中國大陸醫療衛生財政支出問題研究──基於疫情衝擊的思考

Research on the Financial Expenditure of Medical and Health Care in Mainland China－Thoughts based on the Impact of the Epidemic

2019年末發生的新冠肺炎疫情不僅給中國大陸人民生命健康和社會正常運行帶來嚴重的危害，也考驗著中國大陸醫療衛生系統面對突發公共衛生危機的應對能力。通常而言，一個國家的經濟發展能夠為政府擴大醫療衛生支出規模提供經濟基礎，而高質量的醫療衛生服務也能有效促進經濟的發展。本文基於中國大陸醫療衛生財政支出的現狀，分別從醫療衛生財政支出規模、結構和責任三個方面分析了醫療衛生領域的醫療衛生財政支出問題。從規模角度，醫療衛生財政支出占財政總支出的比例也從2011年的6.83%逐步增加到2018年的7.42%。但和民生支出三大項目中的另外兩項──教育和社會保障支出比較，醫療衛生財政支出比重最低。從結構角度，一方面，東部地區醫療衛生財政支出明顯要比中部地區和西部地區多，並且隨著時間的推移，各地區之間的差距越來越大；另一方面，在中國大陸醫療衛生事業飛速發展的同時，伴隨著的卻是公共衛生機構的不斷減少，意味著對公共衛生、疾病預防方面的重視不足。從政府責任角度，在醫療衛生財政支出方面，地方政府財政支出占比高達99%，面臨著巨大的支出壓力。因此，中國大陸醫療衛生財政制度的優化應從提高財政治理能力角度，適當增加醫療衛生財政支出總量、合理調整醫療衛生財政支出結構、科學劃分中央與地方財政的支出責任、強化預防性醫療支出，以便於建立更加完善的醫療衛生服務體系，提高醫療衛生系統的整體質量。

The outbreak of COVID-19 at the end of 2019 not only brought serious harm to the life and health of the people and the normal operation of society in mainland China, but also tested the ability of the medical and health system in mainland China to cope with the sudden public health crisis. Generally speaking, the economic development of a country can provide the economic basis for the government to expand the scale of medical and health expenditure, and high-quality medical and health services can also effectively promote economic development. Based on the current situation of medical and health financial expenditure in mainland China, this paper analyzes the medical and health financial expenditure in the medical and health field from three aspects : the scale, structure and responsibility of medical and health financial expenditure. From the perspective of scale, the proportion of medical and health fiscal expenditure in total fiscal expenditure also gradually increased from 6.83% in 2011 to 7.42% in 2018. However, compared with the other two of the three major items of people ’s livelihood expenditure, education and social security expenditure, the proportion of medical and health expenditure is the lowest. From the structural point of view, on the one hand, the medical and health expenditure in the eastern region is significantly more than that in the central and western regions, and the gap between the regions is increasing over time ; on the other hand, with the rapid development of medical and health undertakings in mainland China, the continuous reduction of public health institutions means that insufficient attention has been paid to public health and disease prevention. From the perspective of government responsibility, in terms of health care fiscal expenditure, local government fiscal expenditure accounts for up to 99 %, facing huge expenditure pressure. Therefore, the optimization of the medical and health financial system in mainland China should increase the total amount of medical and health financial expenditure, rationally adjust the structure of medical and health financial expenditure, scientifically divide the expenditure responsibility of central and local finance, and strengthen preventive medical expenditure from the perspective of improving financial governance ability, so as to establish a more perfect medical and health service system and improve the overall quality of the medical and health system.