The cost of coverage: Rural health insurance in China
The cost of coverage: Rural health insurance in China
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DOI：
10.1093/heapol/11.3.238
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发表时间：
1996-09-01
影响因子：
3.2
通讯作者：
Diwan, V
中科院分区：
文献类型：
--
作者：
Bogg, L;Dong, HJ;Diwan, V
自1978年以来，中国经历了巨大的经济和社会变革，对医疗保健系统产生了深远的影响，并最终影响到人口的健康状况。八十年代的中国医疗改革，把收回成本作为首要目标。城市人口大多受到慷慨的政府医疗保险的保护。政府预算的很大一部分用于城市保健。农村合作医疗保险在20世纪70年代中期达到顶峰，当时覆盖了90%的农村人口。在20世纪80年代，农村合作医疗保险崩溃，目前的覆盖率不到8%。与此同时，有报告称，在保健筹资和获得保健方面的公平问题日益严重。这篇文章是为期四年的关于中国医疗保健融资变化对公平性影响的研究中的第一篇。本文采用自然实验设计，以一个“孪生县”为对照，考察了农村合作医疗保险作为解释变量，医疗费用、治疗与预防费用、三级医疗费用作为因变量之间的关系。研究结果支持了合作医疗保险将促进医疗支出增长的假设，也支持了合作医疗保险将促进预防医学向治疗医学的转变以及三级医疗支出水平的提高的假设。来自中国县域的经验证据与世界银行的卫生筹资政策相矛盾。
China has undergone great economic and social change since 1978 with far reaching implications for the health care system and ultimately for the health status of the population. The Chinese Medical Reform of the 1980s made cost recovery a primary objective. The urban population is mostly protected by generous government health insurance. A high share government budget is allocated to urban health care. Rural cooperative health insurance reached a peak in the mid-1970s when 90% of the rural population were covered. In the 1980s rural cooperative health insurance collapsed and present coverage is less than 8%. The decline has been accompanied by reports of growing equity problems in the financing of and access to health care. This article is the first in a four-year study of the impact on equity of the changes in Chinese health care financing. The article examines the relationship between rural cooperative health insurance as the explanatory variable and health care expenditure, curative vs. preventive expenditure and tertiary curative care expenditure as dependent variables using a natural experimental design with a 'twin' county as a control. The findings support the hypothesis that cooperative health insurance will induce higher growth of health care expenditure.The findings also support the hypothesis that cooperative health insurance will lead to a shift from preventive medicine to curative medicine and to a higher level of tertiary curative care expenditure. The empirical evidence from the Chinese counties is contradicting World Bank health financing policies.