我国公共卫生财政支出区域均等化研究

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浙江财经学院硕士学位论文

VII

摘要

良好的健康状况不仅为社会提供了优质的人力资本，而且促进了社会的进步

与经济的发展。但是以经济效率优先的发展方针在带动中国经济迅猛增长的同时

却也造成了经济社会发展的严重不均衡，公共卫生的公益性遭受到极大的挑战，

我国医疗卫生问题形势严峻。

公平是医疗卫生领域的主要政策目标，医疗卫生体制的改革与发展都要考虑

到卫生服务公平性。尤其是在当前建设和谐社会的背景下，如何满足每一个社会

成员的基本医疗卫生需求，如何通过对社会卫生资源的合理配置从而提高卫生资

源的利用效率，促进公共卫生的平衡发展是亟待解决的现实问题。

在这样的背景下，本文主要从我国公共卫生投入利益归宿分析角度出发，探

讨了改革开放以来我国在卫生领域的不公平现象，并对造成这种公共卫生投入受

益分布的具体现象的原因进行计量分析。

本文首先对我国公共卫生投入状况进行了详细的分析，尤其是公共卫生财政

支出规模与现状的数据分析；其次文章对我国公共卫生投入受益分布差异的实证

分析：采取了单因素方差分析法、集中曲线法、泰尔指数法等方法；最后构建计

量模型，分析判断我国公共卫生财政支出受益分布差异的主要影响因素及原因。

本文主要结论为我国最高收入地区、次高收入地区、中等收入地区、次低收

入地区、最低收入地区在公共卫生财政支出规模上存在显著差异；我国公共卫生

财政支出状况呈现出中间低、两头高的“V”型，主要受益群体为人均收入最高的

地区，收入次低地区却是公共卫生财政支出受益分布的主要受损者；上述实证分

析证明我国人均收入较高的地区居民从公共卫生财政支出中得到的受益要高于人

均收入较低的地区居民。

此外，本文认为影响我国公共卫生财政支出受益分布差异的主要因素为：造

成各个地区公共卫生支出受益分布差异的原因主要在于各地经济发展水平的影

响；年龄对一个地区公共卫生财政支出系数为正，教育与一个地区公共卫生财政

支出负相关。

对此，本文提出以下决策：一是以立法手段界定各级政府的公共卫生财政支

出责任与支出规模；二是增强对“夹心层”地区的公共卫生财政投入及政策扶持

力度；三是引入“对口支援”模式，解决偏远地区医疗人员紧缺问题。

关键词：公共卫生财政支出，均等化，利益归宿分析

浙江财经学院硕士学位论文

VIII

ABSTRACT

Good state of health not only provides society with quality human capital, but also

promotes social progress and economic development. The guiding development

principle of giving priority to economic efficiency propels the rapid advance of China’s

economy; however, meanwhile, it leads to the severe unbalanced development of

economy and society which issues serious challenge to the non-profit characteristic of

public health and to the health and medical care system in China.

The major goal of health and medical care is fairness, which should be taken into

account while reforming and developing the health and medical care system. Especially

in the current context of constructing harmonious society, such problems as how to meet

every social member’s basic need of health and medical care and how to rationally

allocate the health resources so as to improve its utility efficiency and to advance the

balanced development of the cause of public health have to be settled urgently.

Under the circumstances, this thesis, from the perspective of public health

investment benefit incidence, probes into the unfairness phenomena in the field of

health and medical care since the reform and opening policy in China and makes

quantitative analyses into the causes of the above-mentioned phenomenon.

Firstly, this thesis makes a scrutiny into the public health expenditure condition,

especially the expenditure scale and its present condition. Secondly, this thesis conducts

positive analysis of discrepancy in public health investment benefit incidence through

such methods as single factor variance analysis, centralized curve method, Theil index

method, etc. Finally, by means of constructing econometric model, this thesis attempts

to analyze and assess the leading factors influencing the discrepancy in public health

investment benefit incidence and the cause of this phenomenon.

This thesis mainly concludes that there are significant differences in public health

expenditure between high-income regions, sub-high-income areas, middle-income

districts, sub-low-income localities and the low-income areas; that the condition of the

public health expenditure in China assumes a V-shape with the high-income regions as

the main beneficiaries and the sub-low-income regions as the chief casualties; that the

people in the high-income regions enjoy a greater benefit than people in the low-income

areas.

浙江财经学院硕士学位论文

Moreover, this thesis maintains that the principal factors exerting influences on the

public health investment benefit incidence lie in the following aspects: economic

development level, age and education status; that age has a positive correlation with

public health expenditure while education status has a negative correlation with it.

In view of the above-mentioned facts, this thesis put forward the following

solutions: first, the governments’ responsibilities at all levels for public health

expenditure and expenditure scale can be defined by means of legislation; second, the

public health expenditure and policy support should be strengthened in the “sandwich

class” areas; third, the counterpart support mode should be introduced so as to solve the

problem of medical personnel shortage in remote districts.

Key words: Public health expenditure; Equalization; Benefit incidence analyses;

浙江财经学院硕士学位论文

第一章导论 ......................................................... 1

第一节问题缘起与研究意义 ........................................ 1

第二节国内外研究现状评述 ........................................ 2

第三节研究内容、研究方法及本文框架 .............................. 5

第二章我国公共卫生财政投入状况分析 ................................. 7

第一节相关概念界定 .............................................. 7

第二节政府干预公共卫生的理论依据与范围 .......................... 9

第三节我国公共卫生支出历史回顾与现状描述 ....................... 14

第三章我国公共卫生财政支出区域均等化实证分析 ...................... 23

第一节研究方法及数据来源 ....................................... 23

第二节公共卫生财政支出公平性的评价标准 ......................... 26

第三节我国公共卫生财政支出受益分布差异程度 ..................... 28

第四章支出受益分布差异的主要影响原因分析 .......................... 35

第一节健康需求及其影响因素 ..................................... 35

第二节影响我国公共卫生财政支出归宿差异的主要因素分析 ........... 37

第五章主要结论与政策建议 .......................................... 42

第一节本文主要结论 ............................................. 42

第二节相关政策建议 ............................................. 43

参考文献 ........................................................... 46

附录 ............................................................... 50

致谢 ............................................................... 51

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摘要：

浙江财经学院硕士学位论文VII摘要良好的健康状况不仅为社会提供了优质的人力资本，而且促进了社会的进步与经济的发展。但是以经济效率优先的发展方针在带动中国经济迅猛增长的同时却也造成了经济社会发展的严重不均衡，公共卫生的公益性遭受到极大的挑战，我国医疗卫生问题形势严峻。公平是医疗卫生领域的主要政策目标，医疗卫生体制的改革与发展都要考虑到卫生服务公平性。尤其是在当前建设和谐社会的背景下，如何满足每一个社会成员的基本医疗卫生需求，如何通过对社会卫生资源的合理配置从而提高卫生资源的利用效率，促进公共卫生的平衡发展是亟待解决的现实问题。在这样的背景下，本文主要从我国公共卫生投入利益归宿分析角度出发，探讨了...

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