중국의 의료 전달체계

HEALTH SERVICE DELIVERY IN CHINA: A LITERATURE REVIEW

KAREN EGGLESTONa, LI LINGb, MENG QINGYUEc, MAGNUS LINDELOWd and ADAM WAGSTAFFd,*

aUCLA International Institute, Los Angeles, CA, USA bChina Center for Economic Research, Peking University, Beijing, China c Centre for Health Management and Policy, Shandong University, Jinan, China dThe World Bank, Washington, DC, USA

o 의료불균형과 의료접근성 (Affordability, disparities and access)

¡ 의료비용지출이 인구당소득(per capita income)이나 물가(prices)상승보다 빠르게 증가하고 있어서, 1990년과 2002년 사이에 도심지역에서는 8배, 농촌지역에서는 7배 상승하였음. 또한 GDP중 의료비용지출이 차지하는 비율이 1980년 3.17%에서 2003년 5.65%로 증가하였음.

¡ 이러한 비용의 증가는 평균적인 수입의 증가, 질병 양상(caseload)의 변화, 새로운 기술의 도입 등이 주요 원인임.

¡ 빠르게 증가하는 비용과 함께 확실한 것은, 중국의 빈민들에게 있어 이 정도의 비용은 감당할 수 없는 수준이라는 사실이며 이로 인해서 중국의 보건의료시스템은 농촌 지역과 도심 지역 사이에 의료시스템의 활용 및 결과(outcome)에 엄청난 격차를 가져왔음.

 

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Health Econ. 2008 Feb;17(2):149-65.

Health service delivery in China: a literature review.

Eggleston K1, Ling L, Qingyue M, Lindelow M, Wagstaff A.

Author information

Abstract

We report the results of a review of the Chinese- and English-language literatures on service delivery in China, asking how well China's health-care providers perform and what determines their performance. Although data and methodological limitations suggest caution in drawing conclusions, a critical reading of the available evidence suggests that current health service delivery in China leaves room for improvement, in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector or by simply encouraging providers -- public and private -- to compete with one another for individual patients. By contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid -- shifting away from fee-for-service and the distorted price schedule. Other elements of 'active purchasing' by insurers could further improve outcomes. Rigorous evaluations, based on richer micro-level data, could considerably strengthen the evidence base for service delivery policy in China.

PMID:

 

17880024

 

[PubMed - indexed for MEDLINE]