Zhang Rui: China Public Sanitation Deadly Short Shop

Zhang Rui

The severe COVID-19 (COVID-19) has caused many reflection.Huang Qifan, deputy director of the China International Economic Exchange Center and the former mayor of Chongqing, proposed to cancel the housing provident fund system and attract a lot of arguments, and then called on the country to build infrastructure in the public health field like the repair of railways and highways.

Objectively speaking, it is more reliable to promote investment in public health infrastructure than to cancel the housing provident fund, because the latter is doing subtraction.It is definitely not small to move up to realize the resistance; the former is doing addition, seeking to increase the well -being of the public, and it will be widely applauded and enthusiastic.

Like SARS that year, now stubbornly blocks the crown disease, allowing the world to witness the Chinese government's ability to dispatch and allocate resources across the country, and to clearly appreciate the rare joint efforts of the Chinese people's minds and overcome the time.However, it also exposes important shortcomings of China's domestic public health facilities and its insufficient emergency capabilities.

After a long period of time after the epidemic, many infected people in Wuhan were waiting for a long line to wait for examination., It is also necessary to endure the pain of deterioration of the condition, and even some of them lose their lives because they missed the opportunity to treat the good opportunity.

As an emergency, the Chinese government decided to invest in the construction of Vulgar Mountain and Lei Shenshan Hospital in Wuhan, while converting the square cabin hospital.Although the two play the function of expanding the supply of beds and temporary treatment, it is not difficult to imagine the huge amount of fiscal funds and human resources; after all, the infrastructure construction in the state of crisis is not allowed to verify science and economy carefully.It has increased a lot than usual than usual.It is also true that it is necessary to make deep reflection around the construction of public health facilities after the epidemic.

Health expenditure is seriously insufficient

It is true that investment in public health construction in China has risen with the increasing increase in public financial investment in people's livelihood infrastructure.Compared with only 3.544 billion yuan (RMB, the same, about S $ 700 million) in 1978, in 2018, the funds invested in public health after the founding of New China reached 1.6 trillion yuan, accounting for the GDP (GDP of GDP (GDP (GDP) The ratio also increased from 0.9%to 1.7%.

However, although the absolute amount of investment funds has increased a lot, compared with the proportion of public health expenditures for public health in the developed countries, and 4.5%of the medium -income countries, the proportion of China's fiscal investment is still relatively low, and even evenIt is only slightly higher than the average level of 1.5%of the low -income countries.Not only that, the government's investment in public health has not been rising. The minimum is only 0.62%in 1995, and increases the growth rate of overall public infrastructure investment in the overall public infrastructure.

Through the further inventory of the total public health costs, it can be seen that the Chinese government is unsatisfactory about public health investment.Data show that in 2018, the total cost of public health in China was 5799.8 billion yuan, accounting for 6.6%of GDP, which accounted for less than high -income countries (8.1%average).(Average 6.2%).More importantly, in the total public health expenditure consisting of government health expenditures, personal health expenditures and social health expenditures, the proportion of government health expenditures has declined year by year.

In the last 10 years, the Chinese government's expenditure accounted for 28.7%in 2010, while in 2018, it fell to 28.3%, and the highest year in the middle accounted for only 30.66%, and the overall decline was declining. At the same timeThe proportion of government spending less than 30%in the cost is not only significantly lower than the proportion of 70%to 80%of the major industrialized countries, but also the proportion of 45%of emerging market countries.In addition, the total health expenses of government expenditures in major industrialized countries such as the United States and Japan account for 13%of the average government expenditure, up to 17%, and only 11%in China.

Yes, with the government's coverage of the medical insurance and rural residents' medical insurance in recent years, the cost of personal health expenditure in China has decreased significantly, from 59.0%of the total public health expenditure, which has decreased to 28.7%.Hygiene expenditure has been raised to 43.01%, representing the growth of commercialization and marketization in public health expenditures.

However, international experience shows that the focus of public hygiene should be disease prevention, followed by medical assistance.Although Chinese companies' medical insurance expenditures for employees have continued to increase and private hospitals have become increasingly developed, these new funds and resources are not allocated on disease prevention, but are completely used in medical expenses.

Especially the expansion of private hospitals, although the contradictions of insufficient supply of social health institutions to a certain extent, have the focus of business focus on the treatment of plastic surgery, infertility, and sexual patients.Various common diseases and critical illnesses play a medical treatment role. In terms of public health construction such as health education, nutritional intervention, immunization planning, infectious diseases and chronic disease pre -control, private hospitals are basically incompetent, or they have no intention of getting involved at all.

Heavy medical treatment light prevention

Indeed, even the domestic public health institutions, especially public hospitals, generally have a tendency to focus on medical care and light prevention.On the one hand, the cost of individual medical care, especially public medical expenses, has continued to increase, and at the same time insufficient investment in the disease protection of the group; on the other hand, limited funds and resources are usually allocated to profitable medical institutions, and some have more moreThe fiscal funding for strong and public epidemic prevention departments is getting less and less.This scene appears: the number of domestic medical institutions has increased year by year, but professional public health institutions have continued to shrink.

Data show that at the end of 2018, the total number of Chinese medical and health institutions reached 997,434, an increase of 10,785 over the previous year, but the professional public health institutions decreased by 1,862.For a society, the increasing shrinking of professional public health institutions composed of the Prevention and Disease Control Center and the Maternal and Child Health Center, coupled with the abolition of the disease prevention function of medical institutions, means that the public health system is getting weaker.Correspondingly, the improvement of basic public health conditions, the optimization of water and drinking environment, pre -control of infectious diseases, and the health education capabilities of the people are becoming more and more minimal.

But economics theory tells us that public health services have very significant positiveness, such as cure patients with crown diseases, which is equivalent to reducing the possibility of infection of other social members.This is why public finances must decisively bear the cost of treatment of crown disease.It is not difficult to know that the investment and construction of public health can only be singed by the government, and cannot be hoped to be hoped to be in any other commercial subject.

Comprehensively analyzed that the reason why the Chinese government's finances were insufficient in public health in the past is the backwardness of public health consumption concepts, that is, regarding public health expenditure as a welfare consumption, or even consumable expenditure, not as human capital, not as human capital.Investment; on the other hand, under the taxation system, the central government and local financial power and rights are asymmetric. Sanitary expenditure is mainly responsible for various local governments. In the case of very limited fund supply, the public health construction urban and rural areas appeared.Unbalanced conditions between the regions.

However, it is necessary to emphasize that increasing investment in public health can rely on the correlation effect of the industrial chain to drive economic growth; and experience shows that only about 30%of infrastructure such as financial investment railways and highways is transformed into GDP of the year, while investment education, hygiene, andPublic services and facilities such as culture can be transformed into GDP of the year.Therefore, it is also a fiscal investment that has higher investment efficiency in the public health field and has a greater effect on GDP.

In addition, the two cornerstones of human capital as education with education are both the foundation of personal learning ability and the basis of personal labor productivity, and the basis of personal intelligence, physical strength, emotion, and development ability.Therefore, investing in public health is investment healthIt is the investment in human capital; and this investment behavior can not only improve the efficiency of labor power, but also increase the increase in enterprise output, and it can also bring a stable growth of national fiscal and tax revenue.

It is also clear that the primary goal of public health is not profitability but public welfare.Increasing public health institutions, adding complete medical beds, and recruiting more professional public health personnel may produce resources idle, but from long -term and global review, they are the guarantee of social physical health operations, and the improvement of government public security capabilities.The sign of a country is a strong barrier to a country isolation and blocking huge public health disasters.With their protection, a country and a city will have the confidence that is more dangerous and unwilling, and will not cause deep damage and blows to the people's lives and the national economy due to disaster raging.

In summary, in the fourteenth five -year planning, the five years after the start of the start, it is necessary for China to use the equivalent funds of 200 billion to 300 billion yuan from the central to the local governments to give the shortcomings of the entire public health system in China as a whole.In addition, the central government should provoke the beam of public health investment.To this end, the central government can raise funds by issuing public health special Treasury bonds and public health lottery tickets, while increasing the issuance of local government public health bonds, and attracting social capital support through public -private partners (PPP).

Based on the strengthening of the infrastructure of hospitals and public health institutions, the fiscal incremental funds must focus on the establishment of four beams and eight -column types such as disease prevention and control, major epidemic prevention and control, medical insurance and assistance, and emergency materials protectionNational and local public health emergency management systems.

The author is a director of the Chinese Market Society

Professor of Economics at Guangdong University of Foreign Studies

Graduate mentor