Henderson G E, Cohen M S
Am J Public Health. 1982 Nov;72(11):1238-45. doi: 10.2105/ajph.72.11.1238.
During a three-month period, all admissions to an infectious disease ward at a tertiary care hospital in the People's Republic of China were studied. The hospital's catchment area covered a population of almost eight million, 10 per cent urban and 90 per cent rural. Seventy-two per cent of the patients admitted to this facility were city dwellers with illnesses which were significantly less serious in degree than the illnesses encountered among patients transferred from rural facilities. Ease of travel, nature of the disease process, availability of beds, ability to manipulate the referral ladder, and cost of health care may account for these results. Charges for health care in China proved very expensive relative to per capita income. This may be of major consequence to rural persons who are personally liable for some portion of this cost. These results suggest that although referral to tertiary care in China occurs more commonly among rural patients than is the case in other developing nations, access to this care and its cost are significant problems of the present system. During the drive for modernization, a multifactorial approach (including health policy, administrative controls, and patient and physician education) will be essential to avoid deterioration of the rural health system, and the increase financial burden to be expected with the introduction of advanced medical technology.
在中国一家三级医疗机构的传染病病房，对三个月内的所有入院病例进行了研究。该医院的服务区域覆盖了近800万人口，其中10%为城市人口，90%为农村人口。该机构收治的患者中有72%为城市居民，其病情严重程度明显低于从农村医疗机构转来的患者。出行便利程度、疾病进程特点、床位可用性、转诊流程的操控能力以及医疗保健费用等因素可能导致了这些结果。事实证明，相对于人均收入而言，中国的医疗保健费用非常昂贵。这对于需自行承担部分费用的农村居民来说可能会产生重大影响。这些结果表明，尽管在中国农村患者中向三级医疗机构转诊的情况比其他发展中国家更为常见，但获得这种医疗服务及其费用是当前医疗系统的重大问题。在现代化进程中，采取多因素方法（包括卫生政策、行政管控以及患者和医生教育）对于避免农村卫生系统恶化以及随着先进医疗技术的引入而增加预期的经济负担至关重要。
