财政投入、激励相容与中国疾病防控体制改革

Fiscal Investment,Incentive Compatibility and Reform of China's Disease Preventionand Control System

本文运用激励理论,建立理论框架分析当代中国疾病防控体制变迁和未来改革方向。从多任务平衡问题出发,提出绩优的疾病防控体制应该是一个激励系统,其内部各项制度要素协调互补,激励相容,以实现多任务激励平衡。作为激励系统,疾病防控体制模式选择受财政体制、疾病谱等一系列外部条件的影响。外部条件变化引起疾病防控体制的制度变迁,这种制度变迁的最终结果是激励系统的整体演化,其过程包括渐进式三阶段。基于1949年以来中国疾病防控体制演变的经验资料验证了本文主要理论观点。中国未来改革趋势是以管理体制为重点带动全面改革,即从疾病防控的属地管理体制走向垂直管理,并提高财政补偿中的激励强度。

This paper establishes a framework for analysing changes in contemporary China's disease prevention and control system and the direction of further reform through the application of the incentive theory.Based on multitasking balance issues,the optimal disease prevention and control system is considered to be a multitasking"incentive system",in which internal elements must be coordinated and complement each other to achieve a balance of multitasking incentives.As an incentive system,the disease prevention and control system is influenced by a number of external conditions,such as the fiscal system and the disease spectrum.Changes in external conditions cause institutional changes in the disease prevention and control system.The result of such institutional changes is an overall evolution of the incentive system,the process of which includes three progressive stages.The main theoretical conclusions are demonstrated by investigating empirical data on the evolution of China's disease prevention and control system since 1949.The future trend is expected to consist of comprehensive reforms with a focus on the management system,i.e.,from the territorial management system to a vertical management system,to increase the intensity of incentives based on fiscal compensation.