本文選題：艾滋病 + 資金��； 參考：《山東大學》2008年博士論文

【摘要】： 背景 艾滋病的流行已成為一個嚴重影響人類健康和全球社會經(jīng)濟發(fā)展的公共衛(wèi)生危機問題,艾滋病對人類健康已經(jīng)造成的危害和潛在的威脅是史無前例的。聯(lián)合國在其發(fā)布的《人類發(fā)展報告2005》中斷言:“艾滋病造成了人類發(fā)展史上最為嚴重的倒退”。世界各國艾滋病流行態(tài)勢及防治經(jīng)驗表明,預防和控制艾滋病是一項刻不容緩、復雜而長期的艱巨任務。與艾滋病防治工作所需要的資金數(shù)量相比,資金不足是一個全球性的問題。根據(jù)聯(lián)合國艾滋病規(guī)劃署(UNAIDS)的測算,目前全球艾滋病防治國際合作資金每年約有100億美元,而實際需要則高達每年200—230億美元。 中國政府高度重視艾滋病防治工作,不斷加大艾滋病預防和控制力度,資金投入也迅速增長。2006年1月29日,國務院頒布《艾滋病防治條例》�！稐l例》明確了“以政府投入為主,分級承擔、多渠道籌資”的籌資機制,規(guī)定“縣級以上地方人民政府按照本級政府的職責,負責艾滋病預防、控制、監(jiān)督工作所需資金”,“中央財政對在艾滋病流行嚴重地區(qū)和貧困地區(qū)實施的艾滋病防治重大項目給予補助”,“國家鼓勵和支持開展艾滋病防治工作的國際合作與交流”。為此,中央財政設立了艾滋病防治專項資金,并且已經(jīng)列入年度中央財政預算。該資金主要用于中央有關部門開展防治工作和對重點疫區(qū)和經(jīng)濟困難地區(qū)進行補助。 從艾滋病防治資金來源構成看,目前我國艾滋病防治資金的主要來源為政府財政投入。它具有資金數(shù)量大、穩(wěn)定性強、可持續(xù)性強的特點,對整個艾滋病防治工作的開展發(fā)揮著主導作用。此外,國際合作項目資金數(shù)量僅次于政府投入,其來源相對穩(wěn)定,對艾滋病防治工作起著重要的補充作用。 近年來,隨著國內(nèi)艾滋病防治資金的迅速增長,對艾滋病籌資問題的學術關注也逐漸增強。綜合國內(nèi)關于艾滋病籌資的研究結果,可以做出以下結論: 1)目前各級地方政府尚未完全承擔起艾滋病防治工作籌資的職責; 2)中央財政轉移支付資金在各省的分配體現(xiàn)了補助“艾滋病流行嚴重地區(qū)”的原則,但是沒有體現(xiàn)補助“貧困地區(qū)”的原則。 由于受到數(shù)據(jù)可得性的影響,已有研究內(nèi)容還比較局限,并且研究對象局限在國家或省級層面。但是艾滋病各項防治工作的落實主要是在縣級,而已有的研究和結論主要是在國家級和省間層面上做出的,目前尚缺少在省內(nèi)、特別是縣級層面點對艾滋病籌資問題的研究,而這樣的研究對于評價艾滋病籌資政策的執(zhí)行情況和指導決策具有重要的應用價值。另外,艾滋病防治工作的投入產(chǎn)出情況、艾滋病項目資金的實際使用狀況和效率是決策者關心的一個重要問題,目前國內(nèi)文獻還沒有提供這樣的研究信息。 本研究的主要目的是通過分析我國艾滋病防治資金的籌集、分配和利用狀況,揭示縣級政府在艾滋病籌資中的職責履行情況,中央財政資金在縣級分配的合理性,以及影響艾滋病資金利用效率的因素,為我國艾滋病籌資決策和項目管理提供參考信息。 研究方法 本研究以定量研究為主并結合案例分析。根據(jù)研究目的,分別選取并收集四川省181個縣(市、區(qū))2004—2006連續(xù)三年的疫情、資金籌集和分配數(shù)據(jù),中原七省(安徽、河北、河南、山東、山西和陜西省)72個艾滋病項目縣2005-2007連續(xù)三年的疫情、資金使用及產(chǎn)出數(shù)據(jù)作為研究對象。 數(shù)據(jù)的分析方法包括描述性統(tǒng)計分析、方差分析、Probit回歸模型和線性回歸模型。由于本研究全部數(shù)據(jù)均為面板數(shù)據(jù)結構(橫斷面時間序列數(shù)據(jù)),面板數(shù)據(jù)在進行統(tǒng)計分析時需要進行特殊的處理,這包括方差分析進行重復測量因素的校正,回歸分析根據(jù)分析目的區(qū)分為組間效應模型和組內(nèi)效應模型,組內(nèi)效應模型又劃分為固定效應模型和隨機效應模型。 數(shù)據(jù)的描述性統(tǒng)計分析和統(tǒng)計圖表主要使用MS Excel軟件,統(tǒng)計模型分析使用Stata 10軟件。 研究結果 縣級財政設立艾滋病專項資金的比例很低。2004年四川省181個縣(縣級市、區(qū))中僅有16個縣級財政(8.84%)設立了艾滋病專項資金,投入總額為48萬元,投入最高者為10萬元,最低者為0.2萬元;2005年全省僅有28個縣級財政(15.47%)設立了艾滋病專項資金,投入總額為157萬元,投入最高者為20萬元,最低者為0.3萬元�？h級財政是否設立艾滋病專項資金及資金的數(shù)量與HIV感染者人數(shù)和人均GDP沒有關系。人口數(shù)對縣級財政資金的影響作用具有統(tǒng)計學意義,人口數(shù)每增加10萬,縣級財政資金數(shù)量平均增加910元,其實際意義不大。并且人口數(shù)對縣級財政資金數(shù)量的解釋作用僅為4.5%。 HIV感染者人數(shù)、人口數(shù)和人均GDP三個變量對中央財政資金在縣級的分配數(shù)量的影響作用均具有統(tǒng)計學意義,但是資金數(shù)量主要受疫情因素的影響,其它兩個變量的影響作用較小。HIV感染者人數(shù)越多、人口數(shù)越多、人均GDP越高,縣級獲得中央財政資金的數(shù)量越多。中央財政資金在縣級的配置體現(xiàn)了“重點支持高疫情地區(qū)”的原則,但沒有體現(xiàn)“重點支持貧困地區(qū)”的原則。 2005年—2007年,中原七省艾滋病項目活動資金執(zhí)行率逐年上升,2007年平均資金執(zhí)行率達98.36%。多部門合作資金占總活動資金的比例逐年增加,2007年已接近總資金數(shù)量的一半。參與艾滋病防治工作的非政府組織主要包括工會、共青團、婦聯(lián)、紅十字會、計劃生育委員會、相關學會和協(xié)會、學術機構(高校和研究院/所)、草根組織等。每項活動支持的資金額度從千元到數(shù)十萬元不等,平均為1.5萬元,學術機構和國際組織資金相對較高,草根組織資金較少。 VCT單位成本在各省之間和各周期間存在明顯的差異,最高時為356.65元,最低時為30.25元。從項目第2周期開始,隨著項目進展,各省的VCT單位成本均呈現(xiàn)逐漸下降的趨勢。周期1各省平均VCT單位成本為100.24元,至周期6下降為61.63元,下降了38.52%。VCT單位成本隨著項目累計資金投入數(shù)量的增長而下降,回歸模型結果表明縣均累計資金數(shù)量每增加10萬元,VCT單位成本降低30%。 ART單位成本在各省和各周期間存在巨大差異,最低時為51.84元,最高時達到8601.06元。與VCT單位成本的變化趨勢相反,隨著項目進展,各省的ART單位成本總體上呈現(xiàn)逐漸上升的趨勢。周期1各省平均ART單位成本為193.55元,至周期6上升為450.92元,上升了3.82倍。ART單位成本隨著項目累計資金投入數(shù)量的增長而上升,回歸模型結果表明縣均累計資金數(shù)量每增加10萬元,ART單位成本上升81%。 中原七省的艾滋病防治項目預防干預工作取得了明顯的效果。2007年與2005年相比,大眾人群艾滋病知識知曉率提高了31個百分點,FSW艾滋病知識知曉率提高了32個百分點,FSW最近一次商業(yè)性行為安全套使用率提高了13個百分點。 結論與政策建議 市、縣級地方財政沒有承擔起艾滋病籌資的應有職責�？傮w上講,縣級財政對艾滋病防治工作的投入嚴重不足,沒有承擔起艾滋病防治應有的籌資責任。建議采取有效措施使地方政府承擔起艾滋病籌資的應有的職責。地方財政特別是縣級財政對艾滋病防治資金的投入數(shù)量應該明文確定并予以量化。地方財政的投入應與地方政府的財政能力相適應,經(jīng)濟發(fā)達地方投入較多的資金,經(jīng)濟欠發(fā)達地方可以投入較少的資金。經(jīng)濟欠發(fā)達地區(qū)不足部分可通過中央財政和省財政的轉移支付補足。 中央財政資金在縣級的配置體現(xiàn)了重點支援艾滋病流行嚴重地區(qū)的原則,但沒有體現(xiàn)出對經(jīng)濟欠發(fā)達地區(qū)的重點支援。建議明確并公開上級財政資金分配方案,充分發(fā)揮財政轉移支付職能。中央轉移支付資金需要加大對欠發(fā)達地區(qū)轉移支付的力度,使經(jīng)濟欠發(fā)達地區(qū)的防治資金得到必要的保證。中央財政和省財政資金在進行區(qū)域配置時應充分發(fā)揮財政轉移支付職能,這不僅能起到平衡各地區(qū)艾滋病防治資金的作用,同時還可以促使地方政府發(fā)揮其在艾滋病防治籌資中的職能,調動地方政府對艾滋病防治工作的積極性和責任意識。 在艾滋病項目執(zhí)行過程中,應加強對各工作領域資金使用效率的測算并對其影響因素進行研究。根據(jù)測算和研究結果,適時調整資金在項目地區(qū)和工作領域的分配,以提高資金的使用效率。以VCT和ART為例,本文研究結果表明,VCT資金的使用效率隨著項目進展和資金的持續(xù)投入而逐漸提高,從效率角度考慮,應保障VCT工作的持續(xù)投入。但是,由于艾滋病項目一般為持續(xù)數(shù)年的短期項目,在項目結束后,資金的持續(xù)性如何保證是決策部門應該考慮的問題;相反,ART資金的使用效率隨著項目進展而逐漸下降,從效率的角度考慮,項目管理部門應根據(jù)對ART效率的測算數(shù)據(jù),確定一個合理的效率界限值,對ART資金使用效率低于界限值的地區(qū)的ART資金做出適當?shù)恼{整,將其ART資金調整為其它領域資金,或將其ART資金調整到其它效率高的地區(qū)使用。項目資金調整的前提是資金的可調整性,目前艾滋病項目資金的調整,包括資金在各工作領域的調整和在各項目地區(qū)的調整,均需要繁瑣的審批手續(xù),實際執(zhí)行難度很大,這是項目管理機構和出資方應該關注的一個問題。
[Abstract]:background
The epidemic of AIDS has become a public health crisis which seriously affects human health and the global social and economic development. AIDS has caused unprecedented dangers and potential threats to human health. The United Nations in its release of human development report 2005>: "AIDS has caused the most human development history. The epidemic situation and control experience of all countries in the world show that the prevention and control of AIDS is an urgent, complex and long-term arduous task. The shortage of funds is a global problem compared with the amount of funds needed for AIDS prevention and control. According to the estimate of the United Nations Programme on AIDS (UNAIDS), At present, the Global Fund for international cooperation in AIDS prevention and treatment is about $10 billion a year, and the actual demand is as high as $200 to $23 billion per year.
The Chinese government attaches great importance to the prevention and control of AIDS and increases the efforts of AIDS prevention and control. The investment in AIDS has also increased rapidly in January 29th. The State Council promulgated < Regulations for the prevention and control of AIDS >. < Regulations >. The financing mechanism of "government input, hierarchical commitment and multi-channel financing" has been defined by the State Council, which stipulates "civil affairs at the county level and above". In accordance with the responsibilities of the government, the government is responsible for the prevention, control and supervision of AIDS, "the central finance gives subsidies to major AIDS prevention and control projects in the areas of AIDS epidemic and poor areas". "The State encourages and supports international cooperation and exchanges on AIDS prevention and treatment." The government has set up special funds for the prevention and control of AIDS, and has been included in the annual central financial budget. The fund is mainly used in the central departments concerned to carry out prevention and control work and to subsidize key epidemic areas and economically difficult areas.
From the source of AIDS prevention and control, the main source of AIDS prevention and control funds in China is the government financial input. It has the characteristics of large amount of funds, strong stability and strong sustainability. It plays a leading role in the development of the whole AIDS prevention and control work. In addition, the number of international cooperation projects is second only to the government investment. The source is relatively stable, which plays an important supplementary role in AIDS prevention and control.
In recent years, with the rapid growth of domestic AIDS prevention and control funds, the academic concern on AIDS financing has gradually increased. The results of comprehensive domestic research on AIDS financing can be made as follows:
1) at present, local governments at all levels have not yet fully assumed the responsibilities of raising funds for AIDS prevention and control.
2) the allocation of the central financial transfer payment in the provinces reflects the principle of subsidized "the epidemic area of AIDS epidemic", but it does not reflect the principle of subsidized "poor areas".
Due to the effect of data availability, the existing research content is limited, and the research object is limited to the national or provincial level. However, the implementation of the AIDS prevention and control work is mainly at the county level, while the existing research and conclusions are mainly made at the national and inter provincial levels, and are still lacking in the province, especially at the county level. The research on the problem of AIDS financing is of great value to the evaluation of the implementation of AIDS financing policy and the guidance and decision-making. In addition, the input and output of AIDS prevention and control work, the actual use and efficiency of AIDS project funds are an important issue for the decision-makers. The domestic literature has not provided such information.
The main purpose of this study is to analyze the financing, distribution and utilization of AIDS prevention and control in China, to reveal the performance of the duties of county-level governments in AIDS financing, the rationality of the distribution of central financial funds at the county level, and the factors affecting the efficiency of AIDS fund utilization, for the decision-making of AIDS financing and project management in China. Provide reference information.
research method
According to the purpose of this study, we selected and collected 181 counties (cities, districts) of Sichuan province (city, district) 2004 to 2006 consecutive three years of epidemic, fund and allocation of data, seven provinces of the Central Plains (Anhui, Hebei, Henan, Shandong, Shanxi and Shaanxi province) 72 AIDS counties 2005-2007 consecutive three years of epidemic situation, Gold use and output data are used as research objects.
Data analysis methods include descriptive statistical analysis, ANOVA analysis, Probit regression model and linear regression model. Because all the data are panel data structures (cross section time series data), panel data need special reasons for statistical analysis, which includes variance analysis for repeated measurement factors. The regression analysis is divided into the inter group effect model and the intra group effect model according to the analysis purpose, and the intra group effect model is divided into the fixed effect model and the random effect model.
Descriptive statistical analysis and statistical charts of data are mainly based on MS Excel software and statistical model analysis using Stata 10 software.
Research results
The proportion of AIDS special funds at county level was very low in 181 counties (county-level cities and districts) in Sichuan province (8.84%) of County Finance (8.84%) set up special funds for AIDS in 16 counties (8.84%), the total input was 480 thousand yuan, the highest was 100 thousand yuan and the lowest was 2 thousand yuan. In 2005, only 28 county finance (15.47%) set up AIDS special. The total investment is 1 million 570 thousand yuan, the highest input is 200 thousand yuan and the lowest is 3 thousand yuan. The number of AIDS special funds and funds at the county level is not related to the number of HIV infected persons and the per capita GDP. The influence of the population on the county financial funds is of unified significance, the population number is increased by 100 thousand, and the county financial capital is increased. The average increase in the amount of gold is 910 yuan, and its actual significance is not large. And the number of population is only 4.5%.
The number of HIV infection, the number of population and the three variables of per capita GDP have statistical significance on the distribution of central financial funds at the county level, but the amount of funds is mainly affected by the epidemic factors, the other two variables have less influence on the number of.HIV infected people, the more the population, the higher the per capita GDP, the county-level gain. The number of central financial funds is more. The allocation of central financial funds at the county level embodies the principle of "key support for high epidemic areas", but does not reflect the principle of "key support to poor areas".
From 2005 to 2007, the implementation rate of AIDS activities in the seven provinces of Central Plains increased year by year. The proportion of the average funds in 2007 increased with the proportion of 98.36%. multi sector cooperative funds, which was nearly half of the total funds in 2007. The non-governmental organizations involved in the AIDS prevention and control work included the trade unions, the Communist Youth League and the women's Federation. The Red Cross, the Family Planning Commission, the relevant societies and associations, academic institutions (universities and institutes / institutes), grassroots organizations, etc. each activity supports a range of funds ranging from 1000 yuan to hundreds of thousands of yuan, averaging 15 thousand yuan, relatively high funds for academic institutions and international organizations and less capital in grass-roots organizations.
VCT unit cost has obvious difference between each province and each cycle, the highest is 356.65 yuan and the lowest is 30.25 yuan. From the second period of the project, with the project progress, the cost of VCT unit in each province is decreasing gradually. The average cost of VCT unit of each province is 100.24 yuan, and the decrease of 61.63 yuan to 6 of the period is 61.63 yuan, down by 38.52. The unit cost of%.VCT decreased with the increase of the amount of funds invested in the project. The regression model showed that the total amount of capital in the county increased by 100 thousand yuan, and the cost of VCT unit reduced by 30%.
There is a huge difference between ART unit cost in all provinces and cycles, at the minimum of 51.84 yuan and up to 8601.06 yuan at the highest level. Contrary to the change trend of VCT unit cost, as the project progresses, the cost of ART unit in each province is on the rise. The average cost of ART unit in each province is 193.55 yuan, and to the cycle 6 is up to 450.92. Yuan, up 3.82 times.ART unit cost increases with the increase in the amount of capital investment in the project. The regression model results show that the total amount of funds in the county increases by 100 thousand yuan, and the cost of ART unit increases by 81%..
The prevention and intervention of AIDS prevention and control projects in the seven provinces of central China have achieved significant results in.2007 years compared with 2005, the awareness rate of AIDS knowledge in the mass population increased by 31 percentage points, and the awareness rate of FSW AIDS knowledge increased by 32 percentage points, and the use rate of the latest commercial behavior safety set in FSW was increased by 13 percentage points.
Conclusions and policy recommendations
Municipal, county and local finance did not assume the responsibility for AIDS financing. On the whole, the input of the county finance to AIDS prevention and control work is seriously inadequate, and there is no responsibility for the financing of AIDS prevention. It is suggested that effective measures be taken to make the local government undertake the due responsibility of AIDS financing. The investment in the funds for the prevention and control of AIDS should be clearly defined and quantified. The input of local finance should be adapted to the financial capacity of local governments, more funds are invested in the developed areas, less funds can be invested in underdeveloped areas, and the insufficient part of the underdeveloped areas can be passed through the central finance and the province's wealth. The transfer payment of the government is complemented.
The allocation of central financial funds at the county level embodies the principle of focusing on the serious AIDS epidemic areas, but does not reflect the key support for the underdeveloped areas. It is suggested that the financial transfer scheme should be made clear and open, and the financial transfer payment function should be fully played. The central transfer payment needs to increase the transfer of funds to the less developed areas. The efforts to transfer payment make the funds for the prevention and control of the underdeveloped areas necessary guarantee. The central financial and provincial financial funds should give full play to the financial transfer payment function in the regional allocation, which can not only balance the role of AIDS prevention and control funds in various regions, but also promote the local government to play its role in the prevention and control of AIDS. In the fund-raising function, we should mobilize local governments' initiative and sense of responsibility for AIDS prevention and control.
In the implementation of AIDS projects, we should strengthen the calculation of the efficiency of the use of funds in various work areas and study its influencing factors. According to the results of calculation and research, we should adjust the allocation of funds in the project area and work field in time so as to improve the efficiency of the use of funds. The results of this study show that the VCT funds are made by VCT and ART. With the progress of the project and the continuous investment of funds, the efficiency of the VCT should be ensured. However, since AIDS projects are generally a short-term project for several years, how to guarantee the sustainability of funds after the end of the project is a problem that the decision department should consider; on the contrary, the use of ART funds. Efficiency decreases gradually as the project progresses. From the efficiency point of view, the project management department should determine a reasonable limit of efficiency according to the measured data of ART efficiency, make appropriate adjustments to the ART funds in the area where the use efficiency of ART is lower than the limit value, and adjust its ART funds to other domain funds, or its ART capital. Gold is adjusted to other areas with high efficiency. The premise of the adjustment of the project funds is the readjustment of funds. At present, the adjustment of funds for AIDS projects, including the adjustment of funds in various work areas and the adjustment in each project area, requires tedious examination and approval procedures, and it is difficult to carry out the actual implementation. This is the project management organization and the capital contribution. A matter of concern.

【學位授予單位】：山東大學
【學位級別】：博士
【學位授予年份】：2008
【分類號】：R184

【引證文獻】

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