Fiedler J L
Birch & Davis Associates, Silver Spring, MD 20901.
Soc Sci Med. 1987;25(8):867-74. doi: 10.1016/0277-9536(87)90255-3.
This study analyzes the causes and effects of the persistent underfinancing of recurrent costs in the Ministry of Health (MOH) of El Salvador over the past decade. Causative factors identified and discussed include (1) a functionally unintegrated MOH structure--consisting of (a) the autonomous hospitals and (b) the remainder of the Ministry; (2) the functional isolation of the Ministry's planning department from its budgetary department; (3) the use of historical-budget based decision-making--in lieu of more explicitly goal oriented resource allocation and planning criteria; (4) donor agencies' funding of infrastructure construction projects, coupled with their unwillingness to financially support the recurrent costs such projects ultimately give rise to; and finally, (5) the civil war and its associated economic dislocation, altered central government funding priorities and general state of disarray. The effects of persistent underfinancing of recurrent costs in El Salvador are the growing proportion of the MOH budget being consumed by outlays for personnel at the expense of virtually all other budgetary categories; the shortages of drugs and general medical supplies in public health facilities; and reduced levels of utilization of those facilities from what would otherwise be expected; all of which together imply a reduced level of both productivity and effectiveness of the public health care system. Policy implications and recommendations are briefly noted.
本研究分析了过去十年中萨尔瓦多卫生部经常性成本持续资金不足的原因及影响。已确定并讨论的成因包括：（1）卫生部结构功能未整合——由（a）自治医院和（b）卫生部其余部门组成；（2）卫生部规划部门与预算部门在功能上相互隔离；（3）采用基于历史预算的决策方式——而非更明确以目标为导向的资源分配和规划标准；（4）捐助机构为基础设施建设项目提供资金，却不愿为这些项目最终产生的经常性成本提供财政支持；最后，（5）内战及其相关的经济混乱、中央政府资金优先事项的改变以及普遍的混乱状态。萨尔瓦多经常性成本持续资金不足的影响包括：卫生部预算中越来越大的比例被人员支出消耗，几乎牺牲了所有其他预算类别；公共卫生设施中药品和一般医疗用品短缺；这些设施的利用率低于预期水平；所有这些共同意味着公共医疗系统的生产力和效率水平降低。文中简要提及了政策影响和建议。
