目的 分析美国医学院校收入及结构与卫生支出的关系,为我国建立稳定的医学教育经费投入保障机制提供依据。方法 采用美国医学院校协会(Association of American Medical Colleges,AAMC)官方网站公布的1980年至2017年的美国医学院校收入数据,与美国医疗保险与医疗补助中心(Centers for Medicare and Medicaid Services,CMS)发布的1980年至2017年的美国卫生支出数据,分析美国医学院校收入和美国卫生支出近40年的变化趋势,并分析两者及其内部结构之间的关系。结果 美国卫生总支出每年约3万亿美元,美国医学院校总收入每年约1 000亿美元;1980至2017年美国医学院校收入中医疗服务收入与美国个人卫生保健支出的比值均值为2.2%(40.49/1 879.93);医学院校的联邦政府科研经费收入与卫生投资支出的比值均值为11.1%(13.6/122.43);美国医学院校总收入与美国卫生总支出的比值均值为3.4%(74.94/2 227.68)。结论 借鉴美国经验,我国政府可以拓宽我国医学教育经费筹措渠道,适当扩大我国卫生总支出中科研经费的投入,可考虑结合国家卫生总支出构建医学教育经费保障机制。

Objective To analyze the quantitative relationship between the medical school revenues and health expenditures,including the internal structures of them,and provide evidence to establish a stable guarantee mechanism for medical education funding in China. Methods Based on the data of all accredited American medical schools released by the Association of American Medical Colleges(AAMC),and the health expenditure data released with the Centers for Medicare and Medicaid Services(CMS) from 1980 to 2017,this study has analyzed the changes and relationship in the revenue structure of the U.S. medical schools and the health expenditure structure in the past nearly 40 years. Results Compared with the total annual health expenditure of US $ 3 trillion,the annual revenue of medical schools in the United States is about 100 billion US dollars.From 1980 to 2017 in medical schools in the United States,the average ratio of medical service revenue to personal health care expenditure was 2.2%(40.49/1879.93);the average ratio of federal scientific research funding income and health investment expenditure was 11.1%(13.6/122.43);the average ratio of total school revenues to total health expenditure is 3.4%(74.94/2 227.68). Conclusions Drawing on the experience of the United States,the government can broaden the funding channels for medical education and expand research funding in China's total health expenditure.Therefore we can establish a stable guarantee mechanism for medical education funding in China.