Huong Dang Boi, Phuong Nguyen Khanh, Bales Sarah, Jiaying Chen, Lucas Henry, Segall Malcolm
Institute of Development Studies, University of Sussex, Brighton, United Kingdom.
Int J Health Serv. 2007;37(3):555-72. doi: 10.2190/H0L2-8004-6182-6826.
China and Vietnam have adopted market reforms in the health sector in the context of market economic reforms. Vietnam has developed a large private health sector, while in China commercialization has occurred mainly in the formal public sector, where user fees are now the main source of facility finance. As a result, the integrity of China's planned health service has been disrupted, especially in poor rural areas. In Vietnam the government has been an important financer of public health facilities and the pre-reform health service is largely intact, although user fees finance an increasing share of facility expenditure. Over-servicing of patients to generate revenue occurs in both countries, but more seriously in China. In both countries government health expenditure has declined as a share of total health expenditure and total government expenditure, while out-of-pocket health spending has become the main form of health finance. This has particularly affected the rural poor, deterring them from accessing health care. Assistance for the poor to meet public-sector user fees is more beneficial and widespread in Vietnam than China. China is now criticizing the degree of commercialization of its health system and considers its health reforms "basically unsuccessful." Market reforms that stimulate growth in the economy are not appropriate to reform of social sectors such as health.
在中国和越南的市场经济改革背景下，两国在医疗卫生领域都推行了市场化改革。越南发展起了庞大的民营医疗卫生部门，而在中国，商业化主要发生在正规的公共部门，目前使用者付费是医疗机构资金的主要来源。结果，中国计划卫生服务的完整性遭到破坏，在贫困农村地区尤为如此。在越南，政府一直是公共卫生设施的重要资助者，改革前的卫生服务在很大程度上得以保留，尽管使用者付费在医疗机构支出中所占份额不断增加。两国都存在为创收而过度服务患者的现象，但在中国更为严重。两国政府卫生支出占卫生总支出和政府总支出的份额均有所下降，而自付医疗费用已成为卫生筹资的主要形式。这尤其影响到农村贫困人口，使他们难以获得医疗保健服务。在越南，为穷人支付公共部门使用者费用提供的援助比中国更具成效且更为普遍。中国目前正在批评其卫生系统的商业化程度，并认为其卫生改革“基本不成功”。刺激经济增长的市场化改革并不适用于卫生等社会部门的改革。
