Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, Beijing, China.
Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, Beijing, China; Faculty of Health, University of Canberra, Canberra, Australia.
J Adolesc Health. 2020 Nov;67(5S):S38-S47. doi: 10.1016/j.jadohealth.2020.03.033. Epub 2020 Nov 24.
Adolescent health has been gaining increasing attention in the Sustainable Development Goals era. Data on adolescent health financing are essential for evidence-based policy planning and evaluation. Little is known on national expenditure on adolescent health in China. To inform decision-making on national strategies of adolescent health and development, this study estimated expenditure on adolescent health-care utilization in China and identified funding sources and their allocation among different health functions.
We constructed and implemented an institutional survey and collected primary financial data from health institutions in the nine selected administrative provinces in 2014. We used the collected data to generate estimate of proportion of health spending on adolescent health and its breakdowns by health-care functions, health-care financing schemes, and diseases based on primary diagnosis. We applied the proportion estimates to the 2014 national-level health expenditure data and estimated national-level estimates of spending on adolescent health and breakdowns in aforementioned areas.
Spending on adolescents health in 2014 amounted to CNY82.1 billion (USD 13.4 billion) or 2.6% of the total health expenditures in the year. Per adolescent health expenditures was CNY525 (USD 85.5), less than per capita health spending (CNY2349, USD382.4). National spending on adolescent health was 73.1% on curative care and 10.3% on preventive care. Out-of-pocket spending is the major source of adolescent health financing, contributing to 57.9% of total spending on adolescent health. Spending on respiratory, digestive, injury and poisoning, genitourinary diseases, and neoplasms accounted for 59.8% of curative care expenditures on adolescents.
Current financing mechanism on adolescent health stressed on curative care and imposed a large portion of financial burden on households. Future investment on adolescent health shall focus more on preventive care. Financing schemes shall be adjusted so as to reduce household out-of-pocket spending on medical care used by adolescents.
青少年健康在可持续发展目标时代受到越来越多的关注。青少年健康融资数据对于循证政策规划和评估至关重要。中国在青少年健康方面的国家支出情况知之甚少。为了为青少年健康和发展的国家战略决策提供信息，本研究估计了中国青少年医疗保健利用的支出，并确定了不同卫生功能的资金来源及其分配。
我们构建并实施了一项制度调查，并从 2014 年九个选定的行政省的卫生机构收集了主要财务数据。我们使用收集的数据生成了青少年健康支出在卫生支出中所占比例的估计值，并根据主要诊断将其按卫生保健功能、卫生保健融资计划和疾病进行细分。我们将比例估计值应用于 2014 年国家级卫生支出数据，并估计了国家级青少年健康支出和上述领域细分的支出。
2014 年青少年健康支出为 821 亿元人民币（134 亿美元），占当年卫生总支出的 2.6%。每名青少年的健康支出为 525 元人民币（85.5 美元），低于人均卫生支出（2349 元人民币，382.4 美元）。国家对青少年健康的支出 73.1%用于治疗保健，10.3%用于预防保健。自付支出是青少年健康融资的主要来源，占青少年健康总支出的 57.9%。呼吸、消化、伤害和中毒、泌尿生殖系统疾病和肿瘤占青少年治疗保健支出的 59.8%。
目前青少年健康融资机制强调治疗保健，并给家庭带来了很大的经济负担。未来对青少年健康的投资应更多地侧重于预防保健。应调整融资计划，以减少家庭在青少年医疗保健方面的自付支出。
