Abstract In China, there are two problems in the allocation of resources, including the serious lack of health resources and poor equity of the allocation of these resources, due to previous health policy of "Giving Priority to Efficiency and Fair Balance". Along with the growth of economic of China, the health resources increase. However, current Chinese Total Expenditure on Health out of GDP is only 5%, which just is above the WHO' s lowest standard. China has a wide territory and a large amount of population, thus the issue of equity of resource allocation would be more important for China to consider and pay more attention on it. World Health Report (2000) shows that the rank of the performance of Chinese health system is 144 out 191 countries and the fairness in financial contribution only ranks the 188th. There is distinction of resources allocation among the urban and rural areas, also within the city among different populations. Equity means the equitable chance for people to pursue health and need. The equity in health care commonly means equal access to health care for those in equal need of health care; equal utilization of health care for those in equal need of health care; equal (or, rather, equitable) health outcomes (measured by). People pay more attention on the issue of equity in health, and the discussions about the field of health tend to focus on the analysis of equity in health care. How to allocate health resources appropriately has been a pivotal issue in China. The comparison of the equity in health care among different areas of China would show, to some extent, the equity in health care of whole China. On the other hand, the lack of total resources forces us to put the improvement of economic ahead. However, it needs us to examine whether the inequity in health care has been improved with the rapid growth of economic. -3-

摘要 在中國,一方面衛生資源一直處於嚴重缺乏的狀態;另一方面,“效率優先, 兼顧公平”的政策指導更是使得衛生服務在公平性上有著極大的缺陷。雖然隨著 我國經濟的快速發展,政府在衛生資源上的投入隨之增加,近幾年中國衛生總費 用(CTEH)占GDP的比例達到了5%,剛剛超過了WHO提出的最低標準。然而,我國 幅員廣闊,人口眾多,這些衛生資源在地區和人群間的配置是否公平,是需要我 們加以注意的課題。世界衛生組織2000年的World Health Report即指出,中國 衛生系統的整體表現在191個國家排名第144位,而資金分配的公平性(fairness in financial contribution) 排名僅僅在第188位。若再更進一步的觀察,我國 的衛生資源分配不僅在城鄉間存在很大的差距,即使是不同城市以及城市內部, 也都存在著衛生資源在不同群體間分配的不公平。 隨著社會的發展,健康公平已經成為人們關注的一個話題。公平(equity) 意味著人們的需要、健康的機會平等。而衛生服務(health care)的公平性是 指有相(不)同的衛生服務需要者,有相(不)同使用衛生服務的機會(access to health care); 相(不同的衛生服務使用情形(utilization of health care); 相同的,或者更確切,公平的(調整了的)健康狀態(health outcomes)。本研 究在衛生領域中公平性的分析上,主要通過對不同地區衛生服務公平性的比較, 探討發展經濟為先的政策前提下,中國衛生服務的公平性情況。然而近年隨著中 國的經濟增長,中國衛生服務的公平性是否得到了一定的改善,也是我們需要考 量的。 研究衛生服務提供公平性的較簡單直接的方法,是借由分析地區間衛生資源 分佈的公平性來。本研究比較和分析中國五個省市96年的每萬人口醫生數、每萬 人口醫院病床數兩個衛生資源配置的重要指標,發現衛生資源配置在我國的確存 在地區間的不均衡。進一步分析96-05年十年間上述兩個指標在這五個省市的變 化情況,發現在地區間衛生資源不均衡的現象在這十年間並沒有得到顯著改善, 每萬人口醫院病床數在地區的差距甚至不斷擴大。也就是說,中國經濟的增長並 不伴隨著衛生資源的同步增加,尤其是在衛生資源配置的方面,更需要政府重新 思考公平性的課題 - 衛生政策制定者應該在不違反衛生公平的前提,加大政府 -1- 澳门大学硕士学位论文 在衛生市場的調控力度,避免衛生醫療市場僅受市場機制的左右,藉以改善我國 地區間衛生服務的不均衡。在“公平優先、兼顧效率”的新政策指導下,中國衛 生服務應大力加強衛生資源配置的優化,增強對於鄉村、城郊居民和弱勢群體的 關注和救助機制,使得中國衛生服務能最終達到高效率、高產出,使得中國的廣 大國民都能享受應有的衛生服務,達到應有的健康狀態,獲得公平的健康。 關鍵字:衛生資源;資源配置;衛生服務;衛生服務公平性。