2003 年至 2011 年中国卫生服务获取和财务保护的变化趋势：一项横断面研究。

Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study.

机构信息

Centre for Health Statistics Information, Ministry of Health, People's Republic of China.

出版信息

Lancet. 2012 Mar 3;379(9818):805-14. doi: 10.1016/S0140-6736(12)60278-5.

Abstract

BACKGROUND: In the past decade, the Government of China initiated health-care reforms to achieve universal access to health care by 2020. We assessed trends in health-care access and financial protection between 2003, and 2011, nationwide. METHODS: We used data from the 2003, 2008, and 2011 National Health Services Survey (NHSS), which used multistage stratified cluster sampling to select 94 of 2859 counties from China's 31 provinces and municipalities. The 2011 survey was done with a subset of the NHSS sampling frame to monitor key indicators after the national health-care reforms were announced in 2009. Three sets of indicators were chosen to measure trends in access to coverage, health-care activities, and financial protection. Data were disaggregated by urban or rural residence and by three geographical regions: east, central, and west, and by household income. We examined change in equity across and within regions. FINDINGS: The number of households interviewed was 57,023 in 2003, 56,456 in 2008, and 18,822 in 2011. Response rates were 98·3%, 95·0%, and 95·5%, respectively. The number of individuals interviewed was 193,689 in 2003, 177,501 in 2008, and 59,835 in 2011. Between 2003 and 2011, insurance coverage increased from 29·7% (57,526 of 193,689) to 95·7% (57,262 of 59,835, p<0·0001). The average share of inpatient costs reimbursed from insurance increased from 14·4 (13·7-15·1) in 2003 to 46·9 (44·7-49·1) in 2011 (p<0·0001). Hospital delivery rates averaged 95·8% (1219 of 1272) in 2011. Hospital admissions increased 2·5 times to 8·8% (5288 of 59,835, p<0·0001) in 2011 from 3·6% (6981 of 193,689) in 2003. 12·9% of households (2425 of 18,800) had catastrophic health expenses in 2011. Caesarean section rates increased from 19·2% (736 of 3835) to 36·3% (443 of 1221, p<0·0001) between 2003 and 2011. INTERPRETATION: Remarkable increases in insurance coverage and inpatient reimbursement were accompanied by increased use and coverage of health care. Important advances have been made in achieving equal access to services and insurance coverage across and within regions. However, these increases have not been accompanied by reductions in catastrophic health expenses. With the achievement of basic health-services coverage, future challenges include stronger risk protection, and greater efficiency and quality of care. FUNDING: None.

摘要

背景：在过去的十年中，中国政府启动了医疗改革，旨在到 2020 年实现全民健康覆盖。我们评估了 2003 年至 2011 年期间全国范围内医疗可及性和财务保护的趋势。

方法：我们使用了来自 2003、2008 和 2011 年国家卫生服务调查（NHSS）的数据，该调查采用多阶段分层聚类抽样方法从中国 31 个省、市、自治区中选取了 2859 个县中的 94 个县。2011 年的调查是使用 NHSS 抽样框架的一个子集进行的，以监测 2009 年宣布国家医疗改革后的关键指标。选择了三组指标来衡量覆盖范围、医疗活动和财务保护的趋势。数据按城乡和东、中、西部三个地理区域以及家庭收入进行了细分。我们检查了跨地区和地区内部的公平性变化。

结果：2003 年、2008 年和 2011 年接受采访的家庭数量分别为 57023 户、56456 户和 18822 户，响应率分别为 98.3%、95.0%和 95.5%。接受采访的个人数量分别为 193689 人、177501 人和 59835 人。2003 年至 2011 年期间，保险覆盖范围从 29.7%（193689 人中的 57526 人）增加到 95.7%（59835 人中的 57262 人，p<0.0001）。住院费用从保险中报销的平均份额从 2003 年的 14.4%（13.7-15.1）增加到 2011 年的 46.9%（44.7-49.1）（p<0.0001）。2011 年，医院分娩率平均为 95.8%（1219 例/1272 例）。2011 年，医院住院人数增加了 2.5 倍，从 2003 年的 3.6%（193689 人中的 6981 人）增加到 8.8%（59835 人中的 5288 人，p<0.0001）。2011 年，有 12.9%（18800 户中的 2425 户）的家庭发生了灾难性的医疗支出。剖宫产率从 2003 年的 19.2%（3835 例中的 736 例）增加到 2011 年的 36.3%（1221 例中的 443 例，p<0.0001）。

结论：保险覆盖范围和住院报销的显著增加伴随着医疗保健使用和覆盖范围的增加。在实现服务和保险覆盖的区域内和区域间公平方面取得了重要进展。然而，这些增长并未伴随着灾难性医疗费用的减少。随着基本医疗服务覆盖范围的实现，未来的挑战包括加强风险保护以及提高护理的效率和质量。

资金来源：无。