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目的:分析近年来政府卫生支出结构变化特征及原因。方法:以1990年价格为基础分析了1990—2012年政府卫生支出的结构变化,并结合医疗改革政策进行定性分析。结果:发现23年间医疗保障支出所占总体支出比例出现大幅上升趋势并达到46.3%,而医疗卫生服务支出则随之下降了25个百分点,行政管理与人口和计划生育支出比重相对稳定。进一步揭示了卫生支出结构变化的原因是医疗卫生政策引致的预算偏好使医疗保障支出增长率超过总体增长率水平,从而影响了整个支出结构变化。结论:研究认为预算偏好的背后逻辑是医疗资源逐步走向市场化配置,并且政府应致力于构建以医疗保障制度为主体的医疗服务市场。
Objective: To analyze the characteristics and causes of the changes of government health expenditure structure in recent years. Methods: Based on the 1990 price, the structural changes of government expenditure on health from 1990 to 2012 were analyzed and the qualitative analysis was carried out in combination with the medical reform policy. Results: It was found that the proportion of total medical expenditure in 23 years increased sharply to 46.3% while the expenditure on medical and health services decreased by 25%. The proportion of administrative expenditure to population and family planning expenditure was relatively stable. The reason why the structure of health expenditure is further revealed is that the budgetary preference caused by health policy makes the growth rate of medical security expenditure exceed the overall growth rate and thus affects the entire expenditure structure. Conclusion: The study suggests that the logic behind budgetary preference is that medical resources should gradually move toward market-oriented allocation, and the government should devote itself to building a medical service market with the medical insurance system as the main body.