中国的医疗改革 [推广有奖]

2 years ago, China announced a major shake-up of its health system to try to make it both better and fairer for its billion citizens. Ted Alcorn and Beibei Bao review the developments so far.
Forests of apartment buildings, endless new roads, and whole cities where just years ago there was empty space: the landscape across China is being remade by economic growth and urbanisation at an extraordinary speed and scale. Less visible but just as important are the ongoing changes being enacted in the country's health system, reforms touching on nearly every aspect of the way health care is financed and delivered for China's 1·3 billion citizens.
The ambitious plan, announced in April, 2009, attempts to increase the accessibility, equity, and quality of health care and to reassert government control over a sector of the economy that for the past 30 years had been largely left to the will of the market. With the implementation of the reforms now approaching deadlines for several 2011 targets, it is becoming apparent which areas have made progress and those in which more intractable challenges remain.
The conditions facing policy makers at the outset were, and remain, grave. Until the 1980s, China had maintained a strong public health system providing an enviable level of health services for its level of income, but the economic reforms of the following three decades that unloosed the country's economy also unravelled its social safety net. “The market orientation of the health sector starting from the mid-to-late 1980s made the health-care providers really profit-oriented”, says Yan Mu, an economic policy specialist at UNICEF. “When the subsidies they received from the government were cut substantially, the public clinics and hospitals received a green light from the government that they could just set their prices to maximise their profits.”
As government support for the sector dropped precipitously, rural health insurance schemes also fell apart. Impoverishment due to medical expenses became commonplace and grave disparities emerged between urban and rural populations and across regions. By 2000, patients were paying 60% of their medical costs out-of-pocket on average (figure); in that same year, WHO ranked China 188 of 191 countries in terms of the fairness of financial contributions to health care.