Xin Haichang
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham , Birmingham, Alabama.
Popul Health Manag. 2016 Aug;19(4):291-7. doi: 10.1089/pop.2015.0086. Epub 2015 Nov 13.
Health care systems often face competing goals and priorities, which make reforms challenging. This study analyzed factors influencing the success of a health care system based on urban health insurance reform evolution in China, and offers recommendations for improvement. Findings based on health insurance reform strategies and mechanisms that did or did not work can effectively inform improvement of health insurance system design and practice, and overall health care system performance, including equity, efficiency, effectiveness, cost, finance, access, and coverage, both in China and other countries. This study is the first to use historical comparison to examine the success and failure of China's health care system over time before and after the economic reform in the 1980s. This study is also among the first to analyze the determinants of Chinese health system effectiveness by relating its performance to both technical reasons within the health system and underlying nontechnical characteristics outside the health system, including socioeconomics, politics, culture, values, and beliefs. In conclusion, a health insurance system is successful when it fits its social environment, economic framework, and cultural context, which translates to congruent health care policies, strategies, organization, and delivery. No health system can survive without its deeply rooted socioeconomic environment and cultural context. That is why one society should be cautious not to radically switch from a successful model to an entirely different one over time. There is no perfect health system model suitable for every population-only appropriate ones for specific nations and specific populations at the right place and right time. (Population Health Management 2016;19:291-297).
医疗保健系统常常面临相互竞争的目标和优先事项，这使得改革颇具挑战性。本研究基于中国城市医疗保险改革的演变，分析了影响医疗保健系统成功的因素，并提出了改进建议。基于医疗保险改革策略和机制成败的研究结果，能够有效地为医疗保险系统设计与实践以及整体医疗保健系统绩效（包括公平性、效率、有效性、成本、财务、可及性和覆盖范围）的改进提供参考，无论是在中国还是其他国家。本研究首次运用历史比较法，考察了20世纪80年代经济改革前后中国医疗保健系统随时间推移的成败。本研究也是首批通过将中国医疗系统绩效与医疗系统内部的技术因素以及医疗系统外部的潜在非技术特征（包括社会经济、政治、文化、价值观和信仰）相关联，来分析中国医疗系统有效性决定因素的研究之一。总之，当医疗保险系统与社会环境、经济框架和文化背景相契合时，它就是成功的，这意味着医疗保健政策、策略、组织和提供方式是一致的。没有深深扎根于其中的社会经济环境和文化背景，任何医疗系统都无法生存。这就是为什么一个社会应该谨慎行事，避免随着时间的推移从一个成功的模式彻底转向一个截然不同的模式。不存在适用于所有人的完美医疗系统模式——只有在合适的时间和地点，适用于特定国家和特定人群的恰当模式。（《人口健康管理》2016年；第19卷：第291 - 297页）
