Controlling cost escalation of healthcare: making universal health coverage sustainable in China.
Controlling cost escalation of healthcare: making universal health coverage sustainable in China.
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DOI：
10.1186/1471-2458-12-s1-s8
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发表时间：
2012
影响因子：
4.5
通讯作者：
Bekedam H
中科院分区：
文献类型：
--
作者：
Tang S;Tao J;Bekedam H
在过去十年中，越来越多的中低收入国家制定并实施了全民医保国家政策。其中包括中国，其健康保险覆盖率已从2003年的约29.7%扩大到2010年底的90%以上。虽然中国中央和地方政府都大幅增加了对两项新建立的医疗保险计划的财政投入：针对农村人口的新型合作医疗计划（NCMS）和城镇居民基本医疗保险（URBMI），但中国的医疗费用在过去二十年中也以每年17.0%的速度快速增长。卫生总费用从1990年的747亿元增加到2010年的1998亿元，人均卫生费用从1990年的65.4元增加到2010年的1490.1元。政府支持的医疗保险计划的人口覆盖率的增加刺激了医疗保健的使用，从而增加了中国成本控制的压力。在医疗卫生领域，有许多有效的供给侧和需求侧成本控制措施。在过去三十年中，中国通过一系列共同支付机制，采取了许多措施来控制对保健的需求。本文介绍和讨论了中国为控制医疗费用上涨而采取的新举措和措施，包括替代提供者支付方式、改革药品采购制度和加强标准临床路径在医院治疗患者中的应用，并分析了这些举措和措施的影响。最后，本文提出了使中国全民健康覆盖更具可持续性的前进方向。
An increasingly number of low- and middle-income countries have developed and implemented a national policy towards universal coverage of healthcare for their citizens over the past decade. Among them is China which has expanded its population coverage by health insurance from around 29.7% in 2003 to over 90% at the end of 2010. While both central and local governments in China have significantly increased financial inputs into the two newly established health insurance schemes: new cooperative medical scheme (NCMS) for the rural population, and urban resident basic health insurance (URBMI), the cost of healthcare in China has also been rising rapidly at the annual rate of 17.0%% over the period of the past two decades years. The total health expenditure increased from 74.7 billion Chinese yuan in 1990 to 1998 billion Chinese yuan in 2010, while average health expenditure per capital reached the level of 1490.1 Chinese yuan per person in 2010, rising from 65.4 Chinese yuan per person in 1990. The repaid increased population coverage by government supported health insurance schemes has stimulated a rising use of healthcare, and thus given rise to more pressure on cost control in China. There are many effective measures of supply-side and demand-side cost control in healthcare available. Over the past three decades China had introduced many measures to control demand for health care, via a series of co-payment mechanisms. The paper introduces and discusses new initiatives and measures employed to control cost escalation of healthcare in China, including alternative provider payment methods, reforming drug procurement systems, and strengthening the application of standard clinical paths in treating patients at hospitals, and analyses the impacts of these initiatives and measures. The paper finally proposes ways forward to make universal health coverage in China more sustainable.