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1、摘 要改革开放以来， 随着公共卫生需求的不断增加，我国的公共卫生在体制、管理和经费等方面出现了许多新的问题。造成这种状况的原因是多方面的，除了国家对公共卫生机构的投入力度相对减弱，促使这些机构更注重有偿服务外，还有一个很重要的原因就是我国公共卫生支出缺乏公平，目前的拨款方式无论对公共卫生机构还是对个人都明显缺乏约束和激励。本文以公共卫生理论为基础，从关注国民健康，实现公共卫生服务均等化的理念出发，研究我国公共卫生支出不公平的问题，分析公共卫生支出的不公平与公共卫生资源配置的非均等以及公共卫生服务的非均等的对应关系，为提高我国公共卫生支出公平性，实现公共卫生服务均等化提供政策建议。目前，国内在探
2、讨公共卫生财政投入方面已有很多研究，但大多是呼吁政府提高认识、明确责任、增加投入以及扩大无偿服务、调整收费标准等，而在如何改进现有拨款方式，优化资源配置，提高公共卫生支出公平性方面却很少涉及。因此，本文具有一定的理论和现实意义。本文是按照以下思路来进行的：政府为什么要负担公共卫生支出？我国目前的公共卫生的现状是什么？我国公共卫生支出分配是否公平？由此对我国公共卫生支出的公平性进行分析和评价，通过深入分析，得出政策建议。本文的研究内容分为五部分，第一部分是导论，提出整篇文章所要研究的问题，介绍本文选题背景和研究意义。第二部分对我国公共卫生资源配置以及公共卫生支出的现状进行勾勒与概括。第三部分对我
3、国地区之间、城乡之间的公共卫生支出情况进行比较分析，并对应分析我国地区之间、城乡之间公共卫生服务的公平现状，得出结论。第四部分深层次分析我国公共卫生服务不公平的主要原因。第五部分提出要实现公共卫生服务的均等化，首要任务是提高公共卫生支出的公平性，并具体从三个方面提出政策建议。关键词：公共卫生支出 资源配置 公平 AbstractSince the reform and opening up policy, with the increasing demands of public health, many new problems arise in our public health in t
4、erms of system, management and funds. The reasons that lead to such a situation is various, except that the national investment in public health organizations relatively abates, which prompted these institutions pay more attention to the paid service, still a very important reason is that our countr
5、ys public health appropriation lacks fairness. The current ways to allocate funds obviously lack restraint and incentive whether in aspect of individual or public health institutions. Based on the theory of public health, from the concept of paying attention to the national health and realizing the
6、equal access to public health service, this paper aims at exploring the unfair spending of Chinas public health, analyzing the unfairness of public health expenditure, the ineqality of public health resource allocation and the parallelism of the inquality of public health services, in order to provi
7、de some policy suggestions that improve the equality of Chinas public health allocation, realizing the equal access to public health services. At present, there have been many studies that discuss domestic financial input in the public health, but they are merely calling on the government to improve
8、 the awareness, to define the responsibilities, to increase investment and to expand free services, as well as to adjust charging standard and so on. However, those discussions rarely involve the questions like how to improve the existing appropriation ways, how to optimize the allocation of resourc
9、es and how to improve the equity of public health spending. Therefore, this article has theoretical and realistic significance to some degree.This paper carries out illustration in turn from the following ideas: why does the government have to bear the public health spending? What the current status
10、 of Chinas public health is alike? Whether the allocation of Chinas public health expenditure is fair or not? Thus the paper is to analyze and evaluate the fairness of Chinas public health spending. Then policy suggestions come out through in-depth analysis. This paper is divided into five parts, th
11、e first part is to put forward questions of the whole article and to introduce the background and significance of this research paper. The second part is to map and summarize Chinas public health resource allocation and the current situation of public health spending. The third part of this paper is
12、 to compare and analyze the situation of public health spending between regions, between urban and rural areas, carrying out the comparative analysis of the public health service status quo correspondingly between regions, between urban and rural areas so that it bears out conclusions. The fourth pa
13、rt deeply analyse the main reasons that lead to the unfairness of Chinas public health services. The fifth part puts forward the idea that in order to realize the equality of public health services, the primary task is to improve the fairness of public health expenditure, and specific policy suggest
14、ions from three aspects follows.Keywords: public health expenditure, resource allocation, fairness目 录 第一章 导论1第一节 选题的背景及研究意义1第二节 公共卫生与公共卫生支出的概念 2一、公共卫生的内涵和内容2二、公共卫生与医疗服务的差别3三、政府介入公共卫生领域的理论依据 4四、公共卫生支出的概念5五、公平与公共卫生服务公平的概念6第三节 相关文献综述6一、对公共卫生支出理论的相关文献6二、对我国公共卫生支出规模的相关文献7三、对公共卫生支出公平性的相关文献8第四节 本文的研究内容和框架8第二章 我国公共卫生资源配置的现状9第一节 我国公共卫生支出的情况9一、公共卫生支出占卫生总费用的比重情况10二、公共卫生支出占GDP的比重情况11三、公共卫生支出占财政支出的比重情况12第二节 公共卫生资源配置的情况13第三节 开展公共卫生项目的情况15第四节 农村公共卫生的情况16第三章 我国公共卫生支出公平性分析17第一节 我国各地区公共卫生支出的公平性分析18一、各地区公共卫生支出比较18二、各地区公共卫生服务的公平性分析21第二节 我国城乡公共卫生支出的公平性分析
