Medical and health care protection of public **** financial input: effectiveness and policy path
Abstract: At present, basic medical and health care is one of the areas to improve people's livelihood. The economic and social attributes of basic medical and health services determine the input of its protection is an important element of people's livelihood finance. In the government's financial resources and input scale of the reality of the constraints, the effectiveness of the public **** financial input should become the focus of attention. As the main mechanism of health care resource allocation, public **** finance must lend a hand in adjusting the input structure and implementing effective policies and measures to ensure the fairness and efficiency of the distribution of health care resources from both the supply and demand sides.
Keywords: health care security; public **** financial input; effectiveness; policy path
CCTS: FS10 Literature ID: A Article No.: 1000-176X(2010)01-0089-05
A. Problems
The problem is raised
Health care services can be differentiated into two aspects: one type of public **** health services, such as immunization services, and the other type of health care services, such as immunization services. *** health services, such as immunization prevention and control of infectious diseases; and the other is general medical services, i.e., the diagnosis and treatment of individual diseases. Modern society does not have any government completely let go of market forces to solve the problem of health services, but all through the public **** financial intervention in the field of its financing and protection, the main reason is that the public **** health services with significant externalities, increasing returns to scale and the characteristics of the public **** goods; and ordinary medical services with uncertainty, information asymmetry, moral hazard, adverse selection and possible occurrence of induced consumption and other characteristics, leading to ? market failure? and sub-optimal levels of supply. Of particular importance is the widespread view of receiving essential health services as a fundamental human right, consistent with basic social values. This view is supported by public **** spending in most countries? the expansion of health care systems and the universalization of individual access to health care at low cost? can be demonstrated.
While government intervention can, to some extent, correct? market failures? and enhance social welfare, however, there can be intervention? Failure? China in the transition process of government intervention in the health care market? The absence of government intervention in the health care market during the transition process in China is the cause of the unsuccessful reform of the health care system. is one of the important factors leading to the unsuccessful reform of the health care system. Therefore, in order to realize the Party? 17th National Congress? the party's 17th National Congress? medical care for the sick? The goal of the people's livelihood, it is necessary to rationally position and effectively play the leading role of the government in assuming the responsibility of universal medical protection.
The government's intervention in the field of health care is mainly realized through government health expenditure (i.e., the government is committed to carrying out health care activities using all public **** resources), and accordingly, health care security is transformed into a public **** financial input issues. In what way should the government assume its responsibility in the field of health care? To what extent? To what extent? There exists in the country on this issue? Government-led? and? the market competition school? The viewpoints of the government-led and the market-competition In? The government-led school of thought the government should invest more in the healthcare service delivery system, control the healthcare service delivery system, and take responsibility for the investment in the healthcare sector and the remuneration of healthcare workers, so as to encourage them to provide basic healthcare services to the public free of charge or at a reduced fee, thereby reducing the burden of healthcare on the public. In the ? the market competition school? view. Government funding should be invested in the social health insurance system, which should be organized by providing subsidies to the low-income class, and at the same time promote competition in the health care delivery system in order to improve efficiency. The bias of the above viewpoints is to focus on the financing perspective, the size of the public **** financial input and the direction of the investment analysis, while ignoring the performance of the input research. From the scale of China's government health expenditure, with the coordinated development of social and economic development and the transformation of government functions, the government's investment in health has increased, and the proportion of government health investment in the total amount of financing for health in society as a whole has begun to rebound. Since the late 1990s, certain key indicators have been close to those of South Korea and ahead of India, indicating that government health expenditures are of a certain scale under a consistent caliber of comparison. The Research Report on China's Total Health Costs 2006, issued by the Institute of Health Economics of the Ministry of Health, shows that from 1978 to 2005, the average annual growth rate of total health costs was 11.47 percent, slightly faster than the growth rate of GDP. from January to November 2008, the national fiscal revenue was 580,682,100,000,000 yuan, an increase of 20.5 percent over the same period of the previous year; and the national fiscal expenditures were 4,582,534,000,000 yuan, an increase of 23.6 percent. The national financial expenditure of 45825.34 billion yuan, an increase of 23.6%; health care expenditure of 194.871 billion yuan, an increase of 37.3%.
However, while the scale of government health expenditure is expanding, China's healthcare security has not effectively formed a mechanism of equity and efficiency. the efficiency and fairness of the utilization of healthcare resources have been on a downward trend since the 1990s, which is centrally reflected in the extraordinary and rapid growth of healthcare costs, the inequitable burden of healthcare costs, the decline in the accessibility of healthcare for low-income groups, and the improvement of healthcare service levels. limited, the negative expectation of most residents on medical problems, and the supply of medical and health resources can not effectively meet the individual's demand for medical and health care, and so on. It can be seen that in order to realize ? establish a universal medical insurance system to ensure that everyone enjoys basic medical protection? goal, while the government's investment in health care increases, the orientation of public ****policy should gradually shift from ? Expanding inputs? to? Effective investment , pay more attention to the effectiveness of the public *** financial input method and its resulting policy effects, improve the target efficiency of the use of government health care funds.
Second, health care public **** financial input effectiveness of the determination
In the supply and demand chain of health care, public **** financial input on the supply and demand will have a direct impact (as shown in Figure 1). On the one hand, the public *** financial inputs are converted into public *** health resources, forming the supply of health care goods and services; on the other hand, the formation of direct subsidies to individuals as well as subsidies to health insurance institutions, which in turn affects the choice of demand for health care. Since the individual's demand for health care is a derived demand, and access to health care is a fundamental way to meet health needs, the logical measure of the effectiveness of supply and demand is that the supply of health care formed through public *** financial input can meet the needs of residents to obtain effective health care services, and to achieve the desired goal of health improvement.
From the supply side, the effectiveness of public **** financial inputs is the unity of efficiency and equity at the level of healthcare resource allocation, and should contain four basic dimensions: (1) From the perspective of economics, to ensure the effective provision of healthcare services with the nature of a public **** good, the externalities and to avoid a net loss of social welfare. (2) Rational allocation of health care resources under the established budget and maximization of the marginal output of health care expenditures. That is, homogeneous health care services or commodities should be obtained at the lowest possible cost, or the unit of expenditure can result in the maximum number of health care services. (3) Coordinated allocation of health care resources. Expressed in different regions, different levels, between different health care projects, as far as possible to reduce the input direction of the resource allocation mismatch problem, to avoid idle and waste of resources. (4) The efficiency and quality of the supply of health care services can form an effective demand for health care.
China's public **** financial health care investment in the improvement of residents' health is not obvious, highlighted in the health care resources are mainly invested in large and medium-sized hospitals in the city, grass-roots health institutions lack of funds, preventive resources are out of balance with medical resources. In terms of investment programs, more investment is made in fixed assets, neglecting the improvement of the quality of health personnel and the quality of medical and health services. According to the analysis of the study on total health costs, from 1990 to 2005, the proportion of health costs accounted for by urban hospitals basically maintained an upward trend, rising from 32.76% to 50.09%; the proportion of health costs accounted for by county hospitals and township health centers all declined markedly, with the proportion accounted for by township health centers, in particular, dropping from 10.62% to 6.26% year by year. Such an allocation of resources gives rise to imbalances between urban and rural areas, between geographic areas, and between prevention and treatment, as well as wide disparities in the degree of benefit to different social groups. This is because those who make high use of hospitals (especially high-level hospitals) are mainly high-income residents living in urban areas, while rural or low-income groups are constrained by various conditions and are unlikely to make full use of these resources. In this sense, the overall effect of health care investment is poor, and the impact on the health of most people is relatively small.
Under the established conditions of the public **** financial health care input budget, the effectiveness of the inputs also depends on the efficiency and quality of service provision in the public **** health care sector. Efficient and good health care services are the transmission and transformation mechanism between inputs and the realization of health improvement goals. If the management of health care institutions is inefficient, or health care institutions
and personnel to provide excessive services, government inputs will not help to improve health, the accessibility, availability and satisfaction of the residents of health care will decline. From the reality of China's rural health care security, although in most provinces and cities in the country basically realized the townships have health centers, villages and villages have health clinics, but due to the poor condition of the medical equipment, the quality of the medical staff is low, not able to meet the medical needs of the farmers who participate in the new rural cooperative medical care, it is difficult for the farmers to increase the amount of their own health capital stock through the government-provided health care services. In addition, the low quality of services also triggers health care avoidance (Bypassing) behavior (patients choose higher costs, such as more distant, higher-priced health care institutions for treatment), which further reduces the utilization rate of public **** health care facilities and resources. From the demand side, the effective impact of public **** financial health care inputs on demand is to increase the ability of residents to purchase health care services and maximize the quality of services coupled with their demand by reducing the opportunity cost of their demand. Accordingly, the mechanism of public *** financial inputs is designed.
1 Reasonable determination of the proportion of the cost burden of the government and individuals
The cost of health care is a determining factor in the residents' demand for health care, especially for low-income groups, it has a greater impact. From the situation of countries around the world, the level of residents' health care needs is inversely proportional to the level of health care costs borne by individuals. The higher the proportion of personal out-of-pocket expenses for health care, the smaller the impact of government spending on individual demand. If government spending does not alleviate the burden on individuals in terms of health care needs, then government inputs will not lead to effective demand. Around the world, despite the large personal burden of health care costs in low-income countries, the residents' demand for health care is much lower than that of residents of high-income countries, due to the latter's ability to obtain the services provided by the public *** health sector free of charge or at a much lower price. In the composition of China's total health costs, government budgetary health expenditures declined from 25.1 per cent in 1990 to 20.3 per cent in 2007, while individual cash health expenditures rose from 35.7 per cent in 1990 to 45.2 per cent in 2007. Therefore, despite the rising level of income of the population, but the level of personal demand for health care is decreasing, the residents of the public **** health care institutions to avoid the trend of intensifying the behavior of domestic demand in China is also an important reason for the lack of domestic demand.
2 Moderate definition of the scope of health care security
The coverage of the health care security system includes basic medical care and public **** health. The magnitude of the price elasticity of demand for different health care programs is positively correlated with the effect of government inputs on individual demand, so policymakers should purposefully choose areas of intervention based on the elasticity of individual demand for health care. In general, for essential health services, such as major or serious illnesses, individuals are insensitive to changes in factors affecting the price and accessibility of purchasing these services, whereas preventive services have a high elasticity of demand relative to the price and accessibility of curative services.
From the perspective of increasing demand, investing more in health care and preventive services is a viable option. However, for the consideration of the equity concept of increasing the demand of low-income people, under the constraints of the government's limited financial resources and management capacity, the focus of public **** financial investment should also be on projects with low elasticity of demand, because the ability of low-income people to pay for health care is strictly limited by the income of the budget, and tends to focus on projects with low elasticity of demand.
3 Correctly Considering the Factors Affecting the Demand for Health Care
Individuals' demand for health care is a combination of factors, the main ones of which include income level, health insurance system, and employment status. In addition, the characteristics of the healthcare organization (healthcare accessibility, availability, healthcare personnel, healthcare costs, waiting time, etc.) factors are also important variables influencing the individual's demand for healthcare. A high level of income, a sound health insurance system, and a good employment status directly determines a high degree of demand for health care and an increased likelihood and feasibility of accessing health care resources. On the contrary, the demand for healthcare services of people with low income levels, self-financed medical care and those who are laid off and jobless will be suppressed to a certain extent. The study shows that a 10% increase in the household income of urban residents will increase the probability of their demand for healthcare facilities, decrease the probability of self-treatment (from 41.82% to 36.98%), and the proportion of their demand for hospitals above the municipal level will increase significantly, with a relative growth rate of about 15%. After a 10% increase in the household income of rural residents, the probability of patients choosing health care institutions at the county level and above the municipal level increases by 15% and 38.11%, respectively; by increasing the proportion of the number of people covered by the basic health insurance for urban residents and the proportion of people covered by the new type of rural cooperative medical care, the demand for public hospitals by individuals is significantly increased, while the demand for private institutions and for self-treatment are both decreased. However, since the two types of insurance are still quite different in terms of scope, nature, and compensation amount, the effect of the new rural cooperative medical care on the increase in individual demand for health care is thus lower than that of the urban basic medical insurance, with the probability of self-treatment decreasing by 9.9% in the former and by 33.2% in the latter.
The above analysis shows that public **** financial investment in health care is only one variable that affects individual health care demand, and that when formulating policies to improve the effectiveness of government health care expenditure or to provide effective health care services, it is necessary to comprehensively take into account other relevant public **** financial policies, such as income distribution policies, social security systems, and fiscal policies to promote employment, and to integrate them into the policy system for effectively improving health care demand. Effective improvement of health care demand policy system, the coordination of various policies, *** with the goal of optimizing government health care spending to provide demand mechanisms.
Third, the public **** financial input structural adjustment and policy path selection
In the case of a certain scale of public **** financial input, the feasible way to solve the limited public **** financial input and residents of the infinite contradiction between the demand for health care is that, according to the actual situation of the public **** health care resources for reasonable structural adjustments, a radical change in the emphasis on input, light output, heavy scale, light performance, and the need to improve the quality of health care. output, and to completely change the mode of public *** financial expenditure that emphasizes scale over performance. This is also of great practical significance for the new round of medical and health system reform, as well as in the current economic crisis to protect the basic livelihood of the people, increase the rate of consumption, promote economic growth and improve the stability and sustainability of economic operation.
1 Sound medical and health service system
The establishment of a medical and health service system must be the responsibility of the government, which should retain or even improve a number of reasonably laid out, highly accessible, low-cost, community-based public medical and health institutions, mainly to solve the basic medical problems of the poor population and the general public. In view of the irrational layout of China's current medical and health care service system, the policy orientation of public **** financial investment should be ? Grasp the small and enlarge? , focusing on supporting the construction of urban community health service centers, health service stations and township health centers and central health centers. Community health service institutions are the core of primary health prevention and medical care for urban residents, and play a great role in meeting the grassroots health care needs of urban residents; they should strive to basically realize full coverage of urban community health services in 3-5 years. Rural and township health center services are mainly aimed at rural areas, representing rural health care resources, and are closely related to the basic health care needs of farmers. By increasing the investment in infrastructure such as medical equipment and business premises in rural areas, we can improve the conditions for farmers' access to health care and the medical environment, effectively change the negative growth in the construction of township health centers, and enhance the accessibility and availability of health care for rural residents.2 Promoting inter-regional equalization of basic health care services As an important part of human capital investment, equalization of health care investment requires that all members of society be provided with basic health care services regardless of how and by what means they are provided. The equalization of healthcare investment, as an important component of human capital investment, requires that all members of society have equal access to and enjoyment of basic healthcare services in terms of opportunity, quantity and quality, regardless of the way or means they use, and does not depend on their ability to pay. Changes in China's financial system and the implementation of the policy of decentralizing local finances have had a negative impact on the equalization of basic medical and health services among different regions. The widening gap in the level of local economic development has led to widening local disparities in the development of basic health care. For this reason, there is a need to reform the financial relationship between the central and local governments so that the responsibilities of all levels of government for health-care spending are matched by their financial resources. The central government's responsibility is to improve the fairness of basic medical and health services, and to reduce local disparities in basic medical and health services by improving the system of financial transfers between the central and local governments. The responsibility of the local government is to improve the level of local basic medical and health services, and fully utilize the advantage of fiscal decentralization to study and set up basic medical and health service standards that suit local characteristics. In the design of the transfer payment system, it is necessary to fully utilize the scientific ? Factor method? , comprehensively consider the tax capacity of each region, the degree of scarcity of health care resources, the level of provision of effective services, the extent of the needs of residents at different income levels and the improvement of the overall health of the population, etc., to determine the scale of transfers and the basis for the scale of subsidies to health institutions, facilities and personnel in each region, so as to improve the capacity of inter-regional allocation of basic medical and health resources, and to improve the social nature of basic medical and health services, Public welfare and welfare.
3 Establishment of a long-term financing mechanism for the new rural cooperative medical insurance
There are two ways in which the government can provide basic medical care for its residents: one is to invest funds on the supply side to strengthen the construction of public medical and health care institutions; the other is to subsidize the demand side, and to establish a social medical insurance system through subsidies for the insured. In recent years, a number of countries (typical examples include the United Kingdom) have implemented reforms to shift from investment in health-care providers to purchasers of health-care services, with the aim of introducing a market competition mechanism into the health-care service delivery system, providing compensation for funding based on the effectiveness of health-care services, and incentivizing health-care providers to shift from a profit-oriented approach to one that protects the health of the population, and better respecting the right of the demand side to make choices about health-care services. The demand side's right to choose medical and health services is better respected. At the same time, subsidizing the demand side with limited financial resources facilitates the use of financial inputs to take more targeted care of specific groups, such as the poor, thus promoting health equity. China's trial of the new rural cooperative medical care is in accordance with this idea, the use of central and local financial subsidies to guide residents to participate in the establishment of a voluntary, non-profit health insurance.
The effectiveness of the new rural cooperative medical care depends largely on the design of the financing mechanism. In accordance with the ? Government-led support, collective support, individual input-based? The principle of financing, governments at all levels to pay attention to and increase the proportion of financial subsidies to the new rural cooperative medical care, is to reduce the cost of collective and individual financing an important guarantee. In order to make financial subsidies scientific and standardized, it is necessary to weigh the local rural population's demand for health care, the level of socio-economic development and the affordability of the individual and collective economy, and to adopt various forms of medical protection in accordance with the economic situation of rural areas in different regions. For example, in poverty-stricken rural areas, State and collective funding should be the mainstay, combined with individual funding, in a semi-accumulation, semi-pay-as-you-go system; in affluent rural areas, a fund-based system should be adopted, with individual accumulations forming the fund, to establish a stable source of funding for medical security. Another issue related to the financing mechanism is to maximize the coverage of the population. The feasible options for solving this problem are ? Implicit compulsion? The implementation of this system, so as to reduce the management costs of the new rural cooperative medical care, enhance the ability to coordinate funds, improve the level of compensation and the ability of farmers to resist the risk of serious illnesses, so that the insured farmers to get the maximum benefit from it, and then attract more farmers to join the new rural cooperative medical care.
4 standardize the public **** health service voucher system for a long time, China's public **** health services are provided by the public health institutions or state-owned hospitals paid, the service users not only have to pay a certain amount of service fees to these institutions, and the government's public **** health funding, but also do not directly subsidize to the head of the people, but in the form of personnel funding and work funding fixed subsidies to the public health institutions. Under such circumstances, there is no sense of competition among health institutions and residents simply do not have the right to choose, which is also the cause of the current ? It is difficult and expensive to see a doctor. is one of the reasons. Public *** health service vouchers are the government's way of subsidizing public *** health services in the form of ? vouchers. in the form of subsidies to? The government subsidizes the cost of public health services in the form of vouchers. It not only enables residents to become independent consumers of public **** health services and health organizations to become independent producers of public **** health services, but also, more importantly, promotes fair competition and elimination of the best and the worst among health organizations, and improves the service efficiency of the medical market. Public **** health service vouchers as a financial expenditure system, the essence is to change from public **** financial input to the purchase of public **** health services, from the investment to the supply side to the demand side, from the ? Raising people? to? To support the affairs of the people. In addition, it is a reasonable, efficient and fair allocation of medical and health resources.