“補供方”與“補需方”對醫療費用的影響比較：基於三明市新醫改的實證研究

在醫療衛生體制改革中，“補供方”還是“補需方”的爭論持續多年。這不但是決策者需要面對的重大政策問題，也是衛生經濟學和醫療政策研究的重要理論問題。以福建省三明市為例，以公立醫療機構作為分析單位，研究地方財政對醫院的補助、社會醫療保險的發展與醫療費用增長之間的關係。研究發現，財政補助占收入比重高的醫療機構的次均費用更可能低於財政補助比重低的機構；而醫保的壯大與醫療機構費用增長之間沒有顯著關係。“補供方”和“補需方”的選擇意味著尋找政府管理和第三方機構經辦的平衡點。就三明市而言,政府補助對於醫療機構費用控制的作用表明，通過“補供方”的經濟杠桿效應控制醫療費用的過快增長仍有很大潛力,“補供方”和“補需方”的平衡點需要進一步挖掘。
In the reform of medical and health system, the depute about either "aiding the supplier" or "aiding the demander", which is not only a significant policy issue the policymaker need to face but also an important theoretical issue for the study of health economics and healthcare policy, has been going on for several years. Taking Sanming City in Fujian Province as an example and public medical institution as unit of analysis, this article studies local financial aid to hospitals and the relationship between the development of social medical and healthcare insurance and the increase of medical expense, which finds that the average hospitalization expenses in the medical institution with its financial aid accounting for a high proportion of income may be more likely to be lower than the ones in the institution with low proportion of financial aid; while there is no significant relationship between the expansion of medical and healthcare insurance and the increase of the expenses of medical institutions. The option of "aiding the supplier" or "aiding the demander" means to find a balance between government administration and the third-party agency handling. With regard to Sanming City, the effect of government aid to the control of medical institution expense indicates that controlling the rapid growth of medical expenses by domino effect of the economic leverage of "aiding the supplier" is still great potential, while the balance between "aiding the supplier" and "aiding the demander" need to be examined further. Copyright © 2017 北京行政學院.