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Abstract 摘要

Approximately sixty million Chinese people live in China's poverty-stricken rural areas (annual income per capita is lower than 400 Chinese yuan, or US $50). Most people in these areas do not have any level of health insurance. About 72.6% of the individuals who need to visit physicians are not unable to do so because of financial difficulties. The death rate of newborns is as high as 10%. Many households are caught up in a vicious circle: they contract disease because of poverty, and they become poor because of disease.

It is vitally important to establish a basic level of health care insurance for these people. According to our investigation and calculation, it requires about 18 hundred million Chinese yuan per year in total (based on medical prices in 1993) to provide a minimum amount of health care for these people, including four prenatal care visits and delivery service, vaccine shots for children (thirteen times total for every child before the age of 13), and basic medical care (including three clinic visits and half a day hospitalization per capita per year). In our investigation, most people in these areas support such a plan for basic health care insurance and express their willingness to pay part of premium.

Currently, the average health care spending per capita per year in these areas is 17.40 yuan, or 3.75% of the annual income per capita. Accordingly, there should be no serious difficulty for everyone to pay 2.50% of their annual income for health insurance, except for those whose annual income is lower than 200 yuan. In addition, our investigation found that about 28% of the average household expenditures in these areas are spent for tobacco and liquor. Individuals can be encouraged to save this type of spending for their medical care. Currently, from individual premiums (2.50% of annual income), particular funds from villages and towns, and special government financial subsidies, the total amount of funding can reach about 10 hundred million yuan yearly. In order to obtain 18 hundred million yuan as required, about 8 hundred million yuan a year needs to be raised.

China used to attempt to provide basic medical care for people by way of providing financial support to health care providers, i.e., hospitals and clinics, so that they could offer cheap medical care for patients. This has not turned out to be a good strategy. The government should, instead, directly provide financial support to health care recipients, especially those living in poverty-stricken rural areas, so that they will financially be able to set up basic health care insurance for themselves. In contemporary times, it is vitally important to help them establish a basic amount of health care insurance.

中國農村貧困地區衛生保健面臨籌資與組織等方面的問題,尤其是貧困地區經濟發展滯後,嚴重影響了衛生保健需求的購買力,因而形成了因病致貧和因貧致病的惡性循環,嚴重阻礙着生產力的發展。儘管貧困地區的政府對衛生保健的投資力度不大,但衛生資源的利用極不充分,表現為人力過剩,業務量不足,設備閑置。調查中發現,貧困地區農民在煙酒、求神拜佛、請客送禮等方面的開支甚大,故仍存在保健籌資的潛力。在保健制度方面,合作醫療比例不大,婦幼保償制和免疫保償制覆蓋面低,病人流向在不同保健制度之間差別較大。調查中發現,經濟與保健有着雙向互制作用。衛生保健應與經濟發展同步。政府應承擔發展保健事業的主要責任,加大對保健的投入,引導農民調整消費結構,改善籌資環境,普及健康教育,同時採取分步到位的辦法,逐步建立合作性質的保健制度,並建立相應的法規。

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