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我国少数民族地区基本公共卫生服务均等化研究

2016-09-28 18:44:07   来源:中国人权网   作者:周燕 陈昶 黄川 宋平 殷霁薇

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西南政法大学副教授 周燕  (赵一帆 摄)


我国少数民族地区基本公共卫生服务均等化研究
-----关于四川省阿坝州甘孜州凉山州为例的调查

周燕  陈昶  黄川  宋平  殷霁薇 


  健康权是人类的基本权利,健康公平是各国政府追求的社会指标。为提高健康的公平性和基本公共卫生服务的可及性,近年来中国颁布了一系列关于推进基本公共卫生服务均等化的政策,并将其作为深化医药改革的一项制度加以逐步推进。中国民族地区经济和社会发展相对落后,医疗卫生条件差,少数民族群众看病难、看病贵的情况较之发达地区更为严重,不利于改善群众的健康状况。在少数民族地区推进基本公共卫生服务均等化,有利于少数民族群众健康权益的实现,有利于民族团结与社会和谐。本研究以中国四川省阿坝州、甘孜州和凉山州的基本公共卫生服务的现状为切入点,通过问卷调查法、访谈法以及资料分析法,收集整理了来自阿坝州、甘孜州、凉山州2012年财政决算表、2013年四川卫生和计划生育统计年鉴、2013年四川卫生统计年鉴、2006-2013年四川统计年鉴及国家卫生计生委基层卫生司的官方数据资料,运用包络数据分析法分析各种数据,对阿坝州、甘孜州、凉山州的基本公共卫生服务现状进行了描述,找出问题、分析成因,以期为实现中国少数民族地区基本公共卫生服务均等化提出相关政策建议。阿坝州甘孜州凉山州基本公共卫生服务主要存在两大问题:其一,城乡、区域公共卫生服务的资源分布不合理;其二,城乡、区域公共卫生服务水平差距甚远。其成因主要在于:经济发展水平较低影响了少数民族地区的财政收支,导致少数民族地区的卫生财政供给基本公共卫生服务的能力低,与其他地区相比差距较大;地理、人文环境的影响使得民族地区的基本公共卫生服务成本较高;不同地区群众对基本公共卫生服务需求不同,以同样标准的资金和补助来支持少数民族地区的卫生事业,不利于少数民族地区与其他地区基本公共卫生服务均等化的实现;公共财政体制、转移支付制度、政府重视程度等方面因素也成为基本公共卫生服务均等化过程中的障碍。因此,中央政府和各少数民族地区政府应当从开展和落实基本公共卫生服务项目、建立完善公共财政体系、适度公共卫生政策倾斜、创新基本公共卫生服务供给模式、完善绩效考核机制着手,针对少数民族地区因地制宜地完善并推行相关政策,以实现我国少数民族地区基本公共卫生服务均等化。
 

On the Equalization of Basic Public Health Services in China’s Minority Ethnic Regions:
A Case Study of Aba, Ganzi and Liangshan Prefectures of China’s Sichuan Province

Zhou Yan

The right to health is a basic human right, so the equality and fairness in health is a social indicator that all countries around the world have been following closely. In order to improve equality in health and the people’s accessibility to basic public health services, the Chinese government has promulgated a series of policies intended to boost public health service equalization, and has been steadily advancing equalization in access to public health services as part of its bid to deepen the reform of China’s medical care system. Particularly, promoting equalization in access to basic public health services in regions mainly inhabited by minority ethnic groups is highly conducive to the realization of the minority communities’ exercise of their right to health and to consolidating ethnic unity and social harmony, in view of the fact that in such regions, due to the relative backwardness in social and economic development of such regions, the local ethnic minority communities’ lack of access to cost-effective medical services is more acute than in more developed areas of the country, which is highly detrimental to the realization of local residents’ right to health.

This study, proceeding from the current state of basic public health services in three prefectures in Sichuan Province, namely, Aba, Ganzi and Liangshan, all of which are mainly inhabited by minority ethnic groups, described current state of basic public health services in the three places on the basis of analyses of official data obtained from numerous documents, including the 2012 Fiscal Balance Sheets of the three prefectures, the 2013 Yearbook for Health and Family Planning in Sichuan Province, the Statistical Yearbooks of Sichuan Province for 2006-2013, as well as official data and information offered by the Grassroots Health Division of the National Health and Family Planning Commission for the three prefectures. In the process, problems were identified, the causes of such problems were analyzed, so as to put forward policy proposals for the equalization of basic public health services in ethnic minority regions.

In the present study, it was found that there exist two major problems in basic public health services in the three prefectures: unreasonable distribution of public health service resources between urban and rural areas as well as between different regions; there is a glaring gap between rural and urban areas, as well as between different regions, in terms of the level of basic public health services offered. The two problems can be primarily attributed to the following factors: Those regions are relatively backward in terms of economic development, which adversely affect the fiscal funding for ethnic minority regions, which in turn weakens the capability of local governments in such regions to finance basic public health services, resulting in a considerable gap between those regions and other areas; unfavorable geographic and demographic factors pushed up the cost of basic public health services in those regions; although there exist cross-regional differences in terms of local residents’ need for basic health services, the same rate of financing and subsidies are offered to all regions regardless of their differences, which hinders the equalization of basic public health services; such factors as the public fiscal system, transfer payment system and the varying degree of attention paid by the government have also become hindrance to basic public health service equalization. In summary, the central government and the governments in ethnic minority regions should, for starters, carry out and fulfill basic public health services, establish a sound public fiscal system, put in place favorable policies, innovate on basic public health service supply patterns and improve performance evaluation mechanism, and after that, they should carry out certain policies in order to realize basic public health service equalization in the ethnic minority regions.

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