政府卫生投入与医药费用控制关系研究

经过三十多年的改革发展，我国已经建立起较为完善的公共卫生服务体系、基本医疗服务体系、基本医疗保障体系和药品供应保障体系，医疗卫生行业迎来了崭新的发展阶段。但是随着人口老龄化的发展，应用新药械技术的迅速提高和我国医疗卫生服务需求多样化及快速增长态势，我国医疗卫生行业健康发展面临众多考验。从全球看，没有一个国家的医疗卫生体制是完美的，也没有一个国家的医疗卫生改革是一劳永逸的。世界各个国家总是持续不断地对本国的医疗卫生行业进行改革，其中对政府投入管理制度的改革和调整是其中的重要一环。     

区域卫生行业政府投入对经济增长的贡献分析

本文首先对中国区域卫生行业政府投入差异进行统计检验.检验表明,东、中和西部地区政府投入规模差异明显,在人均投入水平上却没有明显差异,因此,投入规模应该作为区域卫生行业政府投入对其经济增长贡献分析的起点.在此基础上,本文构建卫生生产函数,并实证分析区域卫生行业政府投入对其经济增长的贡献.结果显示,区域卫生行业政府投入对经济增长影响显著,而且具有明显的地域特征.中、西部地区较低的政府投入规模对于提高当地居民健康水平及缩小与东部地区经济的差距十分不利.最后,本文提出相应的政策建议.     

我国农村医疗卫生领域中的政府缺位分析

农村医疗卫生体系建设滞后日益成为制约我国农村可持续发展的突出问题,而政府缺位则是造成这一问题的重要因素。本文分析了政府缺位问题的根源及对我国农村医疗卫生事业发展的影响,提出相关矫正措施。     

中国工业绿色全要素生产率测度及影响因素研究

将中国35个工业行业划分为资源型行业、低技术行业、中等技术行业和高技术行业,测度并分析2005—2016年各类行业GTFP的变动趋势和差异,选取影响因素指标进行面板数据回归分析,得出结论:研究期内中国工业整体GTFP稳步增长,低技术行业GTFP增长主要依赖技术进步的推动,中、高技术行业GTFP增长主要得益于技术效率的提升。企业规模是推动工业整体、低技术行业和高技术行业GTFP增长的主要因素,资本深化和技术进步分别是推动资源型行业和中等技术行业GTFP增长的主要原因。同时,大量污染物排放和不合理的环境规制政策阻碍了GTFP的增长。研究结论对于政府工业行业差异化的绿色发展政策制定具有重要的借鉴意义。     

广西医疗卫生基本公共服务领域市场与政府调控双失灵的财政投入选择

我国的医疗卫生体制在计划经济时期,政府的主导作用曾是决定性因素。改革开放以来,中国医疗卫生体制发生了很大变化(见表1)。目前,中国医疗体制改革处于关键时刻。总体来说,市场主导了社会医疗卫生     

转轨过程中政府卫生投入与体制改革的评价及建议

健康权是最基本的公民权利,是社会起点公平的保障,对健康投入是国家和政府不可推卸的职责。改革以来,我国卫生费用增长较快,然而卫生绩效却不容乐观。中国医疗卫生体系从改革前被国际组织推崇的典范“沦落”为当前的反面案例,[1]结果令人深思。卫生领域的过度、扭曲的市场化和高度分权化是问题的主要根源。因此,建议确立公共卫生和基本医疗支出的政府主导地位,特别要强化中央财政的支出责任,建立不同层级政府间规范的责任分担与资金筹集机制。通过有效的体制构建以及合理的管理制度安排,提高投入绩效,满足广大人民群众基本医疗需求。     

中国铁路行业产出变化的驱动因素——基于2005—2012年面板数据的实证研究

基于"索洛余值"法建立扩展型索洛模型,利用灰色关联分析方法计算模型的弹性系数,利用2005—2012年中国铁路行业的面板数据,计算了技术进步、政府投资、非政府投资和劳动力投入等对铁路行业产出增长的贡献率,并分析了中国《中长期铁路网规划》颁布实施以来铁路行业产出变化的驱动因素。得出结论:近年来中国铁路行业的巨大成就与技术进步和政府投资密不可分,政府的大规模投资和支持已帮助中国铁路企业步入以技术进步和创新为主导的内生驱动式发展阶段,技术进步已成为影响中国铁路行业产出增长的最重要因素。     

对我国医改中四大矛盾的再认识

中国医改的初衷是要提高卫生系统的效率,遏制迅速增长的卫生服务费用,减轻居民的疾病经济负担,从而在最大程度上缓解居民的“看病难”问题。但中国医改并未达到其初衷,反而呈现出四大矛盾:卫生服务需求量增长但利用率降低;卫生资源拥有量增长但利用率降低;医疗卫生费用快速增长但收入增长较缓;城乡差距明显且有扩大趋势。政府投入不足、医疗资源分配不均虽是原因之一,但内在根源是政府对医疗公共服务未尽到应有的责任。要解决这个问题,根本的措施是要强化政府责任,确定基本政策框架、服务内容和标准,完善相应的筹资与组织管理体制后,逐步纠正医改中的市场失灵和政府失灵问题。     

编者按

仿制药品的研发、生产和流通使用是关乎国家卫生政策如何更好保障千家万户民众健康的大事。促进仿制药品在中国的发展不但有利于民众使用性价比较高的药品,更好管理医疗卫生费用的增长,也能促进中国药品行业和国民经济的整体发展。为了配合中国仿制药品的发展,本刊特设“仿制药品”专栏,就仿制药品相关的问题进行学术探讨,为仿制药品政策在中国更好落实提供参考意见。     

探究社区医疗发展之路

随着中国经济的高速增长,中国居民的收入大幅度增加、贫困人口减少、生活水平也得到相应的提高。然而,在经济长足发展的同时,中国政府在医疗卫生方面的投入并没有达到与经济发展水平相适应的程度。分析了目前中国社区医疗存在的问题,并通过其他国家医疗保障体制与社区卫生服务的发展状况,对中国的社区医疗发展提出借鉴和启示,提出发展全科医学和与基本医疗保险相结合是中国社区医疗发展的关键。     

Optimal Social Insurance and Health Inequality

This paper integrates into public economics a biologically founded, stochastic process of individual aging. The novel approach enables us to quantitatively characterize the optimal joint design of health and retirement policy behind the veil of ignorance for today and in response to future medical progress. Calibrating our model to Germany, our analysis suggests that the current social insurance policy instruments are set close to the (constrained) socially optimal levels, given proportional contribution rates for health and pension finance, the equivalence principle in the pension system, and a common statutory retirement age. Future progress in medical technology calls for a potentially drastic increase in health spending and a higher retirement age without lowering the pension contribution rate. Interestingly, from an ex ante point of view, medical progress and higher health spending are in conflict with the goal to reduce health inequality.     

城镇居民健康差异与医疗支出行为

文章在CHIP2002城镇住户调查的基础上,讨论了影响我国城镇居民健康和医疗支出行为的经济原因以及医疗费用及医疗补贴向高收入者集中的问题。健康状况是影响医疗支出行为的重要因素,收入对医疗费用有显著作用,收入差距程度、医疗费用高低也构成医疗支出行为的影响因素。     

妇幼保健院规模与妇幼保健水平的关系:基于全国省级面板数据的研究

妇幼保健院在中国医疗卫生领域具有相当特殊的地位。在妇幼保健院对中国妇幼健康水平有积极作用的假设下,采用31个省级地区的面板数据构建实证模型,研究妇幼保健院规模对妇幼保健水平和医疗费用的影响。妇幼保健院床位数与孕产妇死亡率有显著的正相关,对活产数有显著的消极影响,出现这一现象的原因可能是妇幼保健院相对落后的医疗技术条件。同时,妇幼保健院床位数的增长对卫生机构支出存在正向影响,但对于居民家庭人均医疗支出则存在城乡差异。建议应重视妇幼保健院的发展,全面提升妇幼保健院的技术和服务水平,缓解大综型医疗机构接诊压力。     

社会医疗保障改革的福利效应:以中国城镇为例

This paper evaluates Chinese public health insurance reform enforced since 1998 in terms of its welfare effects. We evaluate China health insurance reform since 1998 using the China Health and Nutrition Surveys (CHNS) data with relevant econometric models. The results of empirical studies show that the public health insurance status has significant impact on medical service utilization and expenditure. The reform reduces the positive effect of public health insurance on medical service utilization, meaning the utilization gap is narrowed after the reform. However, the empirical studies find that the medical expenditure growth of the sample individuals in urban China has not been controlled after the Basic Medical Insurance (BMI) program even if a new co-payment is enforced. Two main reasons for this failure might be the rising cost of medical service and physician’s severe moral hazard, while both of them come from no managed care mechanism for medical service providers in China.      

State versus private provision: How does China’s market‐oriented reform affect healthcare delivery?

The role of the government in health care provision remains a contested issue worldwide. Public hospitals dominate China’s health care industry. However, in the early 2000s, the eastern China city of Suqian privatized all its hospitals and relaxed entry barriers for private hospitals. We assess the impact of the pro‐market reform on hospital performance using a differences‐in‐differences approach. We find that the pro‐market reform decreased medical price and expenditure, improved self‐reported health outcomes, and reduced search time and cost for patients. We show that after the reform, Suqian residents had greater trust in doctors than did residents from other cities.     

Convergence in per capita health expenditures and health outcomes in the OECD countries

Our analysis of 19 Organization for Economic Co-operation and Development (OECD) countries over the period 1972 to 2006 provides evidence of convergence in per capita health care expenditures for 17 countries, while the US and (to a lesser degree) Norway follow a different path. A simple decomposition of per capita health expenditures reveals that the divergence of the US comes from the divergence of the ‘ratio of health care expenditures to Gross Domestic Product (GDP)’ component, while Norway's divergence is mainly caused by the ‘labour productivity’ component. Interestingly, our results suggest that convergence in per capita health expenditures among the 17 OECD countries does not lead to convergence in health outcomes. Finally, we extend our analysis to examine convergence in various determinants of health expenditures.     

Health economics of medical devices: opportunities and challenges

Expenditure on medical devices is substantial and is expected to grow in the future. This Editorial draws attention to health economic issues surrounding medical devices. To this effect, opportunities and challenges involved in the economic analysis of the market structure of medical device sectors and in the economic evaluation of medical devices are identified.

Markets for medical devices tend to be fragmented and suffer from a lack of transparency and competition. In response to this, there is extensive government intervention in many developed countries with a view to keeping down prices, restricting public reimbursement and promoting an efficient use of medical devices. Studies are called for that evaluate and compare country approaches towards regulating medical device markets with a view to informing medical-device policies.

Whereas economic evaluation of medicines is well established, and is used to inform pricing and reimbursement decisions in many developed countries, this is less the case for medical devices. There is a need for economic evaluations of medical devices with a view to demonstrating their cost effectiveness. In addition, countries need to implement frameworks for the assessment of new and emerging medical devices with a view to taking pricing and reimbursement decisions.     

Human development and decentralization: The importance of public health expenditure

In this article, we empirically analyze the impact of central and subnational government spending on human development in a sample of 57 developed and developing countries over the period 2000–18. Specifically, we focus on the effects of health and education public expenditure on the Human Development Index (HDI) and its dimensions (life expectancy, education, and income). Applying data panel analysis, our empirical evidence shows the importance of central and subnational government health expenditure positively impacting on HDI and each of its components, while in the case of the education expenditure, this positive effect is only confirmed on the educational dimension of HDI. Our study shows how governments can stimulate human development, improving the well-being of citizens, by allocating more resources to healthcare through the different administrative levels.     

A nonparametric analysis of insufficient wage incentives in the Chinese health industry

ABSTRACT

This study provides empirical results on the insufficient wage incentives in the Chinese health industry, which may result in the poor productivity of high-ability medical personnel. We first propose a signaling game by capturing the progressive wage incentive in this industry. Then, we show that the model primitives are nonparametrically identified and estimable using recently developed methodologies related to measurement errors. Adopting a dataset from the China Household Income Project, we provide empirical evidence of the negative influence of insufficient wage incentives on the productivity of high-ability workers, especially those in higher job positions. As the number of high-ability workers in higher job positions is high, it is important to improve wage incentives in the Chinese health industry, especially for workers in higher job positions, to promote the productivity of high-ability medical workers.     

Coping with the financiers: attracting venture capital investors and end-users in the biomaterials industry

A substantial amount of research has been committed to exploring how university-based research can be transferred to industry and be commercialised. This literature emphasises the substantial institutional, cultural and financial barriers to what has been referred to as academic entrepreneurship. At the same time, and most noteworthy in the USA, university patenting has grown remarkably since the mid-1960s; today (2014), much of the basic life science research conducted by universities is being transformed into health care innovations. This paper reports on a case study of the biomaterials and medical device industry in Sweden and emphasises that, while capital funding is a key challenge for university spin-outs, an additional and less widely recognised concern facing these companies is how to make the public sector health care organisations, primarily, actually buy the products developed. The study suggests that perhaps too much emphasis is being put on ‘upstream activities’, including the early stage support provided by incubators and state agencies that provide seed-money funding, while more mature biomaterials and medical device companies are suffering from both a lack of unified regulatory frameworks and policies governing the procurement of new health care innovations.