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作 者:孙琳[1] 高司民 Sun Lin;Gao Simin(School of Economics,Fudan University,Shanghai 200433,China)
机构地区:[1]复旦大学经济学院,上海200433 [2]复旦大学经济学院公共经济学系,上海200433
出 处:《复旦学报(社会科学版)》2022年第6期170-181,共12页Fudan Journal(Social Sciences)
基 金:上海市教育委员会科研创新重大项目(项目批准号:2019-01-07-00-07-E00034);复旦大学人文社科先导计划项目(项目批准号:2021RWSKXD015)的阶段性成果。
摘 要:“十四五”规划等重要文件明确提出建立稳定的公共卫生事业投入机制,创新医防协同机制。本文着眼于我国长期存在的“重医疗、轻预防”现象,重点关注财政分权体制和人口老龄化两类因素对其的影响机制,并利用2002—2019年省级面板数据进行实证分析。研究发现,中国式财政分权下地方政府缺乏资源和激励提供卫生防疫服务,而人口老龄化所带来的健康需求多为诊疗而非预防,以上双重因素均对卫生防疫服务供给产生显著的负向作用,造成了地方医疗卫生服务供给的结构性分化;同时,我们在拓展分析中发现,现行疾控人员编制标准政策的实施效果并不明显。基于此,应适时将预防性公共卫生指标纳入地方绩效评价体系,优化医疗卫生支出结构,构建医防协同和区域联防机制,并积极推动疾控体系改革。Important documents such as“Outline of the 14 th Five-Year Plan for National Economic and Social Development and Vision 2035”clearly propose to establish a stable public health investment mechanism,innovate the medical and prevention coordination mechanism,and improve the ability to respond to public health emergencies.This paper focuses on the phenomenon of“heavy treatment and light prevention”of the growth of medical service supply and the weakening of health and epidemic prevention services in China,and pays attention to the influence mechanism of the fiscal decentralization and population aging.This paper uses the panel data of 31 provinces in China from 2002 to 2019 to conduct empirical research and finds that local governments lack resources and incentives to provide medical and health services under Chinese-style fiscal decentralization,especially health and epidemic prevention services.At the same time,the health demand brought about by population aging is mostly diagnosis and treatment rather than prevention.The above dual factors have a significant negative effect on the supply of health and epidemic prevention services,resulting in structural differentiation of local medical and health service supply;In addition,in the expanded analysis,this paper finds that the implementation effect of the current disease control staffing standard policy is not obvious.Based on the above results,the government should incorporate preventive public health indicators into the local performance evaluation system,optimize the structure of medical and health expenditure,build the medical and prevention coordination and regional joint prevention mechanism,and promote the reform of disease prevention and control system.
分 类 号:R197.1[医药卫生—卫生事业管理]
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