China's health care reform: A tentative assessment
China's health care reform: A tentative assessment
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DOI：
10.1016/j.chieco.2009.08.003
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发表时间：
2009-12-01
影响因子：
6.8
通讯作者：
Hsiao, William
中科院分区：
文献类型：
--
作者：
Yip, Winnie;Hsiao, William
中国最近公布了一项雄心勃勃的新医疗改革计划，包括将政府医疗支出增加一倍，以及一些具体的改革。虽然计划的细节尚未完全公布，但我们对改革可能在多大程度上实现其宣称的目标--确保每个公民平等获得负担得起的基本医疗保健--进行了初步评估。这项改革基于三个基本原则：政府在健康方面发挥强大作用，致力于公平，以及愿意试验受监管的市场方法。在这一框架内，改革对卫生系统进行了一些值得称赞的改革，包括增加公共卫生筹资、扩大初级卫生设施和所有增加补贴以实现全民保险覆盖。然而，它未能解决困扰中国医疗体系的浪费和低效的根本原因。例如，分散的交付系统和供应商过度提供昂贵测试和服务的激励。我们的结论是，中国应该考虑将服务提供商的支付方式从按服务收费改为按业绩付费或按人头付费等预期支付方式，并发展代表人群利益的采购代理机构，以增强竞争。(C)2009 Elsevier Inc.保留所有权利。
China has recently unveiled ail ambitious new health-care reform plan, entailing a doubling of government health spending as well as a number of concrete reforms. While the details of the plan have not yet been completely announced, we offer a preliminary assessment of how well the reform is likely to achieve its stated goal of assuring every citizen equal access to affordable basic health care. The reform is based on three fundamental tenets: strong role of government in health, commitment to equity, and willingness to experiment with regulated market approaches. Within this framework, the reform offers a number Of laudable changes to the health system, including an increase in public health financing, an expansion of primary health facilities and ail increase in subsidies to achieve universal insurance coverage. However, it fails to address the root causes of the wastes and inefficiencies plaguing China's healthcare system. such as a fragmented delivery system and provider incentives to over-provide expensive tests and services. We Conclude that China should consider changing the provider payment method from fee-for-service to a prospective payment method such as DRG or capitation with pay-for-performance, and to develop purchasing agencies that represent the interests of the population so as to enhance competition. (C) 2009 Elsevier Inc. All rights reserved.