure responsibilities in accordance with their relevant regional financial capabilities and their disease control and prevention commitments,consummate the mechanism of managing and using financial funds,provide transfer payments for areas with insufficient financial capabilities,and attach importance to the guarantee of individual and institutional operational funds.