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从1980到1989的10年间,我国的农村卫生医疗事业发生着巨大的变化,国家的事业性拨款增加了1.38倍,从而使人均卫生事业费从1.58元增加到3.56元。但是,卫生事业费占财政支出的比例却从7.2%降至4.5%。在农村三级卫生保健网中,县级医疗机构的人、财资源的投入,都有所提高,乡、村两所占的比值,却相应减低。县、乡、村级的医疗服务量,普遍增高。其间,三级所占比例分别为7%、31%和61%;由于业务收入量较服务量成倍的增高,形成次均医疗费及整个社会总费用的显著增加。而且,大部分医疗机构的增益,来源于自费农民的支付。城乡享用医疗服务资源的比为1.5∶1。城乡享受政府补贴之比为12.2∶1,70%以上的农民享受不到减免医疗服务,个人支付比例,农业人口为城镇人口的2.4倍,城乡差别显著。建议:在未来的10年中,将资源投入重点转向乡、村两级,并在村一级倡导和扶持集体办医制度。加强对医疗服务效率和效益的评估及管理,减缓社会医疗总费用的上涨速度。
During the 10 years from 1980 to 1989, great changes have taken place in China’s rural health and medical services. The state’s funding for business has increased by 1.38 times, and the per capita health expenditure has increased from 1.58 yuan to 3.56 yuan. However, the proportion of health expenditures to financial expenditures has dropped from 7.2% to 4.5%. In the rural three-tiered health care network, the investment in people and financial resources at the county-level medical institutions has increased, and the ratio of townships and villages has decreased. The medical services at county, township and village levels have generally increased. In the meantime, the proportions of the three levels were 7%, 31% and 61% respectively; as the business income increased more than the service volume, a significant increase in the average medical expenses and the total social cost of the whole society was formed. Moreover, the gains of most medical institutions come from paying farmers at their own expense. The ratio of medical services to urban and rural areas is 1.5:1. The ratio of government subsidies for urban and rural residents is 12.2:1. More than 70% of the farmers do not enjoy medical services for relief or exemption. The proportion of individuals paying is 2.4% of the urban population. The difference between urban and rural areas is significant. Suggestion: In the next 10 years, the focus of resources will be shifted to the township and village levels, and the collective medical system will be advocated and supported at the village level. Strengthen the evaluation and management of the efficiency and effectiveness of medical services, and slow the rate of increase in the total cost of social medical services.