基于“SHA 2011”的2016—2018年湖南省预防服务费用分析

Analysis on Preventive Expenditure in Hunan Province Based on“SHA 2011”from 2016 to 2018

目的:核算2016—2018年湖南省预防服务费用总量、筹资来源、机构流向和功能配置。方法:基于"卫生费用核算体系2011",结合湖南省预防服务情况,对预防费用的筹资来源、机构流向和功能配置的关系进行二维矩阵分析。结果:湖南省2016—2018年预防服务费用总量分别为106.96、118.67及138.74亿元,占经常性卫生费用的比重分别为6.71%、6.62%及6.84%。预防服务主要由公共卫生机构、基层医疗卫生机构和医院提供。预防费用筹资来源以政府方案、家庭卫生支出和企业筹资方案为主,其中家庭卫生支出占比始终居于第二位,但下降趋势明显,由2016年的34.99%降为2018年的25.19%。预防费用主要用于提供免疫规划、健康体检、孕产妇保健及传染病防治等。结论:加大政府对预防服务的投入,改善"重医疗,轻预防"的现象;调整预防服务功能配置,应加大传染病防治、健康教育等领域的投入;部分预防服务项目的家庭经济负担重,需优化筹资结构。

Objective:To account total prevention expenditure,finance scheme,health provider and service function of the preventive care expenditure of Hunan province from 2016 to 2018.Methods:Based on A System of Health Accouts 2011(SHA 2011)and combined the actual situation in Hunan,it accounted preventive care expenditure of Hunan by recognizing relationships among financing scheme,health provider and service function via two-dimensional matrix analysis.Results:The preventive care expenditures of Hunan from 2016 to 2018 were 10.696 billion yuan,11.867 billion yuan,and 13.874 billion yuan,accounting for 6.71%,6.62%and6.84%of current health expenditure.The preventive services were mainly provided by public health institutions,primary medical institutions and hospitals.The expenditure came from governmental financing,family and institutions health expenditure,and the family health expenditure ranked the second place.While the family health expenditure had a obvious downtrend,for it changed from34.99%in 2016 to 25.19%in 2018.The expenditure was mainly spent on immunization programs,physical examinations,prevention and controlling of infectious diseases,prevention and treatment of infectious diseases and so on.Conclusion:The government must increase the investment in preventive care expenditure,in order to improve the phenomenon of"pay more attention to medical treatment than prevention".The functional assignment of prevention expenditure needed to be adjusted.It must increase input in prevention and treatment of infectious diseases and health education;Since some prevention projects have heavy burden on families,it needed to optimize the financing structure.