Health equity in transition from planned to market economy in China
Health equity in transition from planned to market economy in China
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DOI：
10.1093/heapol/17.suppl_1.20
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发表时间：
2002-12-01
影响因子：
3.2
通讯作者：
Blas, E
中科院分区：
文献类型：
--
作者：
Gao, J;Qian, JC;Blas, E
本文考察了20世纪90年代经济转型和卫生部门改革对中国城乡居民健康公平性的影响。自1980年以来，中国经历了经济的快速发展和社会的根本转型。三个次要数据来源被用作分析和讨论的基础：来自国家死亡通知系统的死亡率数据;来自国家妇幼健康监测系统的婴儿死亡率;以及来自国家卫生住户访谈调查的发病率、卫生保健利用和筹资数据。分析显示了一个非常复杂的情况：城市和农村人口的总体死亡率都在下降，但城市和农村之间的差距在扩大;婴儿死亡率下降，城乡差距在缩小;城市和农村人口的保健需求都在下降，但城市地区的速度更快;城市和农村地区的保健服务支付额都在增加，而与此同时，健康保险覆盖面却在减少。分析表明，尽管人口的健康状况总体上有所改善，但经济和卫生系统政策改革正在导致卫生保健方面的不平等现象加剧。与1993年相比，1998年城市和农村地区收入最低的五分之一人口得到的保健服务少于他们的需求，城乡差距，特别是在接受住院保健服务方面，正在明显扩大。医疗保险制度的改革，加上保健价格的市场确定，对所有人口群体，特别是低收入阶层和农村人口产生了深远的影响。1993年至1998年期间，不得不自己承担不断增加的医疗费用的城市人口比例翻了一番。
This paper examines the impact of economic transition and health sector reform on health equities in the urban and rural populations of China in the 1990s. Since 1980, China has experienced a rapid economic development and fundamental transformation of its society. Three secondary data sources were used as the basis for the analysis and discussion: mortality data from the National Death Notification System; infant mortality from the National Maternal and Child Health Surveillance System; and morbidity, health care utilization and financing data from the National Health Household Interview Surveys. The analysis revealed a very complex picture with: general mortality rates decreasing in both urban and rural populations, but the differences between urban and rural increasing; declining infant mortality rates with narrowing of the urban-rural gap; health care needs declining in both urban and rural populations, but more rapidly in the urban areas; health service payments increasing in both urban and rural areas, while, at the same time, health insurance coverage decreased. The analysis suggests that despite overall improvements in the population's health status, the economic and health system policy reforms are leading to increased inequities in health care. The lowest income quintiles in both urban and rural areas are receiving less health care compared with their needs in 1998 than in 1993, and the urban-rural divide, in particular with regard to receiving inpatient health care, is widening appreciably. The reform of the health insurance system, combined with the market setting of prices for care, have had profound implications for all population groups, in particular the lower income segments and the rural populations. During the period 1993-98 the proportion of the urban population that had to cover the increasing cost of medical care themselves doubled.