我国卫生总费用风险预警系统研究

The total expenditures on health（TEH）will impossibly increase without limits. Various risks in the field of economic, social and health could resulted from the excessive growth of TEH, which has caused the extensive concern of both government and public. However, a scientific and effective system of risk identification, surveillance and warning has not been established. It is of the essence that assessmenting the risks caused by the growth of TEH, predicting the type, intension and time of risks, and analyzing of risk factors. Multiple methods including literature review, Delphi method, Analytic Hierarchy Process, System Dynamics Model, and Extension Theory will be carried out to identify the risk factors of growth TEH that have influence on equity, efficiency and sustainability of health financing and population health, and develop the health expenditure risk assessment system and prediction model. Based on above-mentioned theories and methods, an empirical study will be conducted nationwide and in different provinces, predicting TEH variation tendency, forming the risk analysis modelin each layer of TEH, early warning according to the different level of risks and proposing the countermeasures.

卫生总费用的增长不可能是无条件或无限度的。卫生总费用的过快增长，给经济社会和居民健康带来了诸多风险，这一问题已经引起了政府和社会各界的广泛关注，但目前尚没有形成科学有效的风险识别、监测和预警体系。科学评估卫生总费用增长带来的风险，预测风险发生类型、时间和强度，分析风险因素，提前采取应对措施将是极其重要的。本研究将在文献检索的基础上，综合运用专家咨询、层次分析、系统动力学和可拓学评价等方法，识别卫生总费用在卫生筹资的公平、效率和可持续性以及对居民健康影响等方面的风险因素；建立卫生总费用风险评价指标体系，构建卫生总费用风险预测模型，预测风险变化趋势；建立卫生总费用在各个层面的风险评判模型，划分风险等级；在此基础上对全国及不同省份卫生总费用风险进行实证分析，依据风险等级进行预警并提出相应的对策。

卫生总费用已经成为衡量一个国家在国民健康领域投入力度的重要指标。本研究通过描述我国卫生总费用各阶段运行状况和发展趋势，对其在多维度、多层次上的风险进行界定和识别，构建我国卫生总费用风险预警指标体系，确定关键指标和阈值范围，划定风险等级，实现风险预警。利用构建的指标体系对我国卫生总费用实证分析发现：卫生总费用风险来自筹资过程风险、分配过程风险和使用过程风险三个环节。关键指标包括：卫生总费用占GDP比重、政府卫生支出占财政支出比重、个人现金卫生支出占卫生总费用比重、卫生消费弹性系数等8个指标。卫生总费用占GDP百分比在[5.0,7.6]内为正常，超过12%为重度预警区间；政府卫生支出占财政支出的正常和重度阈值区间分别为[4.8，7.9]和大于12.3%；个人现金卫生支出占卫生总费用比重的正常和重度阈值区间为[15.6，28.4]和大于54.4%。通过对我国卫生总费用风险等级进行划分并做出预警，为我国健康中国2030战略实施提供理论支撑，为顺利推进医疗卫生体制改革提供科学参考。