政府支出对医疗服务健康公平影响的比较和启示

摘要

医疗服务公平和人民的健康是各国卫生系统向其国家居民提供医疗服务所应实现的两个重要目标。但以英美日为例的发达国家根据世界卫生统计年鉴中的医疗服务公平性排名确有明显差距，因此，高收入和高政府医疗卫生支出与医疗卫生服务公平和健康公平性并没有必然关系。本文通过比较分析美日英国的政府间医疗卫生支出责任划分的结构发现高政府医疗卫生支出比例是提高医疗服务筹资公平性的前提，中央承担社会医疗保险责任是实现医疗服务筹资公平性的保证，政府特别是中央政府出资的长期护理有助于提高国民健康水平，地方政府的参与更有助于提高一国医疗系统机构数量特别是医院的数量。%Medical service fairness and people’s health are two important goals of national health system to provide medical services to the residents of the country. But in developed countries like USA,UK and Japan,according to the World Health Statistics Yearbook of medical service fairness ranking does have obvious gap. Therefore ,the high income and high government health expenditure is not necessarily related to health services and health fairness. Through the comparative analysis between USA and UK government health expenditure responsibilities found that the proportion of government health expenditure is to improve the health care financing the premise of fairness,to assume the central social medical insurance is the implementation of health care financing guarantee of fairness,the government,especially central government funding of long-term care helps to improve the health level of national,local government involvement to be more help to increase the number of a country’s health system especially the number of hospital.