Liu Yuanli
Harvard School of Public Health, Boston, MA, USA.
Health Policy Plan. 2004 May;19(3):159-65. doi: 10.1093/heapol/czh019.
Ever since the collapse of the once successful Rural Cooperative Medical System (RCMS) in the early 1980s, when China transformed its system of collective agricultural production to private production, many rural communities, especially the poorer residents, have faced several major problems. In 1993, insurance coverage for rural residents was already low, at 12.8%. By 1998, only 9.5% of the rural population was insured. User charges have effectively blocked access for many rural residents who lack adequate income to purchase basic health care when needed. Impoverishment due to medical expenses is also a serious problem, which begs the question: why has there been no vigorous development of the rural health insurance system in China despite the country's rapid economic growth? This paper analyzes the major underlying reasons for the lack of rural health insurance in China. We found that lack of demand for the voluntary community financing schemes and inadequate government policies are the two major hindrances. Recently, the Chinese government announced a new rural health financing policy that relies on 'matching-funds' by the central and local governments as well as household contributions. The potential for success of this new model might be inferred from China's past experiences, as well as from the pilot projects that are underway.
自20世纪80年代初曾经成功的农村合作医疗体系瓦解以来，当时中国将集体农业生产体系转变为私人生产，许多农村社区，尤其是较贫困居民，面临着几个主要问题。1993年，农村居民的保险覆盖率已经很低，为12.8%。到1998年，只有9.5%的农村人口参保。使用者付费实际上阻碍了许多收入不足的农村居民在需要时购买基本医疗保健服务。因医疗费用致贫也是一个严重问题，这就引出了一个问题：尽管中国经济快速增长，但农村医疗保险体系为何没有蓬勃发展？本文分析了中国农村医疗保险缺失的主要潜在原因。我们发现，对自愿性社区筹资计划缺乏需求以及政府政策不足是两大障碍。最近，中国政府宣布了一项新的农村医疗筹资政策，该政策依赖中央和地方政府的“配套资金”以及家庭缴费。这种新模式的成功潜力可以从中国过去的经验以及正在进行的试点项目中推断出来。
