“补供方”抑或“补需方”?政府医疗投入路径对健康产出的效应分析

当代财经 ›› 2021, Vol. 0 ›› Issue (11): 41-51.

“补供方”抑或“补需方”?政府医疗投入路径对健康产出的效应分析

王增文, 胡国恒

武汉大学社会保障研究中心,湖北武汉 430072

收稿日期:2021-03-09 修回日期:2021-10-08 出版日期:2021-11-15 发布日期:2021-11-23
通讯作者: 胡国恒,武汉大学博士研究生,主要从事医疗体制、社会保障理论与实践研究,联系方式nuonuobiya@163.com。
作者简介:王增文,武汉大学教授,博士生导师,博士,主要从事社会保障理论与实践、危机与风险管理研究。
基金资助:
国家社会科学基金重点项目“健全退役军人工作体系和保障制度研究”（21AZD072）; 教育部哲学社会科学重大项目“社会保障权益与收入分配的公平性研究”（16JJD840008）; 中央高校基本科研业务费专项资金（2020AI017）

“Subsidies to the Supply-Side”or“Subsidies to the Demand-Side”? An Analysis of the Effect of Government Medical Input Path on Health Outcome

WANG Zeng-wen, HU Guo-heng

Wuhan University, Wuhan 430072, China

Received:2021-03-09 Revised:2021-10-08 Online:2021-11-15 Published:2021-11-23

摘要/Abstract

摘要： 在政府财政收支日趋紧缩的背景下,如何合理利用现有存量提高健康产出是政府医疗投入的核心问题。而基于投入路径的健康绩效检验至关重要,关乎未来政府医疗投入的结构性优化。利用2007—2017年省级面板数据,实证分析“补供方”和“补需方”对健康产出的影响,结果表明：一是增加“补供方”与“补需方”的投入均可显著促进健康产出;持续“补供方”或“补需方”对健康边际产出的影响呈现非线性增长,具体表现为倒U型;“补供方”与“补需方”是提高健康产出的一体两面,互为基础。二是“补供方”超过门槛值会直接提高“补需方”对健康产出的促进效应,而持续“补需方”可以间接提高“补供方”的健康产出。因此,提高政府投入的健康产出,需建立结果导向型健康投入机制,实现“以治疗为中心”向“以人民健康为中心”转变;推进健康资源均等化配置,“补供方”应从粗放型转为精准滴灌型,构建对医疗技术水平落后地区的协助网络;以“补需方”为主,构建竞合型医疗服务体系。

关键词: 政府医疗投入, “补供方”, “补需方”, 健康产出效应

Abstract: In the context of the increasingly tightening government fiscal revenue and expenditure, how to rationally use the existing stock to improve the health outcome is a key problem in government medical investment. The health performance test based on the input path is of great significance, which is related to the structural optimization of the future government medical investment. By making use of the provincial panel data from 2007 to 2017, this paper conducts an empirical analysis of the impact of“subsidies to the supply-side”and“subsidies to the demand-side”on the health outcome. The results show that to increase the investment to the subsidies to both the supply-side and the demand-side can significantly improve the health outcome. The impact of continuously subsidies to the supply-side or to the demand-side on the health marginal outcome presents a nonlinear growth, with an inverted U shape as its specific form. Subsidies to the supply-side or to the demand-side is the two sides of one body of the improvement of the health outcome, each is the basis of the other. If the“subsides to the supply-side”exceeds the threshold value, it would directly improve the facilitating effect of“subsidies to the demand-side”on the health outcome, while the continuous“subsidies to the demand-side”may indirectly improve the health outcome of the“subsidies to the supply-side”. Therefore, in order to increase the health outcome of the government investment, it is necessary to establish a result-oriented health investment mechanism, so as to achieve the transformation from “taking treatment as the central”to“taking people's health as the central”; to promote the equalized allocation of the health resources, changing the “subsidies to the supply-side” from the extensive form to the fine dripping irrigation form, and establishing a cooperation network for the areas with backward medical technology; to construct a competition-cooperation medical service system with “subsidies to the demand-side”as the core.

Key words: government medical investment, “subsidies to the supply-side”, “subsidies to the demand-side”, health output

中图分类号:

F812.45

王增文, 胡国恒. “补供方”抑或“补需方”?政府医疗投入路径对健康产出的效应分析[J]. 当代财经, 2021, 0(11): 41-51.

WANG Zeng-wen, HU Guo-heng. “Subsidies to the Supply-Side”or“Subsidies to the Demand-Side”? An Analysis of the Effect of Government Medical Input Path on Health Outcome[J]. Contemporary Finance & Economics, 2021, 0(11): 41-51.

参考文献

[1] 朱恒鹏. 医疗卫生财政投入机制与国家治理体系现代化——学习党的十九届四中全会《决定》的体会[J]. 经济学动态,2019,(12):3-14.
[2] 顾昕. 公共财政转型与政府医疗投入机制的改革[J]. 社会科学研究,2019,(2):141-149.
[3] 王文娟,曹向阳. 增加医疗资源供给能否解决“看病贵”问题?——基于中国省际面板数据的分析[J]. 管理世界,2016,(6):98-106.
[4] 张宁,胡鞍钢,郑京海. 应用DEA方法评测中国各地区健康生产效率[J]. 经济研究,2006,(7):92-105.
[5] Filmer D.,Pritchett L.The Impact of Public Spending on Health:Does Money Matter?[J]. Social Science & Medicine,1999,49(10):1309-1323.
[6] 卫龙宝,毛文琳. 不同筹资渠道的卫生支出对农村中老年居民健康影响的差异——基于CHARLS数据的经验分析[J]. 农业技术经济,2019,(10):53-63.
[7] Mayer S.E.,Sarin A. Some Mechanisms Linking Economic Inequality and Infant Mortality[J]. Social Science & Medicine,2005,60(3):439-455.
[8] Issa H.,Ouattara B.The Effect of Private and Public Health Expenditure on Infant Mortality Rates:Does the Level of Development Matters?[R]. Working Paper 01-16, Department of Economics,University of Wales Swansea,2005.
[9] 毛文琳,卫龙宝. 政府卫生支出规模对居民健康的影响研究[J]. 浙江社会科学,2020,(3):11-20.
[10] 陈天祥,方敏. 公共卫生支出、健康结果与卫生投入政策——基于189个国家和地区的面板门槛分析(1995—2011年)[J]. 浙江大学学报(人文社会科学版),2016,(1):91-107.
[11] 郑喜洋,申曙光. 财政卫生支出:提升健康与降低费用——兼论企业医保降费[J]. 经济管理,2019,(1):5-21.
[12] 李华,俞卫. 政府卫生支出对中国农村居民健康的影响[J]. 中国社会科学,2013,(10):41-60.
[13] Anderson B.A.,Romani J. H.,Phillips H. E., Van Zyl J. A. Environment, Access to Health Care,and Other Factors Affecting Infant and Child Survival among the African and Coloured Populations of South Africa,1989—1994[J]. Population and Environment,2002,23(4):349-364.
[14] 刘晓婷. 社会医疗保险对老年人健康水平的影响——基于浙江省的实证研究[J]. 社会,2014,(2):193-214.
[15] 程令国,张晔. “新农合”:经济绩效还是健康绩效?[J]. 经济研究,2012,(1):120-133.
[16] 栾斌,杨俊. 农村居民收入、健康支付结构与农村健康人力资本——中国省份面板数据的证据[J]. 农业技术经济,2015,(2):76-84.
[17] Baker D.W., Sudano I. J., Albert J. M., Borawski E. A., Dor A. Lack of Health Insurance and Decline in Overall Health in Late Middle Age[J]. The New England Journal of Medicine,2001,345(15): 1106-1112.
[18] Wang H.,Yip W.,Zhang L,C., Hsiao W. C. The Impact of Rural Mutual Health Care on Health Status:Evaluation of A Social Experiment In Rural China[J]. Health Economics,2009,18(2): S65-S82.
[19] 陈永成,蒋金法. 公立医院绩效评价及障碍度测算研究[J]. 当代财经,2019,(11):36-48.
[20] Fisher E.S. Medical Care Is More Always Better?[J]. New England Journal of Medicine,2003,349(17):1665-1667.
[21] Thanh S.D.,Canh N. P. Taxation and Capital Formation:Non-Linear Effects and Asymmetry between Developing and Developed Countries[J]. The Journal of Economic Asymmetries,2020,22:e00174.
[22] Seo M.H.,Kim S.,Kim Y. Estimation of Dynamic Panel Threshold Model Using Stata[J]. The Stata Journal, 2019,19(3):685-697.