2019年上海市卫生总费用核算结果与分析

Results and Analysis on the Total Health Expenditure of Shanghai in 2019

目的:核算2019年上海市卫生总费用,了解上海市卫生筹资规模、特点及存在的问题。方法:采用来源法和机构法核算上海市卫生总费用,并采用时间序列数据分析2001—2019年上海市卫生总费用变化情况。结果:2019年上海市卫生总费用(来源法)总量为2 532.70亿元,占上海市GDP的6.64%,人均卫生总费用为10 430.53元。从筹资结构来看,社会卫生支出、政府卫生支出及个人卫生支出占卫生总费用比重分别为56.84%、22.28%及20.88%。同期卫生总费用(机构法)总量为2 660.58亿元,其中医院占比达67.82%,其次为基层医疗卫生机构,占比为13.33%,公共卫生机构费用占比为2.80%。结论:近年来卫生总费用增速放缓,个人现金卫生支出水平维持在较低水平,但费用机构分配欠合理,基层医疗卫生、公共卫生机构占比偏低。应建立公平、高效、可持续的卫生筹资体系,优化医疗资源配置,加大对基层和公共卫生机构投入,同时加强长三角区域跨省联动。

Objective: To calculate Shanghai’s Total Health Expenditure(THE) in 2019, to identify the scale and characteristicsof health financing in Shanghai, as well as existing problems. Methods: Health accounting methods by financing source and by healthprovider were used. Time series data from 2001 to 2019 were used to reflect the trends in Shanghai’s THE. Results: In 2019, theTHE by financing sources in Shanghai reached 253.27 billion Yuan, accounting for 6.64%of GDP. Average TEH per capita reached10 430.53 yuan. The proportion of social health expenditure, government health expenditure and Out of Pocket Payment(OOP) were56.84%, 22.28% and 20.88 %, respectively. Meanwhile, the THE by health providers accumulated to 266.1 billion yuan, in which hos-pitals expenses accounted for 67.82%. Followed by primary healthcare institutions(13.33%) and public health institutions(2.80%).Conclusion: In recent years, the growth rate of total health expenditure has slowed down, and the level of OOP remined at a low lev-el. However, the distribution among institutions is not reasonable, and the proportion of primary health care and public health institu-tions is low. It was needed to establish a fair, efficient and sustainable health financing system, optimize the allocation of medical re-sources, improve investments in primary health service institutions and public health institutions, and innovative cross-region collabo-ration in the Yangtze River Delta region.