本文選題：財(cái)政支出 + 城鄉(xiāng)醫(yī)療衛(wèi)生　； 參考：《中國海洋大學(xué)》2014年碩士論文

【摘要】：醫(yī)療衛(wèi)生資源在許多方面表現(xiàn)出巨大的城鄉(xiāng)差異，如醫(yī)療資源占有、衛(wèi)生籌資、健康消費(fèi)、醫(yī)療保障等的城鄉(xiāng)不均衡。城鄉(xiāng)醫(yī)療衛(wèi)生配置不均衡不僅影響到國民的健康，也會(huì)帶來一系列社會(huì)問題。造成配置不均衡局面的根本原因就是資金分配問題，而在財(cái)政收入和支出規(guī)模不斷擴(kuò)大的背景下，醫(yī)療衛(wèi)生資源配置的城鄉(xiāng)差距并沒有得到顯著改善，這無疑暴露出財(cái)政衛(wèi)生支出在城鄉(xiāng)分配方面存在的問題。鑒于此，本文力圖在分析醫(yī)療衛(wèi)生資源均衡配置的財(cái)政機(jī)理的基礎(chǔ)上，從醫(yī)療衛(wèi)生經(jīng)費(fèi)結(jié)構(gòu)的角度入手，運(yùn)用時(shí)序分析的方法對我國城鄉(xiāng)衛(wèi)生醫(yī)療資源均衡配置問題進(jìn)行系統(tǒng)的研究，以期為推動(dòng)城鄉(xiāng)醫(yī)療衛(wèi)生資源均衡配置、提高財(cái)政支出精細(xì)化水平提供科學(xué)的政策建議。 醫(yī)療衛(wèi)生的準(zhǔn)公共品屬性為財(cái)政干預(yù)醫(yī)療衛(wèi)生資源配置提供了必要前提條件。公共物品理論、福利經(jīng)濟(jì)學(xué)、最大最小理論和平均主義理論等都支持公共品均衡配置的觀點(diǎn)，是財(cái)政均衡配置醫(yī)療衛(wèi)生資源的理論依據(jù)。財(cái)政通過保障資源有效供給、控制城鄉(xiāng)均衡配置和引導(dǎo)社會(huì)資本持續(xù)投入等層面實(shí)現(xiàn)上述目標(biāo)。為支持城鄉(xiāng)醫(yī)療衛(wèi)生事業(yè)的不斷改革和發(fā)展，中央財(cái)政不斷提高投入水平，支持醫(yī)療衛(wèi)生基礎(chǔ)設(shè)施建設(shè)、提供衛(wèi)生服務(wù)資金支持和保障國家基本藥物制度施行。財(cái)政支持城鄉(xiāng)醫(yī)療衛(wèi)生事業(yè)發(fā)展卓有成效，公共醫(yī)療衛(wèi)生資源穩(wěn)步增加，城鄉(xiāng)配置差距有效改善。但是由于我國醫(yī)療衛(wèi)生資源按照城鄉(xiāng)兩條路徑進(jìn)行配置，財(cái)政支持城鄉(xiāng)醫(yī)療衛(wèi)生事業(yè)發(fā)展仍存在醫(yī)療衛(wèi)生財(cái)政投入比例不足、個(gè)人醫(yī)療負(fù)擔(dān)較大等問題。我國醫(yī)療衛(wèi)生配置差距存在長期的積累效應(yīng)，城鄉(xiāng)配置在衛(wèi)生經(jīng)費(fèi)、衛(wèi)生床位、技術(shù)人員數(shù)量及服務(wù)水平等方面仍然處于非均衡狀態(tài)。 根據(jù)以上事實(shí)，論文利用泰爾指數(shù)法對我國城鄉(xiāng)醫(yī)療衛(wèi)生資源配置狀況進(jìn)行了測度，結(jié)果顯示2006年之后我國城鄉(xiāng)差距開始有明顯改善，但目前城鄉(xiāng)差距仍較大，我國距離實(shí)現(xiàn)城鄉(xiāng)醫(yī)療衛(wèi)生資源的均衡配置仍有較長的道路要走。且呈現(xiàn)城鎮(zhèn)內(nèi)部差距較小、農(nóng)村內(nèi)部差距較大的特點(diǎn)，要增加對農(nóng)村地區(qū)的醫(yī)療衛(wèi)生資源供給，改善農(nóng)村就醫(yī)環(huán)境。為探究財(cái)政支出對城鄉(xiāng)醫(yī)療衛(wèi)生資源配置差距的影響，論文從衛(wèi)生經(jīng)費(fèi)結(jié)構(gòu)的角度出發(fā)，利用狀態(tài)空間模型法分析了財(cái)政衛(wèi)生支出、個(gè)人衛(wèi)生支出和社會(huì)衛(wèi)生支出在縮小城鄉(xiāng)醫(yī)療衛(wèi)生資源配置差距中的不同作用。結(jié)果顯示財(cái)政未能發(fā)揮主導(dǎo)性地位，反而是個(gè)人衛(wèi)生支出的功效最大。醫(yī)療衛(wèi)生資源按照流動(dòng)性劃分可以分為醫(yī)療衛(wèi)生人員類的“軟資源”和醫(yī)療機(jī)構(gòu)床位類的“硬資源”，通過實(shí)證分析發(fā)現(xiàn)“硬資源”的城鄉(xiāng)差距較易改善，而“軟資源”類不易改善。 經(jīng)實(shí)證分析，我國城鄉(xiāng)醫(yī)療衛(wèi)生資源配置差距過大，財(cái)政支出占總經(jīng)費(fèi)比例較少的原因促進(jìn)了這一差距的形成。為扭轉(zhuǎn)目前這種存在較大差距的形勢，財(cái)政從提高財(cái)政投入水平、統(tǒng)籌城鄉(xiāng)醫(yī)療衛(wèi)生資源配置，創(chuàng)建財(cái)政優(yōu)惠條件、調(diào)整城鄉(xiāng)醫(yī)療資源分配結(jié)構(gòu)，變革財(cái)政投入重心、建立城鄉(xiāng)醫(yī)療衛(wèi)生幫扶機(jī)制，強(qiáng)化政府主導(dǎo)職能、建立醫(yī)療衛(wèi)生多元投入體系，，重視農(nóng)村衛(wèi)生宣傳、提高農(nóng)村醫(yī)療衛(wèi)生防御實(shí)力等五個(gè)方面進(jìn)行科學(xué)地規(guī)劃，努力實(shí)現(xiàn)城鄉(xiāng)醫(yī)療衛(wèi)生資源均衡配置。
[Abstract]:Medical and health resources have shown great differences in urban and rural areas in many aspects, such as medical resources, health financing, health consumption, medical security and so on. The imbalance of urban and rural medical and health allocation not only affects the health of the people, but also brings a series of social problems. The fundamental reason for the disequilibrium situation is capital. In the context of the expanding financial income and the scale of expenditure, the gap between urban and rural areas in the allocation of medical and health resources has not been significantly improved, which undoubtedly exposes the problems of the distribution of financial health expenditure in urban and rural areas. From the perspective of the structure of medical and health funds, this paper makes a systematic study on the balance allocation problem of urban and rural health care resources in China by means of time series analysis, in order to provide a scientific policy suggestion for promoting the balanced allocation of urban and rural medical and health resources and improving the fine level of financial expenditure.
The property of medical and health quasi public goods provides the necessary preconditions for financial intervention in medical and health resources allocation. Public goods theory, welfare economics, maximum minimum theory and equalitarianism theory support the equilibrium allocation of public goods, which is the theoretical basis of financial balanced allocation of medical health resources. In order to support the continuous reform and development of urban and rural medical and health undertakings, the central finance continuously improves the level of investment, supports the construction of medical and health infrastructure, provides support for health services and guarantees the implementation of the national basic drug system, in order to support the continuous reform and development of urban and rural medical and health services. Financial support is effective in the development of urban and rural medical and health services, public health resources are steadily increasing, and the gap between urban and rural areas is effectively improved. However, due to the allocation of medical and health resources in urban and rural areas in accordance with the two routes of urban and rural areas, the financial support for the development of urban and rural medical and health undertakings still has insufficient medical and health financial input, and the personal medical burden is negative. The gap between medical and health allocation in China has a long-term accumulation effect, and the allocation of urban and rural areas in health funds, health beds, the number of technicians and the level of service is still in a disequilibrium state.
According to the above facts, the paper uses the Tel index method to measure the distribution of medical and health resources in urban and rural areas in China. The results show that the gap between urban and rural areas in China has been obviously improved after 2006, but the gap between urban and rural areas is still large, and the distance between urban and rural medical and health resources is still a long way to go. In order to explore the effects of financial expenditure on the gap between urban and rural medical and health resources, the paper makes an analysis of the financial health by using the state space model method. Expenditure, personal health expenditure and social health expenditure have different roles in reducing the gap between urban and rural medical and health resources allocation. The results show that the financial failure to play a leading role is the most effective of personal health expenditure. The medical and health resources can be divided into "soft resources" and medical care personnel according to the mobility of medical and health personnel. Through the empirical analysis, we find that the gap between the urban and rural areas of "hard resources" is easier to improve, while the "soft resources" category is not easy to improve.
Through the empirical analysis, the gap between urban and rural medical and health resources is too large and the financial expenditure accounts for a small proportion of the total expenditure, which has promoted the formation of this gap. In order to reverse the current situation, the financial investment level, the allocation of urban and rural medical resources, the establishment of financial preferential conditions, and the adjustment of urban and rural areas are made. The distribution structure of medical resources, the reform of the focus of financial input, the establishment of urban and rural medical and health assistance mechanism, the strengthening of the government's leading function, the establishment of the multiple input system of medical and health, the emphasis on rural health publicity, and the improvement of the strength of the rural medical and health defense, are carried out scientifically in five aspects, and the balanced allocation of medical and health resources in urban and rural areas is achieved.

【學(xué)位授予單位】：中國海洋大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：F812.45

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