Gu X Y, Tang S L, Cao S H
School of Public Health of Shanghai Medical University, China.
Int J Health Plann Manage. 1995 Oct-Dec;10(4):265-82. doi: 10.1002/hpm.4740100404.
The socio-economic reforms launched in China in the late 1970s led to rapid economic growth and, with it, health sector resources expanded rapidly. The rural health services have benefited from the policies of economic reform, but not in an optimal way, particularly in poor areas. This article uses a case study of a poor county--Donglan--to illustrate that the fiscal decentralization combined with the financial responsibility system have resulted in a weakening of financing and provision of rural health services in poor areas. The need for health facilities to generate revenue has had unfortunate consequences for the style of medical care, such as over-prescription. In addition, the collapse of the cooperative medical system and the weakening of the three-tier network of rural health care in Donglan have jeopardized preventive programs and threaten access to basic health care for the peasants, especially the poor. The study found evidence that preventive programs have deteriorated over the past years, the poor had financial difficulty in access to services, particularly hospital care, health facilities at township and village levels have been run down, and less training and supervision have been provided by upper-level health facilities. The article concludes with recommendations for a strategy for rebuilding and strengthening the three-tier network of rural health care, and for establishing a cooperative medical and health care scheme to ensure that the majority of peasants in Donglan can be guaranteed access to basic health services. Limited health resources will therefore be better used.
中国20世纪70年代末启动的社会经济改革带来了经济的快速增长，与此同时，卫生部门的资源也迅速扩张。农村卫生服务从经济改革政策中受益，但受益方式并不理想，在贫困地区尤其如此。本文以一个贫困县——东兰县为例，说明财政分权与财政责任制度导致了贫困地区农村卫生服务筹资和供给的弱化。卫生机构创收的需求给医疗服务方式带来了不良后果，如过度开药。此外，东兰县合作医疗制度的瓦解以及农村三级医疗保健网的弱化危及了预防项目，并威胁到农民，尤其是贫困农民获得基本医疗保健的机会。研究发现，有证据表明，过去几年预防项目已经恶化，穷人在获得服务，尤其是住院治疗方面存在经济困难，乡镇和村级卫生机构破败不堪，上级卫生机构提供的培训和监督也较少。文章最后提出了重建和加强农村三级医疗保健网的战略建议，以及建立合作医疗保健计划的建议，以确保东兰县的大多数农民能够获得基本卫生服务，从而使有限的卫生资源得到更好利用。
