Background:Gout has become a major public health problem worldwide, causing severe pain, discomfort, inflammation, mobility problems and impaired physical functioning, resulting in heavy economic losses and social burdens. Methods:The study was based on System of Health Accounts 2011 (SHA2011) and data of 97,907 patients from 1,084 healthcare organizations were taken using multistage stratified random sampling method. Descriptive analysis of therapeutic care expenditures (CCE), Sankey diagram to analyze the flow of CCE, Mann-Whitney U test to analyze 2 independent samples, Kruskal-Wallis H to analyze K independent samples significance. Multifactorial analysis of CCE influences, Structural Equation Modeling (SEM) to analyze the direct and indirect effects and mediating role. Results:CCE increases from CNY 25.32 million in 2015 to CNY 116.02 million in 2022, with a concentration of ages 30-69. The proportion of public health financing decreases with age and is dominated by general hospitals. The difference is significant in single-factor analysis, and the high cost in multi-factor analysis is related to purchase drugs, elective treatment, basic medical insurance for urban and rural residents, provincial level, Chinese medicine hospitals, and large standardized coefficients in 2020, and outpatient/inpatient care, drugs, type of institution, insurance status, and gender by path coefficients in the SEM in the order of directly or indirectly affecting the CCE. Conclusion:Gout disease in Liaoning Province imposes a heavy financial burden on patients and the health insurance system. It is recommended to increase reimbursement for gout inpatient costs, improve primary care guidelines and purinol dose adherence, strengthen primary care collaborative personalized education and care to achieve uric acid-lowering effects, increase subsidies and inclusion of gout prescription medications in the local health insurance directory, and for men to reduce consumption of high-purine foods and alcohol at social events.

INTRODUCTION:Smoking is the leading, preventable factor which significantly increases the likelihood of household relative poverty in China. This study aimed to explore the association between smoking and relative poverty across different households and provide evidence for targeted tobacco control measures and poverty reduction policies. METHODS:This study adopted a longitudinal design using two waves of unbalanced panel data from the China Family Panel Studies (CFPS) conducted in 2018 and 2020. Data were collected through structured questionnaires and self-reported responses. Smoking status of household members was considered the exposure factor, while household relative poverty status, measured by the Foster-Greer-Thorbecke indices, served as the outcome variable. A panel logit random effects model was employed to estimate the determinants of relative poverty across households with varying smoking status. RESULTS:At the 50% median income poverty line, China's relative poverty headcount ratio was 22.15% in 2018 and 22.54% in 2020, with the poverty gap index declining from 11.08% to 10.82% and the squared poverty gap index increasing slightly from 7.13% to 7.17%. Former-smoking households showed the highest poverty incidence (26.3% in 2018; 26.24% in 2020), followed by current-smoking (24.94%; 23.28%) and non-smoking households (22.75%; 22.37%). The panel logit model revealed significantly higher likelihood for current-smoking (adjusted odds ratio, AOR=1.63; 95% CI: 1.44-1.86, p<0.01) and former-smoking households (AOR=1.95; 95% CI: 1.60-2.36, p<0.01) compared to non-smoking households. Additional factors associated with increased odds of poverty included having ≥65 years members, members with chronic disease, and members reporting a two-week illness (all p<0.01). CONCLUSIONS:We conclude that China faces a substantial challenge of relative poverty, with tobacco use significantly increasing the likelihood of household poverty. Potential policy directions may include evaluating the effects of adjusting tobacco excise taxes and reforming tax collection mechanisms, exploring rural smokers' preferences for smoking cessation information to inform the development of targeted interventions and so on.

Introduction: Depression is the leading cause of disability worldwide and has become a health issue of global concern. Based on the “System of Health Accounts 2011” (SHA 2011) for patients with depression, this paper studies the changes in the current curative expenditure (CCE) of outpatient depression in Liaoning Province, China, and provides policy recommendations.Method: A stratified multistage random sample of 56,994 patients with depression included from 1,227 healthcare facilities in Liaoning Province were included. The significance of differences in variables within groups was analyzed by univariate analysis (including descriptive statistics analysis, Mann-Whitney U test and Kruskal–Wallis H test), and factors influencing depression outpatient CCE were analyzed by multiple linear regression analysis and constructing structural equation models (SEM).Results: The CCE of outpatient depression was ranging from CNY 75.57 million to CNY 100.53 million in 2015–2020, with the highest of CNY 100.53 million in 2018, CNY 103.28 million in 2019. Medical expenditures are mainly concentrated in general hospitals and provincial healthcare institutions, accounting for about 90% of all provincial scope expenditures. The multiple regression results show that provincial healthcare institutions, purchase of drug, select medical treatment for depression, general hospitals and urban employees’ health insurance are the main influencing factors for depression outpatient CCE. The results of SEM show that insurance status negative impact outpatient expenditure.Conclusion: Health insurance is an important factor in equitable access to healthcare resources for patients, and medication expenditure is the influential factor affecting the high expenditure of outpatient clinics. It is of great importance to reduce the medical burden of patients by increasing the coverage of medical insurance, increasing the proportion of bills that are eligible for reimbursement, and improving the system by guaranteeing the supply of psychotropic medication.

IntroductionAnxiety disorders are the most common mental disorder, experienced by more than a quarter of the population. This study examines total outpatient curative care expenditures (CCE) for anxiety disorders and changes in their composition based on the System of Health Accounts 2011 (SHA 2011).MethodsThis study used multi-stage stratified random from a total of 9,318,513 outpatient sample data by 920 healthcare organizations, a total of 109,703 cases of anxiety disorders from 53 sample organizations (5.76%) from 2015 to 2020. Univariate analysis, multifactor analysis and structural equation modeling (SEM) were used to explore the influential factors affecting outpatient CCE for anxiety disorders.ResultsAnxiety disorder outpatient CCE from 2015 to 2020 continued to increase from CNY 99.39million in 2015 to CNY 233.84 million in 2020, mainly concentrated in western medicine costs, 15–64 years, general hospital, generalized anxiety disorder and public financing. The results of univariate analysis showed statistically significant differences in all subgroups, and the results of multivariate analysis and SEM showed that the choice to purchase western drugs, purchase prepared Chinese drugs, choice to have a checkup, urban employees’ basic medical insurance, and 0–14 years old were associated with high anxiety disorder outpatient CCE.ConclusionInitiatives to improve the essential drug system, reduce the out-of-pocket (OOP) ratio, and strengthen primary health care to effectively reduce the medical burden on patients.

Objectives Stroke imposes a heavy economic burden and loss of productivity on individuals and society. This study assessed a range of crucial factors, including direct costs and indirect costs, to gauge the economic implications of stroke in China. These outcomes were evaluated with specific reference to the year 2018, using the Chinese yuan (¥) as the unit of measurement and providing the corresponding purchasing power parity dollar ($PPP) currency value.Methods A cost-of-illness methodology was used to ascertain the economic implications of stroke in 2018. Within the constraints of this approach, economic costs were defined as ‘direct costs’ or ‘indirect costs’. We estimated direct costs from sample data, the National Health Service Survey and the National Health Account and Health Statistical Yearbook. A human capital method was used to conservatively estimate indirect costs.Results In 2018, of the economic burden of stroke in China, the direct costs were ¥247.8 billion ($PPP 58.6 billion) and indirect costs were ¥704.4 billion ($PPP 166.5 billion). The curative care expenditure for stroke was ¥193.1 billion ($PPP 45.7 billion), consuming nearly 5.5% of curative expenditure. The cost of stroke treatment relied heavily on public financing, with 58% from social health insurance and 14% from government sources.Conclusions A significant economic burden is imposed by stroke on China’s economy, and there is a risk of underestimating this burden if indirect costs are not comprehensively considered. The importance of implementing effective preventive measures and screening strategies for stroke, with a particular focus on high-risk populations, is underscored by this study’s findings. Such investments in public health have the potential to yield substantial benefits.

目的:探讨建立科学可持续的医疗卫生服务筹资机制,为政府卫生投入和财政预算提供方法学参考.方法:通过对2001-2019年某省医疗卫生服务筹资数据进行梳理分析,构建卫生筹资总量与GDP、政府财政支出、政府财政卫生支出、城镇居民可支配收入、农民纯收入等经济指标分配的卫生经济模型.结果:卫生总费用、政府卫生支出与GDP、政府财政支出等经济指标存在显著回归关系(P=0.000).通过GDP或政府财政支出总预算等经济指标可对卫生总费用和政府卫生支出进行预测,同时提出在政府财政卫生筹资方面预算的应用和责任分析,从而更好地筹划落实政府卫生筹资责任,以及不同情形下各级政府更合理分担卫生支出的责任.结论:基于实证数据构建的政府卫生支出责任的预测和分析有较强的说服力,同时用常见的经济指标进行预测有一定的应用性和适用性.

Objective To understand the liabilities status,analyze the solvency and causes of liabilities of public hospitals in Hebei Province and propose countermeasures.Methods Descriptive statistics and semi-structured interviews were applied to study total liabilities,structure of liabilities and solvency of public hospitals.Causes of liabilities were analyzed through interviews with key informants.Results From 2019 to 2021,the annual average growth rate of liabilities of public hospitals in Hebei Province was 11.61%,and the liabilities were mainly current liabilities.The asset-liability ratio decreased from 49.24%to 48.47%,but it was still higher than the national average level.Conclusions The main reasons for the liabilities of public hospitals were insufficient financial investment,insufficient price adjustment after the abolition of drug and consumables markup,heavy pressure on hospital rigid expenditure,and inefficient operation and management.

目的:核算我国基层医疗卫生机构心脑血管疾病治疗费用,分析治疗费用筹资和配置的结构,为优化我国基层医疗卫生机构心脑血管疾病筹资和防控政策提供决策依据.方法:基于"卫生费用核算体系 2011"核算我国基层医疗卫生机构心脑血管疾病治疗费用,分析其服务功能分布、人群分布和筹资来源等.结果:2020年,我国基层医疗卫生机构心脑血管疾病治疗费用为955.86亿元,占各机构治疗费用的24.75%,其中超过70%用于60岁及以上老年人,超75%用于原发性高血压、冠心病及脑梗死;心脑血管疾病治疗费用近60%发生在门诊服务;心脑血管疾病治疗费用中的家庭卫生支出占比为21.50%.结论:基层医疗卫生机构在心脑血管疾病防治中发挥了重要作用,应进一 步推进基层医疗卫生机构心脑血管疾病防治能力,优化财政投入及医保支付制度,提升对老年人心脑血管疾病及关键危险因素认知水平.

我国人口老龄化问题日益严重,老年照护需求的增长与照护资源短缺的矛盾日趋明显,建立和完善合理的筹资机制是确保老年长期照护服务公平可及的重要保障.澳大利亚较早进入老龄化社会,在提升老年长期照护服务的可及性和公平性方面做了很好的制度设计.因此,文章以澳大利亚为对象开展案例研究,梳理分析其老年长期照护筹资机制,总结归纳其存在的问题,为完善我国老年长期照护服务筹资相关政策提供参考和借鉴.

目的:基于耦合协调理论,探究"十三五"期间我国区域卫生资源配置水平与经济协同发展的耦合协调关系及空间结构特征.方法:分别构建卫生资源配置发展水平和区域经济发展水平两系统的指标评价体系,采用熵值法确定指标权重,利用耦合协调综合评价模型对子系统的综合发展水平指数进行测量,采用空间自相关探究其空间分布和关联特征.结果:2015—2019年我国大部分区域的卫生资源配置水平和经济综合水平呈上升趋势,区域间两子系统综合水平的差距在逐渐缩小,但差异仍然存在,耦合协调度呈现出"东高西低、南高北低"的空间格局,大多数区域的经济发展相对卫生资源配置水平滞后导致了耦合协调等级偏低;通过空间自相关分析发现,两子系统耦合协调度的空间集聚程度在不断加强,耦合协调度高值区辐射带动低值区发展的良好局面逐渐形成.结论:建议逐步完善国家对于卫生资源的投入和保障机制,发挥政府统筹的协调功能,建立并完善财政保障与转移支付机制,完善区域卫生资源配置效率,同时充分发挥耦合协调度空间溢出效应,不断扩大耦合协调度高值区的示范和引领功能.

政府和社会资本合作模式是增加卫生健康领域有效投资、激发市场活力、推动卫生健康体系建设方面的重要工具,系统分析当前我国卫生健康领域政府和社会资本合作模式应用现状进行,发现主要存在缺乏顶层设计、地方政府对政府和社会资本合作模式定位不准确、运营范围和投资回报机制合法合规性有待商榷等问题,提出完善顶层设计、明确适宜领域、建立科学合理汇报机制、加快培养专业合格投资方等建议.

目的:回顾2015年以来我国卫生总费用发展变化情况,分析其变化原因.展望"十四五"时期,我国卫生总费用发展趋势,提出完善卫生筹资的政策建议.方法:采用时间序列指标分析法分析我国卫生总费用变化情况.结果:2015年以来,按当年价格计算,我国卫生总费用增速整体趋缓,卫生筹资结构持续优化,但个人卫生支出占比降幅明显缩小.结论:"十四五"时期,我国卫生总费用规模将继续保持上升趋势,但增速将有所下降.因此,应以人群健康需要为导向,加快构建面向共同富裕的多元化卫生健康筹资机制,强化卫生健康投入绩效监测和评价.

Objective:It systematically analyzed the present situation,existing difficulties and problems of China’s public health input guarantee system,and put forward relevant suggestions to improve China’s public health input guarantee mechanism.Methods:Time series analysis was used to evaluate the changes of level and structural of goverment’s public health input.Combined with literature research,interviews with key insiders,expert consultation,etc.,the difficulties and problems of public health input in China were analyzed.Results:The government’s input in public health is increasing,but there are still some difficulties and challenges,such as the stable public health input mechanism has not been established,the compensation mechanism is still not perfect,and the overall level is still far behind that of developed countries.Conclusion:In view of the difficulties and challenges existing in China’s public health input guarantee mechanism,it is necessary to build a financing strategy with the government as the main body,the society as the supplement,and individuals taking certain responsibilities,and further improve the government’s public health input growth mechanism to promote the establishment of a new operating mechanism for public health service providers.

目的:分析我国公立医院经济运行面临的主要问题,尤其是受新冠疫情影响我国公立医院经济运行情况,为完善疫情防控常态化下公立医院经济运行及补偿政策提供依据.方法:运用卫生健康财务年报资料对比分析疫情之前不同年份公立医院经济运行存在主要问题,运用疫情期间相关专项调查数据,分析疫情期间公立医院经济运行情况.结果:2013—2019年全国公立医院业务收支结余率由4.7％降至2.4％,资产负债率由44.7％增长至46.1％,亏损医院的亏损规模由-82亿元扩大至-313亿元.2020年1-9月份全国公立医院门急诊人次数较上年同期下降18.5％,出院人数较上年同期下降16.5％,医疗收入较上年同期下降9.8％.结论:取消药品加成和耗材加成后,公立医院运行压力巨大,疫情发生后全国公立医院业务量大幅下降,经济运行压力进一步增大,疫情防控常态化下我国公立医院的补偿政策需进一步完善.

推动职工医保门诊保障由个人积累式保障模式转向社会互助共济保障模式,是深化医疗保障制度改革的重要内容之一.本文梳理了我国职工医保门诊保障的现状和特点,在全国层面估算了门诊共济保障改革后可用基金规模、门诊保障需求和可支付水平.结论认为:我国职工医保门诊保障的推进形式和保障水平存在差异,应因地施策、循序渐进,结合人口、地区、原有政策设计等因素做好门诊改革的预测和评估.

目的:核算分析我国基本医疗保险(简称"基本医保")基金在心脑血管疾病上的支出规模、配置和使用情况,为优化基本医保基金支出提供决策依据.方法:基于"卫生费用核算体系2011"核算我国心脑血管疾病费用与基本医保基金支出总量,分析其服务功能分布、机构流向和疾病分布.结果:2018年我国心脑血管疾病费用中基本医保基金支出总量为3312.43亿元,居各类疾病费用基本医保基金支出首位;其中冠心病、原发高血压、脑梗塞、脑出血及心力衰竭五类疾病花费占比超70％.机构配置方面,心脑血管疾病基本医保基金支出超八成发生在医院、超七成发生在住院;筹资贡献方面,基本医保支付占心脑血管疾病治疗费用55％.结论:我国心脑血管疾病消耗大量卫生资源及基本医保基金,心脑血管疾病医保基金支出机构配置不平衡,亟待优化医保资金功能使用与机构配置方向,提高医保资金保障效率.

目的:对2020年我国卫生总费用及个人卫生支出占比开展季度核算,提高数据时效性,并对"十四五"时期该比重变化情况进行科学预测.方法:在常规年度核算基础上,创新性设计季度核算方法,采用组分模型、趋势预测法等对卫生总费用进行预测.结果:2020年个人卫生支出占比将降至28.1％,"十四五"时期该比重仍将持续下降.结论:建议"十四五"末该比重发展目标设定在26.5％～27％之间,继续完善卫生筹资机制,保障卫生筹资的充足、公平和可持续.

目的:通过分析我国基本医保基金的筹集与配置使用情况,为进一步优化政策提供决策参考与建议.方法:基于宏观数据及卫生费用数据分析基本医保基金收支情况,以及基金在不同机构、不同服务和不同人群中的使用情况.结果:基本医保基金收入快速增长,占卫生总费用比重不断提高;基金支出规模不断增加,2009年-2018年年均增速为15.5％.从配置使用情况来看,2018年基本医保基金支出近九成发生在医院、近七成发生在住院服务;在人群使用上,基本医保支出中近50％用于60岁及以上人群,超62％用于循环系统疾病、肿瘤、呼吸系统疾病、消化系统疾病、泌尿生殖系统疾病;超78％用于慢性病.结论:医疗卫生服务需求不断增长,为基本医保基金可持续带来较大挑战;需要在扩大筹资水平的基础上,进一步优化医保基金的功能使用与机构配置方向,提高资金使用效率.

目的:构建我国政府卫生投入分析框架和指标体系,评价新医改以来我国政府卫生投入情况,为完善政府卫生投入政策提供依据.方法:基于卫生筹资政策分析框架,确定政府卫生投入评价维度,结合政府卫生投入相关指标和政策目标,评估新医改以来我国政府卫生投入情况.结果:新医改以来,我国政府卫生投入规模持续扩大,但增速放缓;地方财政承担卫生支出的主要责任,可持续性存在挑战;地区差异不断扩大,"中部塌陷"现象需重视;基层医疗卫生机构和公共卫生机构投入力度有待加强.结论:应建立以健康结果为导向的投入机制,加大对公共卫生事业的投入力度,建立政府间的转移支付制度,探索提高对烟草等税收,并专门用于卫生健康领域.

目的:为我国肿瘤防治政策和筹资机制调整提供数据支撑.方法:基于"卫生费用核算体系2011",核算2018年我国肿瘤治疗费用情况.结果:2018年我国肿瘤治疗费用3924.62亿元;服务分布上,87.53％的费用发生在住院;病种分布上,83.44％的费用用于癌症治疗,主要是肺癌、乳房恶性肿瘤、胃癌、肝癌等;机构流向上,72.53％的费用流向综合医院;年龄分布上,72.79％的费用集中在45～74岁人群;筹资来源上,公共筹资方案占62.76％,家庭卫生支出占27.48％.结论:肿瘤发病趋势将带来治疗费用的持续增长,要建立合理的筹资机制,增加筹资总量,优化资金存量,合理支出结构,以达到更好的肿瘤防治效果.