Health System Reform in China 7 China's health system performance
Health System Reform in China 7 China's health system performance
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DOI：
10.1016/s0140-6736(08)61362-8
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发表时间：
2008-11-01
期刊：
影响因子：
168.9
通讯作者：
Gakidou, Emmanuela
中科院分区：
文献类型：
--
作者：
Liu, Yuanli;Rao, Keqin;Gakidou, Emmanuela
我们建立了一套全面的中国国家和地区卫生系统绩效衡量指标，卫生系统覆盖率和灾难性医疗支出是主要指标。在提供保健服务方面，中国在提供妇幼保健服务方面做得很好，但在应对非传染性疾病方面做得很差。例如，农村地区妇女住院分娩的覆盖率从1993年的20%提高到2003年的62%。然而，2004年，高血压治疗的有效覆盖率在城市地区仅为12%，在农村地区为7%。关于保健筹资情况，2003年，14%的城市家庭和16%的农村家庭承担了巨额医疗支出。此外，15%的城市居民和22%的农村居民在获得医疗保健方面有负担能力方面的困难。尽管1993年至2003年期间城市和农村地区的保健系统覆盖率都有所提高，但农村地区负担能力的困难却更加严重。此外，在卫生系统覆盖率和医疗保健负担能力方面，区域间和区域内存在着实质性的不平等。低收入人群不仅比高收入人群获得更低的医疗系统覆盖率，而且患病时不寻求医疗保健或遭受灾难性医疗支出的可能性也更大。中国目前的卫生系统改革工作需要评估其效果绩效指标，这方面存在大量数据缺口。
We created a comprehensive set of health-system performance measurements for China nationally and regionally, health-system coverage and catastrophic medical spending as major indicators. With respect to performance of health-care delivery, China has done well in provision of maternal and child health services, but poorly in addressing non-communicable diseases. For example, coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas. However, effective coverage of hypertension treatment was only 12% for patients living in urban areas and 7% for those in rural areas in 2004. With respect to performance of health-care financing, 14% of urban and 16% of rural households incurred catastrophic medical expenditure in 2003. Furthermore, 15% of urban and 22% of rural residents had affordability difficulties when accessing health care. Although health-system coverage improved for both urban and rural areas from 1993 to 2003, affordability difficulties had worsened in rural areas. Additionally, substanfial inter-regional and intra-regional inequalities in health-system coverage and healthcare affordability measures exist. People with low income not only receive lower health-system coverage than those with high income, but also have an increased probability of either not seeking health care when ill or undergoing catastrophic medical spending. China's current health-system reform efforts need to be assessed for their effect performance indicators, for which substantial data gaps exist.