连续保健视角下出生缺陷综合防治的筹资策略研究

After the successful achievement of MDG 4, birth defects have become the prioritized public health problem for maternal and child health in China. The current health finance system is fragmented for the comprehensive prevention and treatment of birth defects, which undermines universal coverage of the continuum of maternal and child health care in China. Due to the lack of population based birth defects surveillance system, little basic facts is known about the finance of its interventions, which limits policy research and development. Based on the population based birth defects surveillance system in Beijing, in this project firstly we will systematically measure the demand and efficacies for various birth defects interventions. Secondly we will use Markov Chain Monte Carlo simulation technique to simulate the fertility population. By setting different allocation and reimbursement arrangement, we will simulate the fees, effects and benefits of various finance designs, with the results adjusted by regional disease spectrums. Using the simulation results we then set various finance strategies like "social insurance", "basic public health package plus disease insurance", with which we will do both demand side investigation and policy maker consultation. Finally with these qualitative evidences available, we will do SWOT analysis and stakeholder analysis to explore the feasibility of various integrated finance strategies for further policy researches.

成功实现联合国千年发展目标儿童死亡相关目标后，出生缺陷已凸显为我国亟需优先干预的重大公共卫生问题。目前我国碎片化的出生缺陷干预筹资体系是实现三级预防全面覆盖的重要瓶颈。因缺乏以人群为基础的监测系统提供信息支撑，国内关于出生缺陷防治筹资的基础性研究尚比较匮乏，极大限制了相关政策的研发。本研究将基于北京城乡两区以人群为基础的出生缺陷监测系统展开。首先通过回顾性调查和一比二配对的病例对照研究，系统地测量出生缺陷各级预防服务需求及人群干预效能。然后建立马尔可夫链式反应模型进行生育人群队列的蒙特卡罗模拟，通过设定不同资金配置方案和补偿方案动态预测各种筹资设计的费率和效果、效益，并按地区疾病谱作敏感度分析。最后根据模拟结果设定"社会保险"、"基本公共卫生包+医保"等不同筹资方案开展人群需求调查和政策制定者研讨，利用利益相关者分析和SWOT分析初步探索各种整合筹资策略的可行性，为进一步政策研究打下基础。

在成功实现联合国千年发展目标中增进儿童健康相关目标后，出生缺陷已凸显为我国需优先干预的重大公共卫生问题。目前我国出生缺陷干预的筹资政策亟需优化，碎片化的筹资体系是实现三级预防干预措施全面覆盖的制度瓶颈。但国内关于出生缺陷综合防治筹资的基础性研究尚比较匮乏，极大地限制了相关政策的研究和开发。本项目基于北京市以人群为基础的出生缺陷监测信息系统设计研究方案。以怀柔区2007-2012年全部出生缺陷儿家庭为研究对象，按照一比二配对的病例对照研究设计进行回顾性追踪调查，系统地测量出生缺陷各级预防服务需求、人群干预效能和经济负担。构建政策分析模型，输入相关参数进行微观模拟分析。通过设定不同资金配置方案和补偿方案，动态预测各种筹资设计的成本和效果、效益。经过三年的项目执行，目前已经完成了全部基础信息的采集，包括怀柔区出生缺陷儿和对照组家庭的问卷调查，以及北京市106家出生缺陷筛查和诊断机构的信息采集。同时，已经初步建立起了育龄人群出生缺陷三级预防干预的微观模拟分析模型。该研究的科学意义在于可以量化出产前筛查与诊断服务的成本及其在预防出生缺陷中的社会经济效益，为完善出生缺陷筛查和诊断服务体系提供关键的基础数据。标注本项目基金号已发表（含接收）中英文论文17篇。另外，在该项目资助下，项目负责人进一步获得了国家自然科学基金优秀青年科学基金的资助，课题组5名硕士研究生和2名本科生均有论文发表。