我国心脑血管疾病防治的卫生费用核算方法学研究

Cardiovascular diseases have become major national health problems in China. In order to ensure that the health resources invested in the prevention and treatment of cardiovascular diseases play their due role, it is necessary to conduct research on the accounting of health expenditure on the prevention and treatment of cardiovascular diseases. Cardiovascular diseases accounts can reflect the whole process of health financing, service provision, health utilization, and beneficiaries in a country (or region) in the prevention and treatment of cardiovascular diseases, and reflect the government and society attach importance to the prevention and treatment of cardiovascular diseases, the health financial burden for residents and allocation efficiency of health resources. Building disease based national health accounts is a frontier issue in the field of health expenditure accounting. Up to now, the circulatory diseases accounts under the framework of System of Health Accounts is not established in China. Based on previous research, this study combines national conditions and international classifications to establish a scientific accounting method for the prevention and treatment of cardiovascular diseases. Then the proposed method would be used to produce cardiovascular diseases accounts for a province and the whole country, to examine the issues in health financing, funds allocation, service provision and service utilization, beneficiaries, and resources cost for the prevention and treatment of cardiovascular diseases, which can provide useful information for the policy makers to adjust and develop policies for the prevention and treatment of cardiovascular diseases.

心脑血管疾病已成为我国国民重大健康问题。为确保心脑血管疾病防治资金投入的充足性并发挥应有作用，需开展心脑血管疾病防治的卫生费用核算研究。心脑血管疾病防治的卫生费用核算可反映一个国家（或地区）心脑血管疾病防治领域的卫生资金筹集、提供、使用和人群受益的全过程，反映政府和社会对心脑血管疾病防治工作的重视程度、居民医疗费用负担和资金配置效率。开展基于卫生费用核算体系的疾病防治费用研究是卫生费用核算领域的前沿。目前，我国还未建立起针对心脑血管疾病防治的卫生费用核算方法，未对全国和各地区心脑血管疾病防治费用进行系统地核算。本研究在以往研究基础上，结合我国心脑血管防治实际情况，探索建立科学的心脑血管疾病防治卫生费用核算方法。利用该方法核算某省和全国的心脑血管疾病防治费用，反映我国心脑血管防治费用在筹资结构、机构配置、实际使用、人群受益，以及资源消耗等方面的问题，为调整和制定心脑血管防治政策提供科学依据。

背景及研究内容：心脑血管疾病已成为我国重大公共卫生问题，厘清疾病防治资源投入及配置状况十分必要。本研究基于国际最新卫生费用核算体系（SHA2011），以心脑血管疾病防治活动为核算对象，建立心脑血管疾病防治的卫生费用核算体系，包括建立服务功能、服务提供机构和筹资方案核心维度，受益人群、服务提供要素扩展维度及矩阵平衡等核算，研究心脑血管疾病防治体系的资金筹集、分配和使用状况，并开展实证分析。.主要发现：①我国心脑血管疾病防治费用规模大，2018年全国心脑血管疾病经常性卫生费用超8000亿元，占医疗总花费的18%，占GDP的0.91%。②费用受老龄化影响显著，超过67%的防治资源用于老年人；病种聚集效应明显，近三分之二的治疗花费用于冠心病、原发性高血压和脑梗塞。③防治资源配置不合理，功能配置上预防服务不足4%；机构配置上基层机构占比不足13%。④医保资金配置低效，功能配置上医保资金用于住院与门诊支出为3:1，门诊配置不足；机构配置上医保资金中医院占90%，基层机构占11%，机构配置“倒三角”问题突出。⑤筹资保障不足，心脑血管疾病门诊费用中家庭卫生支出占比接近40%，考虑疾病治疗的长期性及老年患者居多，家庭经济负担不容小觑。未来需在政策制定中进一步强化心脑血管疾病防控体系建设，尤其是预防服务等前端防控能力，加大对基层机构投入、提升防控水平；加大重点人群、重点病种的危险因素干预及管理；医保补偿应发挥好规范诊疗秩序、引导分级诊疗的杠杆作用，对心脑血管疾病及关键危险因素的门诊服务补偿给予倾斜支持，将成本效益好的预防措施纳入补偿范围。.科学意义：本研究构建的核算体系与方法是对卫生费用核算体系的深化和拓展，为综合全面地评价我国心脑血管疾病防治资金的来源、分配、实际使用、人群受益等情况奠定了理论与实践基础。运用此方法分析的结果能够为政府制定和调整心脑血管疾病防控相关政策提供重要数据支撑。