公共卫生领域财政保障政策研究

发布时间：2018-04-10 06:22

本文选题：公共卫生　切入点：财政投入　出处：《南京大学》2014年硕士论文

【摘要】：人类对卫生产品与服务的需求是对健康需求的派生,我国人口老龄化程度的不断加剧、生活环境质量的下降、人均预期寿命的延长以及人们生活水平的普遍提升都将不可避免地导致人们对卫生服务需求的增加。如今,卫生费用的增速已远超同期GDP以及人均收入的增速,高额的医药费用不仅让因病致贫、因病返贫现象在农村更加突出,也使城市居民不堪重负。而公共卫生囊括了和人们生活息息相关的基本公共卫生和基本医疗服务,是一国提高全民身体素质和社会卫生水平的关键环节。由于公共卫生产品的公共物品属性、公共财政的内在要求、国家投资人力资本以及维护社会安定和政治合法性的需要等,政府必须积极干预公共卫生体系的建立健全。政府如何支持公共卫生事业的发展,其核心是公共财政在多大程度上合理引导了公共卫生的发展。研究公共卫生领域的财政保障政策可以为政府更合理地介入公共卫生领域提供理论依据和实践指导,能够明晰我国公共卫生财政保障政策的特点及影响,认清当前卫生财政投入现状,进而帮助学者和政府部门解析当下相关政策的实施效率与不足之处,以形成切实可行的改进方案,增强政府卫生支出分配的合理性,在资源有限的前提下提高资金利用效率,进而提高城乡居民卫生水平,促使政府更好地提供充分适当的公共卫生产品,为经济发展和社会进步提供健康的人力资源。本文综合运用国内外文献研究、比较分析以及泰尔指数等方法,明确了公共卫生的概念,重点探讨公共卫生领域财政保障政策的公平性,不仅就我国财政对公共卫生的投入总量进行了横向、纵向对比分析,也从政府、社会、个人三方承担比例、各级政府承担比例、预防保健费用和医疗费用比例、城乡卫生支出差距、地区间卫生支出差距等方面,详细论证了现行财政政策在公共卫生投入结构上的现状。在谈到地区间政府预算卫生支出差距时,以全国和江苏省2012年医疗卫生投入为例,运用泰尔指数进行定量分析,表明这种地区性卫生支出不均衡现象不单单只存在全国范围内,也存在于省级区域内。通过以上实证分析,本文发现,我国在公共卫生领域的财政支出是远远不够的,投入结构不尽合理,表现在：中央和地方政府对公共卫生的投入分担机制不合理,对治疗性的基本医疗服务和预防性的基本公共卫生服务投入不均衡,财政投入城乡分布严重失衡,财政投入在全国范围内及省内地区间差异均较明显。本文最终从政府职能的行使、城乡二元社会经济结构、财政制度及相关法律政策等方面阐述了财政投入现状的深层原因,并针对研究中发现的问题,提出相应的促进公共卫生财政投入均衡化、合理化的原则和政策建议。
[Abstract]:Human demand for health products and services is derived from the demand for health. The aging of the population in China is increasing, and the quality of living environment is declining.The increase in life expectancy and the general improvement in living standards will inevitably lead to an increase in the demand for health services.Today, the growth of health costs has far outpaced the growth of GDP and per capita income in the same period. The high medical costs not only cause poverty due to illness, but also make the phenomenon of returning to poverty more prominent in rural areas, and also overburdened urban residents.Public health includes basic public health and basic medical services, which are closely related to people's lives. It is a key link for a country to improve the physical quality of the whole people and the level of social health.Due to the attribute of public goods of public health products, the inherent requirement of public finance, the need of national investment in human capital and the need to maintain social stability and political legitimacy, the government must actively intervene in the establishment and perfection of public health system.The core of how the government supports the development of public health is the extent to which public finance reasonably guides the development of public health.The research on the financial security policy in the field of public health can provide theoretical basis and practical guidance for the government to intervene in the field of public health more reasonably, and can clarify the characteristics and influence of the financial security policy of public health in China.Recognizing the current health financial investment situation, and then helping scholars and government departments to analyze the current implementation efficiency and deficiencies of relevant policies, in order to form a feasible improvement plan, and enhance the rationality of the distribution of government health expenditure.Under the premise of limited resources, we can improve the efficiency of capital utilization, improve the health level of urban and rural residents, promote the government to provide adequate and appropriate public health products, and provide healthy human resources for economic development and social progress.In this paper, the concept of public health is clarified by means of domestic and foreign literature research, comparative analysis and Tyr index, and the equity of public health policy in the field of financial security is discussed.Not only has the total financial input to public health in our country been analyzed horizontally and vertically, but also from the government, society, and individuals, the government at all levels has borne the proportion, the cost of preventive health care and the proportion of medical expenses.The difference of urban and rural health expenditure and the gap of regional health expenditure are discussed in detail, and the present situation of public health investment structure of current fiscal policy is demonstrated in detail.When talking about the gap between regional government budget and health expenditure, taking the medical and health investment in the whole country and Jiangsu Province as an example, using the Terre index to carry out quantitative analysis, it shows that this phenomenon of regional health expenditure imbalance exists not only in the whole country, but also in the whole country.It also exists in provincial areas.Through the above empirical analysis, this paper finds that the fiscal expenditure in the field of public health in China is far from enough, and the structure of the input is unreasonable, which is manifested in: the sharing mechanism of the central and local governments' input to public health is unreasonable.The investment in basic medical services and preventive basic public health services is not balanced, the distribution of financial investment in urban and rural areas is seriously out of balance, and the difference of financial investment is obvious in the whole country and between provinces and regions.Finally, this paper expounds the deep reasons of the present situation of financial investment from the aspects of the exercise of government functions, the dual socio-economic structure of urban and rural areas, the financial system and related laws and policies, and aims at the problems found in the study.This paper puts forward the corresponding principles and policy suggestions to promote the equalization and rationalization of public health financial investment.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F812.45;R197.1

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