Carrin G, Ron A, Hui Y, Hong W, Tuohong Z, Licheng Z, Shuo Z, Yide Y, Jiaying C, Qicheng J, Zhaoyang Z, Jun Y, Xuesheng L
World Health Organization, Geneva, Switzerland.
Soc Sci Med. 1999 Apr;48(7):961-72.
During the 1960's and 1970's the Chinese government encouraged the 'rural cooperative medical systems' (RCMS), in order to ensure access to basic health care among the rural population. There was a break in the development of the RCMS in the early 1980's, as a consequence of market economic reforms. These reforms involved a shift from a communal to a household production system. As a result the collective way of financing rural health care was more or less abandoned. However, the government of the People's Republic of China was aware of the need to provide social protection against health care expenses. In March 1994 the government initiated a project to reestablish the RCMS. This project was implemented on a pilot basis in 14 counties of seven provinces. The reestablishment of the RCMS would be guided by the basic principles of health insurance. In October 1995, a first mid-term evaluation of the RCMS Project was held. One of the major research questions concerned the extent to which the RCMS had reduced the risk of paying health care bills that would otherwise be a burden on families. This article addresses this question and assesses the results obtained after two years of RCMS experimental work. A general finding is that the population structure by occupation and income varies, and that the RCMS has adapted itself to this variety. It is also confirmed that the burden of health care costs on families was reduced, more so in some counties than in others, but this reduction has been modest. The research results indicate that there is ample room for improvement. The outlook is hopeful, however. At the national level, there is now systematic thinking about RCMS. The current RCMS work is also having a considerable influence on other counties that are keen to reestablish the RCMS.
在20世纪60年代和70年代，中国政府鼓励发展“农村合作医疗制度”（RCMS），以确保农村人口能够获得基本医疗保健服务。由于市场经济改革，20世纪80年代初农村合作医疗制度的发展出现了中断。这些改革涉及从集体生产制度向家庭生产制度的转变。结果，农村医疗保健的集体筹资方式或多或少被放弃了。然而，中华人民共和国政府意识到有必要提供医疗费用的社会保护。1994年3月，政府启动了一个重建农村合作医疗制度的项目。该项目在7个省的14个县进行了试点实施。农村合作医疗制度的重建将以医疗保险的基本原则为指导。1995年10月，对农村合作医疗制度项目进行了首次中期评估。一个主要的研究问题是农村合作医疗制度在多大程度上降低了支付医疗费用的风险，否则这些费用将成为家庭的负担。本文探讨了这个问题，并评估了农村合作医疗制度两年实验工作后取得的成果。一个普遍的发现是，按职业和收入划分的人口结构各不相同，农村合作医疗制度已经适应了这种多样性。还证实，家庭医疗费用负担有所减轻，在一些县比在其他县减轻得更多，但这种减轻幅度不大。研究结果表明仍有很大的改进空间。不过，前景是乐观的。在国家层面，现在对农村合作医疗制度有了系统的思考。目前的农村合作医疗制度工作也对其他热衷于重建农村合作医疗制度的县产生了相当大的影响。
