THE CHINESE HEALTH-CARE SYSTEM - LESSONS FOR OTHER NATIONS
THE CHINESE HEALTH-CARE SYSTEM - LESSONS FOR OTHER NATIONS
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DOI：
10.1016/0277-9536(94)00421-o
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发表时间：
1995-10-01
影响因子：
5.4
通讯作者：
HSIAO, WCL
中科院分区：
文献类型：
--
作者：
HSIAO, WCL
本文从系统的角度审视了中国的医疗保健，并得出了一些可供欠发达国家借鉴的经验。十年前，中国的宏观卫生政策将其医疗保健融资和提供转向自由市场体系。它鼓励各级保健设施依靠用户付费来支持其业务。然而，中国继续实行价格管制，医院继续由政府经营。这些筹资、定价和组织政策没有得到协调。作者发现，这些不协调的政策造成了系统的严重失调。不合理的价格扭曲了医疗实践，导致过度使用药物和高科技测试。以市场为基础的融资造成了富人和穷人之间在获得保健方面的更不平等。医院的公共控制和管理不善造成了效率低下、浪费和护理质量低下。然而，中国卫生系统的混乱并没有使中国人民的健康状况明显下降。一种解释是，政府保持了公共卫生和预防的资金水平（人均）。另一个可能的解释是，中国收入的迅速增加改善了营养、清洁用水和教育，抵消了医疗服务较差对低收入人口的不利影响。尽管如此，中国的经验表明，通过使用费和保险增加的人均保健支出并没有使健康状况得到相应的改善。中国的经验对欠发达国家有几个教训。首先，医疗保健的融资、价格和组织之间存在密切联系。不协调的政策可能会加剧医疗保健的不公平和效率低下。第二，激励因素对医院和医生使用何种药物和医疗方式治疗患者的行为有很大影响。价格必须合理化，医院和保健中心必须实行现代化管理，以提供更优质的保健服务，提高效率。最后，中国表明，少量支出（美元）公共卫生人均支出为0.21美元，可以为人民带来巨大利益。
This paper examines China's health care from a system perspective and draws some lessons for less developed nations. A decade ago, Chinese macro-health policy shifted its health care financing and delivery toward a free market system. It encouraged all levels of health facilities to rely on user fees to support their operations. However, China continued its administered prices and hospitals continued to be operated by the government. These financing, pricing and organizational policies were not coordinated. The author found these uncoordinated policies created serious dissonance in the system. Irrational prices distorted medical practices which resulted in overuse of drugs and high technology tests. Market-based financing created more unequal access to health care between the rich and poor. Public control of hospitals and poor management caused inefficiency, waste and poor quality of care. The disarray of the Chinese health system, however, had not caused a measurable decline in health status of the Chinese people. One explanation was that the government had maintained its level of funding (per capita) for public health and prevention. Another possible explanation was that rapid rising income in China had improved nutrition, clean water and education which offset any adverse impacts of poorer medical services to the low-income populations. Nonetheless, the Chinese experience showed that its increasing expenditure per person for health care through user fees and insurance had not produced commensurate improvement in health status. China's experience holds several lessons for less developed nations. First, there is a close linkage between financing, price and organization of health care. Uncoordinated policies could exacerbate inequity and inefficiency in health care. Second, incentives had great influence on the hospitals' and physicians' behaviors one what drugs and medical modalities were used to treat patients. Prices have to be rationalized and modern management of hospitals and health centers has to be instituted to produce better quality health services and improve efficiency. Finally, China showed that a small amount of spending (U.S.$0.21) per person spent for public health can yield large benefits for the people.