| [Objective] Health problem is a major livelihood issue that benefits the nation and people.With the rapid development of the national economy,the living standards of the people are increasingly enhanced and people also have a higher demand for health.At the same time,great changes have taken place in the ageing of population and spectrum of disease and people's demand for health prevention and health care is not only to meet the demand of basic public health service.The research and understanding of the proportion of the charge in the preventive services and how to invest in the preventive service have become the focus of attention with people's increasing demand for health service and the constant increasing health fee.This paper clarifies the specific flow of the total health charge and the preventive service charge in Z City through the research analysis of the prevention service charge of Z city in 2016,judges whether the flow process of the prevention service funds is reasonable according to the accounts results of preventive service charges.It aims to find out the problem,to provide reference for the formulation and adjustment of health economic policies,to put forward appropriate countermeasures and suggestions and to provide preliminary research ideas for the future health charge accounts work in other prefecture-level cities in Guangxi.[Method] The corresponding accounts results can be obtained through literature review analysis and field investigation according to the database building of field survey data by accounts methods and accounts principles in “health charge accounts system 2011” and calculation of the processed database through specific operation code by EXCEL,SPSS20.0 and other software.[Result] We can get a preliminary understanding through the above accounts.First,the total health charge of Z city in 2015 was RMB 10.9 billion.Among them,the proportion of government health expenditure is 26.56%,the proportion of social health expenditure is 43.81% and the proportion of residents' personal cash health expenditure is 29.64% from the constitution of health expenditure financing.The hospital charge accounts for 52.25%,fixed assets of the whole society accounts for 13.82%,grass roots medical and health institutions charge accounts for 12.80% and public health agency accounts for 3.74% from the analysis of structural angle of institutional flow.The total charge of preventive services in Z city of Guangxi in 2016 was RMB 1.162 billion,0.47% relative to GDP,and the average charge of preventive service was RMB 293.53.In terms of institutional flow,children's health care service accounts for 23.8%,preventive services,health physical examination and hospital infection control projects account for 12.06%,9.91% and 8.56% respectively.In terms of financing arrangement,the public financing arrangement is RMB 0.434 billion,the voluntary financing arrangement is RMB 0.382,social medical insurance,commercial health insurance and foreign financing arrangement charge are basically zero.Institutional flow is mainly in public health agency,hospital,grass-roots medical and health institutions,which account for 49.72%,24.59% and 24.43% respectively in preventive service charges.The proportions of health administrative,financing and governing agencies in preventive services are almost zero.Second,we can know from the function configuration dimension analysis of prevention service charge accounts result in Z City that there are great differences of the functional flow of various financing arrangements in Z City and the service focuses of various preventive service providers in Z City are different.Third,on one hand,we can know from the financing compensation dimension analysis of prevention service charge accounts result in Z City that there are certain differences in the financing structure of different services from the perspective of the compensation of various kinds of preventive services.On the other hand,49.93% of the hospital preventive service charges depend on household health expenditure and grass-roots medical and health institutions rely mainly on basic public health service funds from the perspective of the charge compensation of various service providers.Although the majority of public health institutions compensate for the charge of preventive services through government financing,they still rely on enterprise financing arrangement to compensate for the charge of preventive services to a certain extent.Fourth,on one hand,we can know from the institutional configuration dimension analysis of prevention service charge accounts result in Z City that the government financing arrangement funds flow mainly to the grass-roots medical institutions and public health institutions,the enterprise financing arrangement funds flow mainly to the public health institutions and hospitals,household health expenditure funds flow mainly to hospitals and public health institutions and the proportion of inflow to hospitals is slightly higher than that of public health institutions from the perspective of institutional flow of preventive service charges financing arrangement.On the other hand,from the institutional flow of service charges of different functions,health physical examination,hospital infection,and monitoring of death causes mainly occur in hospital.The charge of immunization planning,chronic disease management and the management of patients with severe mental illness mainly occur in the grass-roots medical and health institutions.The charges of public health agencies mainly originate from prevention and treatment of endemic diseases,school health,occupational health and so on.[Problem and Suggestion] Z City has the following problems according to investigation process of the whole prevention service charge accounts and data results.First,the information degree of medical and health system is low.Second,the funding structure and institutional flow of health charge are unreasonable.Third,government input in preventive service charges is insufficient and the financing structure is single.Fourth,scope of public health services and the standard of compensation are not clear and the regional public health service system is not perfect.Therefore,the following preliminary suggestions and countermeasures are put forward.First,the government should continue to strengthen and improve the information construction of medical and health systems.Third,the government should optimize and adjust the financing structure and allocation of health expenditure.Third,the government investment mechanism should be improved and fundraising channels of preventive service charges should be expanded.Fourth,the government should clarify the scope of public health services and compensation standards,and actively accelerate the construction of regional public health service system. |
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