| BackgroundTotal health expenditure,which is a monitoring tool for the mobilization,allocation and use of health resources,reflects the relationship between national macroeconomic health policy and macroeconomic development.By researching and analyzing,it provides reference and basis for the adjustment and formulation of health policy in China and various regions.In 2009,a new round of medical and health system reform was launched.To compare the relevant data indicators before and after the implementation of health reform,this paper collected the data of 2005-2008 and 2013-2016 comprehensively.Taking the comparative study on the source and flow of total health expenditure in Shandong Province before and after the implementation of medical reform as the entry point,the macroeconomic index of total health expenditure was used to evaluate the effect of the health reform.It is hoped that the work could provide valuable reference for health financing and resource allocation and health policy formulation in Shandong Province.ObjectiveBy sorting out and summarizing the relevant data indicators before the implementation of health care reform(2005-2008)and after the implementation of health care reform(2013-2016),The financing sources method was used to analyze the financing situation and change trend before and after the health care reform;Using the method of organization flow to analyze the distribution of expenditure and its changing trend,and then compare the two groups of data of total health expenditure before and after the deepening of health care reform;Discuss and put forward suggestions to improve health financing policy.MethodsThrough the relevant data of Shandong Province Health Family Planning Financial Annual Report,Shandong Province Health Family Planning Statistical Yearbook and Shandong Province Statistical Yearbook,the work and results before and after the health reform were analyzed by the method of financing source and organization flow.The paper compared the representative health expenditure data of the four years before and after the medical reform in 2005-2008 and 2013-2016,which was conducted to comprehensively reflect the financing situation and trend of health expenditure in Shandong Province before and after the medical reform.ResultsFrom the perspective of health financing:the total health expenditure was raised from 54.213 billion in 2005 before the medical reform to 335.47 billion in 2016 after the medical reform,The proportion of total health expenditure to GDP increased from less than 3%in 2005 before the medical reform to 5.01%in 2016 after the medical reform.It meets the requirement of WHO that 4%-5%of total health expenditure to GDP.The coefficient of elasticity of health consumption increased from 1.22 before the medical reform to 1.91 after the medical reform.The proportion of government,society and individuals spent from 15:30:55 in 2005 reached 25:45:30 in 2016.In 2016,the financing structure of total health expenditure in Shandong Province was significantly different from that in the country.The government,social and personal health expenditures of Shandong Province accounted for 24.24%,45.81%,and 29.95%,respectively.The national average was 30.31%,41.21%,and 28.78%.Government health expenditures are lower than the national level,while social health expenditures are higher than the national average,and personal health expenditures are slightly lower than the national average.From the perspective of the distribution of health expenses:Before the medical reform,about 75%of the total health expenditure goes to medical institutions(including hospitals and outpatient institutions),about 10%of the health expenses flow to public health institutions,and pharmaceutical retailers accounted for about 6%.The cost of medical institutions and public health institutions continued to decrease after the medical reform,and in 2016 they fell to 65%and 6%,respectively.The proportion of pharmaceutical retailers increased to 16%.The cost of medicines increased from 24.642 billion in 2005 to 116.726 billion in 2016.The proportion of outpatient and inpatient drug costs continued to decline,which from 44.58%and 39.37%in 2005 to 17.69%and 30.31%in 2016,respectively.At the same time,retail drug costs have increased significantly,which from 16.05%in 2005 to 51.99%in 2016.Conclusions1.From the perspective of overall situation of total expenditure:(1)The total amount of total health expenditure continues to increase,but the growth rate is gradually slowing down due to the new normal of economic development.(2)The elasticity coefficient of health consumption keeps rising,and the growth rate is too fast in recent years.(3)The proportion of total health expenditure to GDP is more scientific,the proportion of personal cash health expenditure falls in 30%,and the financing structure of total health expenditure is further optimized.2.From the perspective of health financing structure:(1)The total amount of government health expenditure has been continuously increasing,accounting for an increasing proportion of GDP,total health expenditure and financial expenditure.The per capita government health expenditure has been gradually increasing,and the government's investment in health has been increasing.(2)The increase of total government health expenditure is mainly driven by the increase of medical and health service expenditure and medical security expenditure.(3)The proportion of per capita cash health expenditure has been reduced to less than 30%,and the financing structure of total health expenditure has been further optimized.3.From the perspective of the funds flow:(1)The growth rate of medical expenditure slowes down,the proportion of hospital expenditure continues to decline,and the cost control policy has been continuously implemented.(2)The proportion of drug expenditure continues to decline,and the situation of "supporting doctors with drugs"has gradually been eliminated.(3)Although the proportion of community health service centers,hospitals and other grass-roots institutions in total health expenditure has increased,but the total is still low.(4)Influenced by the further improvement of public health system and institutional reform,the public health expenditure accounts for the proportion of total health expenditure shows an inverted "V"distribution before and after the health reform.Suggestions1.In view of the development trend of the new normal economy,the government's investment in health and the financing capacity of the total health expenditure were further needed.2.The financing structure of health expenditure in Shandong Province needs to be further optimized.3.Further reduce personal health expenditures and alleviate the problem of“expensive medical treatment”.4.Incorporate the drug expenses of drug retail institutions into the scope of medical insurance reimbursement.5.Increasing the government investment and inclination in Public Health.6.Strengthen the capacity building of grass-roots medical and health services to promote a more balanced and rational allocation of health resources. |
PDF Full Text Request