Development and status of health insurance systems in China
Development and status of health insurance systems in China
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DOI：
10.1002/hpm.1109
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发表时间：
2011-10-01
影响因子：
2.7
通讯作者：
Yao, Lan
中科院分区：
文献类型：
--
作者：
Barber, Sarah L.;Yao, Lan
随着时间的推移，中国的医疗保险计划发生了迅速变化。在农村人口中，保险覆盖率从20世纪70年代的几乎普及水平上升到1999年的7%; 2009年达到94%的县。这一大幅增长是一系列医疗改革的结果，这些改革旨在实现普遍获得医疗保健和更好的风险保护，主要是通过推出医疗保险计划以及随着时间的推移逐步增加补贴和福利。本文介绍了2009年底农村和城镇医疗保险项目的发展、筹资和运营模式以及福利和报销方案。我们讨论了农村和城市居民计划的一些问题，包括对地方政府能力的依赖，报销上限和费率，以及在计划设计中对不必要的护理和浪费的激励。建议包括增加财政支助和深化一揽子惠益。控制成本和提高质量的战略包括发展混合提供者支付机制，执行基本药物政策和加强初级保健服务的质量。版权所有（c）2011约翰威利父子有限公司
Health insurance programs have changed rapidly over time in China. Among rural populations, insurance coverage shifted from nearly universal levels in the 1970s to 7% in 1999; it stands at 94% of counties in 2009. This large increase is the result of a series of health reforms that aim to achieve universal access to healthcare and better risk protection, largely through the rollout of the health insurance programs and the gradual increase in subsidies and benefits over time. In this paper, we present the development of the rural and urban health insurance programs, their modes of financing and operation and the benefits and reimbursement schemes at the end of 2009. We discuss some of the problems with the rural and urban residents' schemes including reliance on local government capacity, reimbursement ceilings and rates, and incentives for unnecessary care and waste in the design of the programs. Recommendations include increasing financial support and deepening the benefits packages. Strategies to control cost and improve quality include developing mixed provider payment mechanisms, implementing essential medicines policies and strengthening the quality of primary-care provision. Copyright (c) 2011 John Wiley & Sons, Ltd.