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中国医改新进展

China's Health Reform Update.

机构信息

National School of Development, Peking University, Beijing 100871, China; email:

Department of Political Science, University of Wisconsin-Madison, Madison, Wisconsin 53706; email:

出版信息

Annu Rev Public Health. 2017 Mar 20;38:431-448. doi: 10.1146/annurev-publhealth-031816-044247. Epub 2017 Jan 11.

Abstract

China experienced both economic and epistemological transitions within the past few decades, greatly increasing demand for accessible and affordable health care. These shifts put significant pressure on the existing outdated, highly centralized bureaucratic system. Adjusting to growing demands, the government has pursued a new round of health reforms since the late 2000s; the main goals are to reform health care financing, essential drug policies, and public hospitals. Health care financing reform led to universal basic medical insurance, whereas the public hospital reform required more complex measures ranging from changes in regulatory, operational, and service delivery settings to personnel management. This article reviews these major policy changes and the literature-based evidence of the effects of reforms on cost, access, and quality of care. It then highlights the outlook for future reforms. We argue that a better understanding of the unintended consequences of reform policies and of how practitioners' and patients' interests can be better aligned is essential for reforms to succeed.

摘要

在过去几十年中,中国经历了经济和认识论的转变,对可及性和负担得起的医疗保健的需求大大增加。这些转变给现有的过时、高度集中的官僚体制带来了巨大的压力。为了适应不断增长的需求,政府自 21 世纪末以来推行了新一轮的卫生改革;主要目标是改革医疗保健融资、基本药物政策和公立医院。医疗保健融资改革导致了全民基本医疗保险,而公立医院改革则需要采取更复杂的措施,包括监管、运营和服务提供环境的改变以及人事管理。本文回顾了这些重大政策变化,并根据文献评估了改革对成本、可及性和医疗质量的影响。然后,本文突出了未来改革的前景。我们认为,为了改革取得成功,必须更好地了解改革政策的意外后果,以及如何更好地协调从业者和患者的利益。

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