sars引发的公共卫生事业财政支出问题（Public expenditure on public health caused by SARS）

1/1sars引发的公共卫生事业财政支出问题（PublicexpenditureonpublichealthcausedbySARS）sars引发的公共卫生事业财政支出问题（PublicexpenditureonpublichealthcausedbySARS）sars引发的公共卫生事业财政支出问题（PublicexpenditureonpublichealthcausedbySARS）TheproblemcausedbySARSpublichealthexpenditureTheproblemcausedbySARSpublichealthexpenditure2008-12-2015:15:31Attheendof2002andin2003aftertheSpringFestivalinGuangdongandotherareasoflarge-scaleoutbreakoftheSARSepidemic,isaseveretestoftheChinesegovernment.IntheprocessofovercomingSARS,thegovernmentthedecisionbythegovernmenttoprovidefinancialsupport,inthecrisisplayedasoothingandrapidtreatmenteffect,effectivecontroloftheepidemicplaysanundeniablerole.Then,startingfromthefinancialpointofview,wecanforthecostsandbenefitsofthegovernmentisanaccount,analysisoftheSARScrisisonChina’sfiscalexpenditureinthefield.TheSARScrisistofinancialexpenditure(thetotalcostofthecrisis)Suddeneventshaveoccurredinthecentralandlocalfiscalemergencyspendingalthoughaftermanyefforts,theepidemichasbeeneffectivelycontrolled,buttheTreasuryalsopaidahugecost,thecentralandlocalgovernmentsindealingwithemergenciesintheeventofspendingmorethanatanytimeinthecostofdisaster.FromthebeginningofAprilthecentralgovernmentaccordingtotheStateCounciltoestablishemergencyresponsemechanismforpublichealthemergencies,allocated310millionyuanofspecialfundsfortheconstructionoftheemergencyresponsemechanismofthefirstphaseofthefirstsumofmoney,asofMay14th,thecentralandlocalgovernmentsforthepreventionandtreatmentofSARSfundstotaling12billion600millionyuan,morethan1999to2001totalreliefspendingthreeyear.Canbeseenfromtheabovedata,thecentralandlocalfinancialemergenciesintheSARScrisisintheamountofexpenditureishuge.Inourbudget,dealwithemergencybudgetexpenditureaccounthastwoitems:oneisthecentralfinanceandlocalfinancereservefund,twoislistedundertheprojectcostofreliefreliefspendingonpensionsandsocialwelfare.Chinain2003inthecentralbudgetarrangementsforthegeneralreservefundsof10billion,ittook2billion(notincludingthecentralgovernmenttothelocaltransferexpenditureforthepreventionandcureofSARS),belongstothehistoryofoneofthelargestone-timeexpenditure.Localgovernmentexpenditureofaboutabout8000000000yuan,allbecauseoftheeconomicsituationandepidemicsituationvaries.-taxbreaksandthefinancialexpenditureofthefeewaiverformsinceMay9th,thecentralgovernmentandthelocalgovernmentissuedaseriesofpoliciesandmeasuresoftaxrelief,whichconstitutesalargeamountoftaxexpenditureandFinancialFeesexpenditure,reducethenumberofactualrevenuethisyearaslastyear,accordingtofinancialfeesandtaxesincomeestimates,thisexpenditureistenortheamountofbillionsofdollars.Thedetailsareasfollows:InMay9th,theStateCouncildecidedfromMay1,2003toSeptember30,2003,theSARSaffectedlargehotels,catering,entertainment,tourism,civilaviation,highway,waterwaypassengertransport,taxiindustry,reductionofadministrativefeesandgovernmentfunds15.These15funds,thecentralrevenuebelongstoallfree;belongtolocalincome,specificreductionratedecidedbythelocalgovernment.InMay11th,theStateCouncildecidedonthepartoftheindustrymoreprominentbytheepidemicdirectlyaffecttheimplementationoftaxpreferentialpoliciesintheperiodfromMay1,2003toSeptember30th.Civilaviationpassengertransportandtourismbusinessshallbeexemptedfrombusinesstax,citymaintenanceandconstructiontax,educationsurcharge.Inaddition,theprovinces,autonomousregionsandmunicipalitiesdirectlyunderthecentralgovernmentmayimplementthefollowingpreferentialtaxpoliciesaccordingtotheactualsituationofproductionandoperationofthelocalepidemicandimpactonrelatedindustries:Foodandbeverageindustry,thehotelindustryortheimpositionofataxreductionorexemptionofbusinesstax,citymaintenanceandconstructiontax,educationsurcharge.Thetaxidriverisexemptfrompersonalincometaxleviedorreducethequota.Onthepublictransportationcompanyandthecitytaxicompanyorimpositionofataxreductionandexemptionofbusinesstax,citymaintenanceandconstructiontax,educationsurcharge.Beforethis,incombinationwiththepolicyoftheStateCouncil,otherlocalpoliciesaregraduallyintroduced.IncludingBeijing,Shanghai,GuangdongandHangzhouisatypicalpolicy,Includingfromthemedicalstaffandthetaxiindustryofpersonalincometax;partofthehotel,catering,commerceandTourismServicesadministrativefeesandoperatingfeewaiver;improvetheexporttaxrebatesubsidyratio;increasefinancialsupportfortheeffortsofthemedicalreserve;giventheshort-termcapitalloanguaranteesupportfortourism,catering,theentertainmentindustrycashflowdifficultiesofsmallandmedium-sizedenterprises;adjustthetransportation,tourism,entertainmentandotherdozensoftaxpreferentialtaxpolicies.Becauseofthemacroeconomicslowdown(GDPgrowthdecline)oftheimplicitfiscalexpenditureaccordingtoeconomists’forecasts,China’smacroeconomicslowdownisdetermined.Optimistically,willdropby0.2to0.5percentagepoints,pessimistic,maydrop1to2percentagepoints.Fromthecurrentsituation,althoughthefirstfourmonthsofthisyearChina’staxrevenuegrew30%,reaching727billionyuan,thisfigureisequivalenttotheannualtaxrevenueof18900billionyuanof38.46%.lastyearbutfirstquarterrevenuegrowthwillsoonbetaxcutsandeconomicslowdownoffset.AccordingtotheStateAdministrationofTaxationestimates,byslowingeconomicgrowth,taxrevenuesthisyearwillbereducedby30billionyuan(taxgrowthanddamagedtheindustrywillbenefitfromtheindustrybroughtaboutbythetaxreductionaccount).Otherfinancialfeesandfundprojectswillnaturallyslowdownthespeedofeconomicdevelopmentwiththedecline,alltheseconstitutetheimplicitfiscalexpenditureSARScrisis,thisisnotasmallnumber.OnChina’sfiscalexpenditureonpublichealthsituationoftotalhealthexpenditureistheWHO(who)generalmeasureoftotalhealthinputs.Itincludesgovernmenthealthexpenditureandsocialhealthexpenditureandresidents’personalhealthexpenditureofthreeitems.Thegovernmenthealthexpenditurereferstothecentralandlocalgovernmentsatalllevelsofthehealthexpenditureintotalfunding,governmentfiscalhealthexpenditure.Inourcountry,theobjectofthefinancialexpenditureofpublichealthcoverageofmedicalhealthmanagementorganization(HealthBureau),thepublicmedicalinstitutions(hospitals,clinicsetc),publichealthandepidemicpreventioninstitutions(epidemicdisease,infectiousdisease,occupationdisease,endemicdiseaseandepidemicpreventionstationetc.),medicalresearchinstitutions(theMedicalCollegeofmedicalresearchhospital)andmedicalaidinemergencies(suchasearthquake,flood).Publichealthexpenditureincludehealthmanagementexpenses,publichealthagencystaffwagesandwelfareexpenditure,healthexpenditure,healthexpenditure,equipmentofscientificresearchinmedicaleducationexpenditure,preventionandhealthcareexpenditure,medicalemergencyspending(flooddisaster,earthquake,etc.).Fromtotalhealthexpenditureindexscaleandcomposition,thepasttenyears,theproportionofpublichealthexpenditureonthedecline.1991-2000ofthepasttenyears,China’stotalhealthexpenditurefromthetotalamountincreasingtrendyearbyyear.Nevertheless,fromtheperspectiveofinternationalcomparison,thepercapitahealthexpenditureinChinaranks141in191countriesintheworld,isstillalowlevel.Intotalhealthexpenditure,governmenthealthexpenditureamountisincreasingyearafteryear,increasedfrom20billion230millionyuanin1991to70billion950millionyuanin2000,butaccountedfortheproportionoftotalhealthexpendituredecreased,decreasedfrom22.8%in1991to14.9%.in2000residentspersonalhealthexpenditurehasamomentumofrapidgrowthinthepasttenyears,by1991totalhealthexpendituregrowthof38.3%in2000to60.6%.itcanbeseenthatthechangesofChina’stotalhealthexpendituredirectlyreflectsthehealthinsurancesystemreforminourcountry,namelytheplannedeconomyperiodthepublichealthsystemthoroughlybroken,ourresidentsbegantobecomeamajorburdenonthehealthexpenditureofpeople.However,theSARScrisisgivesusaproblem,althoughgovernmenthealthexpenditurewillnolongerbeaburden,butthegovernment’spublichealthexpenditureisenough?Fromthepublichealthserviceforthehealthexpenditureindex,theproportionintheexpendituredeclined:Thetotalamountoffundsforpublichealthservicesareincreasing,butitsproportioninthenationalfiscalexpenditurehasbeenfalling,downfrom2.36%in1996to1.71%.in2000whichreflectsfromonesideoftheannualgrowthrateandGDPgrowthofChina’spublichealthserviceexpenditureproportionisveryinconsistent,atleastnoconsistenttendency.Thisandtheinternationaleconomicdevelopmentandincreaseinvestmentinpublichealthpracticebequitedifferent.Aseriousshortageoffiscalexpenditureonpublichealth.Fromthisaspect,tohelpidentifypartofChina’spublichealthsystemoftheSARScrisisintheustobetakenbysurprisewhy.Fromhealthexpendituresituation,thepublichealthexpenditureinChinaisverysmallforpreventionandhealthcareandruralhealthorganizationproportionChina’shealthexpenditureinmedicalinstitutions,theinvestmentisthekeytoguaranteefund,althoughthetotalhealthexpenditurefrom1994to1997increasedyearbyyear,butthecountyhospitalsandabovetheexpenditureproportionoftotalexpenditure,ifthehospitalandthehospitaloftraditionalChinesemedicineandtheproportionofthesumof64.2%,city,countrysideareais56.5%;forthetownship(street)hospitalsintheproportion,cityof9.6%,23.8%inruralareasforpreventionandhealthcare;theproportionofthecitywas13.2%,rural15.6%.thatistosay,thegovernmenthealthexpenditureismainlyusedinmedicalinstitutions,especiallycountyhospitalsandabove,andismainlyforpersonnelexpenditurebut,forthehealthofruralgrassrootsandpreventionofbusinessexpensesisrelativelylow.Fromthepublichealthbenefits,ourcountryonlypaysattentiontothecommondiseasespreventioncontrolexpenditures,andlackofsystemanddealwiththesuddenepidemicpreventionabilityperfectdiseaseFromthepublichealthbenefits,whileChina’sfinancialinvestmentindiseasepreventionisfew,achievedgoodresultsthecauseofChina’sdiseasepreventionandhealthlevelofresidentsincreasedyearbyyear,infectiousdiseasemortalityratedecreasedyearbyyear,whichindicatestheefficiencyofhealthserviceinChinaisrelativelyhighinsomeextent.ThisseemstoberelatedtotheeffectofpreventingSARScrisisinvariousmediareportsinChinaisverydifferentfromthedifferenceofdisease.So,whereistheproblemintheend?Firstofall,thisyearChina’scauseofdiseasepreventioneffectisgood,isthepreventionoflong-termeffortssincethefoundingofnewChina,manydiseaseshavegoodpreventivevaccine,anditsincidencehasdeclinedinrecentyears.Secondly,theexistinglegaldiseasepreventionworkhastherighttrack,residentsintheimprovementofeconomicconditionsandthepurchaseofproductspreventioninputsincreased,andthenumberofinfectiousdiseaseoutbreaksinrecentyearsisrelativelylow,sotheannualinvestmentislowalsocanguaranteethehealthoftheresidents.Third,itisonthebasisofgoodresultsofcarelessnegligence,strengthenhealthandepidemicpreventionsystemconstructionandpreventionwork,whichmakesthenewSARSvirussorampant.ThisalsoexposedthedefectsofhealthandepidemicpreventionworkinChinaandtheweaknessofthecontinuousimprovementinthelevelofmedicaltreatmenttoday,healthandepidemicpreventioninfrastructureconstruction,preventionofmedicalequipmentandepidemicpreventionresearchworkhasnotbeenvigorouslydeveloping.And,inthepublichealthandepidemicpreventionsystem,weonlypayattentiontothepreventionofdiseaseshasbeensimple,lackofawarenessofnewepidemicandinfectiousdiseases,researchfornewdiseasesandemergencyabilityispoor,lackofemergencymechanism.Youcancometotheconclusionthat,intheprocessofmarketreform,ourcountryfinanceinpublichealthandepidemicpreventionsysteminthepositioninfacthasbeenweakened.So,forthefiscalexpenditureofpublichealth,weshouldmakeanewwayofthinking.AdjustthedirectionofpublichealthexpenditureinChina--identifythelocationofgovernmentinpublichealthconstruction,increasethepublichealthexpenditureproportionofthiscrisis,werealizethatgovernmentexpenditureshouldplayamoreimportantroleinthehealthofthepublicproductsandquasipublicproducts,torerecognizethefunctionsandproblemstheorientationofgovernmentintheprocessofmarketorientedreform.Inrelationtothequalityofthelaborforceandbeneficialtothepeople’slivelihoodofpublichealthproductsinthemarkettoprovidedefect,thegovernmentshouldplayaverygoodpublicsupportfunctions.So,forpublichealthproducts,financeshouldbethemostimportantinvestment.Inthenextbudgetexpenditure,thegovernmentshouldinrecentyearstherapidrevenuegrowthsituation,theuseoftaxrevenuegrowth,establishalegalguaranteestablesourceoffundsandsupervisionmechanism.-preventionandhealthcareexpenditureshouldincreasetheproportionofChina’smedicalsystemreformwascarriedoutinthemarketasthegoalin1990safterthefiscalexpenditureofpublichealth,tosolvethefiscalburden.Butatthesametime,themarketofmedicalsystemalsobringssomeproblems.Firstofall,thehospitalsystemshouldhavethemarketregulation,hasreceivedstrongsupportfromthegovernment(whichcanbeseenfromtheabovedata).Secondly,thelackoffinancialinvestmentinpublichealth,thegovernmentshouldsupportandshouldnotgotomarkettheepidemicpreventionsystemdidnotgetenoughfinancialsupport,thebasicpreventionandemergencymanagementinthestateoflong-termshortageoffunds.Third,theimpactofmarketchangesthepatternofincomedistribution,focusingongrassrootshealthandepidemicpreventionworktoallkindsofrevenuegeneratingservices,healthandepidemicpreventiondepartmentsatalllevelsofthepublichealthfacilitiestoprovidemarketingservicestoraisemoney,takethepaidservice,thiswillinevitablymakepublicbytheepidemicpreventionsystemconstructionsectorinterestsimpact,influencestrainthecapacityofhealthandepidemicpreventionsystemandemergencytreatmentofmajorepidemic.Thecrisis,weclearlyseeinthemarketeconomyintheprocessofgovernmentinvestmentabsenceandoffsidebehavior,andmanagementinpublichealthso,shouldadjustthegovernmentbehaviorandthestructureoffiscalexpenditure,increasegovernmentinvestmentinthecauseofdiseasepreventioninthepreventionwork,reasonablemanagement,constructionofthefirstlineofDefenseforresidentslivingandnationaldevelopment.-theproportionshouldberationalallocationofemergencymedicaleventspriorandpostinvestmentinvestment,increasetheproportionoffiscalexpenditurepreventionInthescopeofC