摘 要
改革开放以来， 随着公共卫生需求的不断增加，我国的公共卫生在体制、管理和经费等方面出现了许多新的问题。造成这种状况的原因是多方面的，除了国家对公共卫生机构的投入力度相对减弱，促使这些机构更注重有偿服务外，还有一个很重要的原因就是我国公共卫生支出缺乏公平，目前的拨款方式无论对公共卫生机构还是对个人都明显缺乏约束和激励。本文以公共卫生理论为基础，从关注国民健康，实现公共卫生服务均等化的理念出发，研究我国公共卫生支出不公平的问题，分析公共卫生支出的不公平与公共卫生资源配置的非均等以及公共卫生服务的非均等的对应关系，为提高我国公共卫生支出公平性，实现公共卫生服务均等化提供政策建议。目前，国内在探讨公共卫生财政投入方面已有很多研究，但大多是呼吁政府提高认识、明确责任、增加投入以及扩大无偿服务、调整收费标准等，而在如何改进现有拨款方式，优化资源配置，提高公共卫生支出公平性方面却很少涉及。因此，本文具有一定的理论和现实意义。
本文是按照以下思路来进行的：政府为什么要负担公共卫生支出？我国目前的公共卫生的现状是什么？我国公共卫生支出分配是否公平？由此对我国公共卫生支出的公平性进行分析和评价，通过深入分析，得出政策建议。本文的研究内容分为五部分，第一部分是导论，提出整篇文章所要研究的问题，介绍本文选题背景和研究意义。第二部分对我国公共卫生资源配置以及公共卫生支出的现状进行勾勒与概括。第三部分对我国地区之间、城乡之间的公共卫生支出情况进行比较分析，并对应分析我国地区之间、城乡之间公共卫生服务的公平现状，得出结论。第四部分深层次分析我国公共卫生服务不公平的主要原因。第五部分提出要实现公共卫生服务的均等化，首要任务是提高公共卫生支出的公平性，并具体从三个方面提出政策建议。
关键词：公共卫生支出 资源配置 公平
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Abstract
Since the reform and opening up policy, with the increasing demands of public health, many new problems arise in our public health in terms of system, management and funds. The reasons that lead to such a situation is various, except that the national investment in public health organizations relatively abates, which prompted these institutions pay more attention to the paid service, still a very important reason is that our country's public health appropriation lacks fairness. The current ways to allocate funds obviously lack restraint and incentive whether in aspect of individual or public health institutions. Based on the theory of public health, from the concept of paying attention to the national health and realizing the equal access to public health service, this paper aims at exploring the unfair spending of China's public health, analyzing the unfairness of public health expenditure, the ineqality of public health resource allocation and the parallelism of the inquality of public health services, in order to provide some policy suggestions that improve the equality of China's public health allocation, realizing the equal access to public health services. At present, there have been many studies that discuss domestic financial input in the public health, but they are merely calling on the government to improve the awareness, to define the responsibilities, to increase investment and to expand free services, as well as to adjust charging standard and so on. However, those discussions rarely involve the questions like how to improve the existing appropriation ways, how to optimize the allocation of resources and how to improve the equity of public health spending. Therefore, this article has theoretical and realistic significance to some degree.
This paper carries out illustration in turn from the following ideas: why does the government have to bear the public health spending? What the current status of China's public health is alike? Whether the allocation of China's public health expenditure is fair or not? Thus the paper is to analyze and evaluate the fairness of China's public health spending. Then policy suggestions come out
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through in-depth analysis. This paper is divided into five parts, the first part is to put forward questions of the whole article and to introduce the background and significance of this research paper. The second part is to map and summarize China's public health resource allocation and the current situation of public health spending. The third part of this paper is to compare and analyze the situation of public health spending between regions, between urban and rural areas, carrying out the comparative analysis of the public health service status quo correspondingly between regions, between urban and rural areas so that it bears out conclusions. The fourth part deeply analyse the main reasons that lead to the unfairness of China's public health services. The fifth part puts forward the idea that in order to realize the equality of public health services, the primary task is to improve the fairness of public health expenditure, and specific policy suggestions from three aspects follows.
Keywords: public health expenditure, resource allocation, fairness
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目 录
第一章 导论????????????????????????????1 第一节 选题的背景及研究意义??????????????????1 第二节 公共卫生与公共卫生支出的概念 ??????????????2 一、公共卫生的内涵和内容??????????????????2 二、公共卫生与医疗服务的差别????????????????3 三、政府介入公共卫生领域的理论依据 ?????????????4 四、公共卫生支出的概念???????????????????5 五、公平与公共卫生服务公平的概念??????????????6 第三节 相关文献综述??????????????????????6 一、对公共卫生支出理论的相关文献??????????????6 二、对我国公共卫生支出规模的相关文献????????????7 三、对公共卫生支出公平性的相关文献?????????????8 第四节 本文的研究内容和框架??????????????????8
第二章 我国公共卫生资源配置的现状?????????????????9 第一节 我国公共卫生支出的情况?????????????????9 一、公共卫生支出占卫生总费用的比重情况???????????10 二、公共卫生支出占GDP的比重情况??????????????11 三、公共卫生支出占财政支出的比重情况????????????12 第二节 公共卫生资源配置的情况?????????????????13 第三节 开展公共卫生项目的情况?????????????????15 第四节 农村公共卫生的情况???????????????????16
第三章 我国公共卫生支出公平性分析?????????????????17 第一节 我国各地区公共卫生支出的公平性分析???????????18 一、各地区公共卫生支出比较?????????????????18 二、各地区公共卫生服务的公平性分析?????????????21 第二节 我国城乡公共卫生支出的公平性分析????????????23 一、城乡公共卫生支出比较??????????????????23 二、城乡公共卫生服务的公平分析???????????????24
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第三节 对我国公共卫生支出公平状况的基本评价??????????28
第四章 我国公共卫生服务不公平的原因????????????????29 第一节 政府在公共卫生领域的总体投入不足????????????29 第二节 财政能力有限??????????????????????32 一、全国经济发展总体水平较低????????????????32 二、各地区经济发展不平衡??????????????????33 第三节 公共卫生财政投入体制的缺陷???????????????34 一、财政分权化导致公共卫生支出财权事权划分不清???????34 二、公共卫生财政拨款体制不完善???????????????37 三、公共卫生财政转移支付制度的缺陷?????????????38
第五章 提高我国公共卫生服务公平性的对策??????????????40 第一节 建立合理有效的公共卫生投入保障机制???????????40 一、将公共卫生投入纳入法制化轨道??????????????40 二、明确政府的公共卫生支出职责???????????????40 三、合理划分各级政府公共卫生的事权和财权??????????41 第二节 适当加大公共卫生支出规模????????????????43 一、稳步增加公共卫生支出的比例???????????????43 二、积极拓展公共卫生筹资来源????????????????43 三、加大农村公共卫生支出力度????????????????44 第三节 加强财政对公共卫生领域投入的管理????????????44 一、完善转移支付制度????????????????????44 二、改革财政投入预算体制??????????????????45 三、转变财政投入方式????????????????????46 参考文献??????????????????????????????47 致谢????????????????????????????????47
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