중국의 보건의료제도 및 최근 개혁동향image.kma.org/2015/04/2015041502.pdf ·...
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2 0 1 4 - 0 8
2014. 12.
-
: ( )
()
( )
-
i
1 11 3
2 5
2 71 9
2 11
3 15
4 19
3 231 25
2 28
3 36
4 46
5 48
6 66
7 68
4 771 2009 (2009-2011) 79
2 12 5 - (2012-2015) 101
3 (NPC) 126
5 133
149
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ii
2-1. 13
2-2. 16
2-3. 16
2-4. OECD (2011) 20
2-5. 10 (2011 ) 22
3-1. 27
3-2. 28
3-3. 30
3-4. 30
3-5. (2012) 32
3-6. 1,000 (1990-2012) 33
3-7. 34
3-8. (2011) 35
3-9. (2012) 35
3-10. (2012 ) 37
3-11. (2000-2012) 39
3-12. (2006-2012) 39
3-13. (2006-2012) 41
3-14. (2012) 41
3-15. (2012) 42
3-16. 44
3-17. (2011 ) 56
3-18. 59
-
iii
3-19. (2012 ) 67
3-20. (2007-2012) 69
3-21. 1 (2008-2012) 70
3-22. 1 (2008-2012) 70
3-23. 1 (2008-2012) 71
3-24. 72
3-25. (2012 ) 73
3-26. 73
3-27. 1 (2008-2012) 74
3-28. 1 (2008-2012) 74
3-29. 1 (2008-2012) 75
4-1. 2009 87
4-2. 93
4-3. (2009-2011) 95
4-4. 99
4-5. 100
4-6. 12 5 102
4-7. 12 5 121
4-8. 2013 127
4-9. 12 1 (2013) 129
4-10. 12 2 (2014) 132
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iv
2-1. 12
2-2. 14
2-3. 17
2-4. () 18
2-5. OECD 1 (2011) 21
2-6. OECD (2011) 21
3-1. (2005-2012) 40
3-2. GDP 46
3-3. , 1990-2011 47
3-4. (UEBMI) 51
3-5. (URBMI) 53
3-6. (NRCMS) 55
3-7. 58
3-8. 2005-2009 61
3-9. 2000-2010 63
4-1. 2000-2011 79
4-2. 15 93
4-3. 1990-2011 (%) (1/100,000) 95
5-1. 136
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73.5 OECD 80.1 1,000
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OECD .
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2) China Health Service Delivery Profile, WHO & China NHDR 2012
3) China-WHO Country Cooperative Strategy 2013-2015
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OECD .
, 2011 GDP 5.2%
17.7%, 9.2%, 7.4% OECD 9.3% .
(PPP) 1
$432 $8,508, $3,213, $2,198
OECD $3,339 1/8 .
56.0% OECD 72.0% .
47.8%,
55.3% .
2011 1.5 1.7
OECD 3.2 8.7 .
. 2.7 OECD 4.8
. MRI CT 0.18 0.57
OECD 13.2 23.2 .
2011 73.5 OECD 80.1 .
12.6 OECD 4.1
. 5.7% OECD 22.2% 1/4 (
2-4).
-
20
2-4 OECD (2011)
OECD
GDP (%)
5.2 9.2 7.4 8.9 11.2 11.6 11.3 9.4 17.7 9.3
1 ($)* 432 3,213 2,198 3,800 4,522 4,118 4,495 3,405 8,508 3,339
(%) 56.0 82.1 55.3 67.8 70.4 76.8 76.5 82.8 47.8 72.0
( ) 1.5
** 2.2 2.0 3.3 2.4 3.3 3.8 2.8 2.5 3.2
( )
1.7 10.0 4.7 10.1 9.3 8.7 11.4 8.6 11.1 8.7
( )
2.7 13.4 9.6 3.8 2.8 6.4 8.3 3.0 3.1 4.8
MRI ( ) 0.18 46.9 21.3 5.7 8.5 7.5 10.8 5.9 31.5 13.2
CT ( ) 0.57 101.3 35.9 44.4 14.6 12.5 18.3 8.9 40.9 23.2
() 73.5 82.7 81.1 84.2 83.3 85.7 83.2 83.1 81.1 80.1
() 12.6 2.3 3.0 3.8 4.9 3.6 3.4 4.3 6.1 4.1
(%) 5.7*** 4.1 4.3 28.3 25.4 - - 24.8 36.5 22.6
* (PPP) $, ** , *** 2008 Source: OECD Health Statistics, 2013
-
2 21
2-5 OECD 1 (2011)Source: OECD Health Statistics, 2013
2-6 OECD (2011)Source: OECD Health Statistics, 2013
-
22
10
. 1 .
, , , .
1 . , ,
, .
2-5 10 (2011 )
(1/100,000) (%)
(1/100,000)
(%)
1 172.33 27.79 150.83 23.62
2 132.04 21.30 138.68 21.72
3 125.37 20.22 123.69 9.37
4 65.47 10.56 84.97 13.31
5 & 33.93 5.47 & 56.50 8.85
6 18.64 3.01 13.84 2.17
7 16.35 2.64 10.56 1.65
8 7.63 1.23 6.75 1.06
9 6.60 1.06 6.50 1.02
10 5.51 0.89 4.85 0.76
10 - 94.17 10 - 93.51
: , 2012
-
3
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3 25
1
. .
, .9)10)11)
.
(level) (vertical
coordination) .
.12)
. 16 (agencies)
.
(Ministry of Finance, MOF), (Ministry of Human
Resources & Social Security, MOHRSS),13) (National
Health and Family Planning Commission, NHFPC)( , MOH)14)
.
9) Hsiao WC. The Chinese Health Care System: lessons for other nations. Social Science and Medicine
1995;41:1047-55.10) Bloom G. Primary health care meets the market in China and Vietnam. Health Policy
1998;44:232-52.
11) Huang Y. An institutional analysis of China's failed healthcare reform. In: Wu G, Lansdowne
H (eds). Socialist China, Capitalist China: Social Tension and Political Adaptation under Economic
Globalization. New York: Routledge. 2009.
12) Targa B, Hipgrave D, Brixi H, Mu Y. Equity and Public Governance in Health System Reform Challenges
and Opportunities for China. Policy Research Working Paper No. 5530. Washington, DC: World Bank,
East Asia and Pacific Region. 2011.
13) 2008 3 5 11 (NPC) (Ministry of Personnel, MOP)
(Ministry of Labour and Social Security, MOLSS) (Ministry of Human
Resource & Social Security, MOHRSS) .
14) 2013 3 18 (NPC) (MOH)
(National Health and Family Planning Commission, NHFPC) .
-
26
(MOHRSS)
(Urban Employees Basic Medical Insurance, UEBMI)
(Urban Residents Basic Medical Insurance, URBMI)
.15)
(New Rural Cooperative Medical Scheme, NRCMS)
, ,
.
,
.16)17)
() (local)
. (Commission of Development and Reform),
(Bureau of Health), (Bureau of Civil Affairs), (Food &
Drug Administration), (Bureau of Labour and Social Security,
BOLSS) .
(MOHRSS)
2 (UEBMI, URBMI) ,
(NRCMS) .
.18)19)
, (State Council Healthcare Reform
Leadership Committee)
15) M.Ramesh, Xun Wu, Alex Jingwei He. Health governance and healthcare reforms in China. Health
Policy and Planning 2013;1-10
16) Liberthal K, Lampton D.Bureaucracy, Politics and Decision Making in Post-Mao China. Berkeley, CA:
University of California Press. 1992.
17) Hsiao WC, Jamison DT, McGreevey WP, Yip W. Financing Health Care: Issues and Options for China.
Washington, DC: World Bank.1997.
18) Duckett J. Political interests and the implementation of China's urban health insurance reform. Social
Policy and Administration 2001;35:290-306.19) Hsiao WC. The political economy of Chinese health reform. Health Economics, Policy and Law
2007;2: 241-9.
-
3 27
.20)
3-1
(National Development & Reform Commission, NDRC)
,
(Ministry of Finance, MOF) ,
(National Health and Family Planning Commission, NHFPC)*
, , , ; , ,
(Ministry of Human Resources & Social Security, MOHRSS)
,
(Ministry of Civil Affairs, MCA) (poverty alleviation),
(Ministry of Commerce, MOC) , ,
* (State Food & Drug Administration) (Bureau of Traditional Medicine) Source: Ministry of Health, 2012
20) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
-
28
2
1.
.
(, Registered Doctors) (, Assistant Doctors) . (), (, , ), (),
() 4 .
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27) (6)-, , 2006
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. ,
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2012 912 .
, , , 668
. 262 ( 3-5).
3-5 (2012) (: )
911.9
(Health Professional)
667.6
261.6
(Assistant Doctors) 47.7
(Licensed Doctors) 213.9
(Registered Nurses) 249.7
(Pharmacists) 37.7
(Laboratory Technician) 36.4
(Others) 82.2
(Village Doctors & Assistants) 109.4
(Other Technical Personnel) 31.9
(Administrative Personnel) 37.3
(Support Service Workers) 65.4
Source: China Statistical Yearbook(2013), (2013)
28) (6)-, , 2006
-
3 33
.
. 2012 , (),
1 4.94, 1.94, 1.85.
, ,
( 3-6).
3-6 1,000 (1990-2012)(: )
(Health Professionals)
()
(Licensed(Assistant) Doctors)
(Registered Nurses)
1990 3.45 6.59 2.15 1.56 2.95 0.98 0.86 1.91 0.43
1995 3.59 5.36 2.32 1.62 2.39 1.07 0.95 1.59 0.49
2000 3.63 5.17 2.41 1.68 2.31 1.17 1.02 1.64 0.54
2005 3.57 5.82 2.69 1.60 2.46 1.26 1.06 2.1 0.65
2008 3.92 6.68 2.80 1.67 2.68 1.26 1.27 2.54 0.76
2009 4.15 7.15 2.94 1.75 2.83 1.31 1.39 2.82 0.81
2010 4.37 7.62 3.04 1.79 2.97 1.32 1.52 3.09 0.89
2011 4.58 7.9 3.19 1.82 3 1.33 1.66 3.29 0.98
2012 4.94 8.54 3.41 1.94 3.19 1.40 1.85 3.65 1.09
Source: China Statistical Yearbook 2013
. 2012
(22.7%), (12.9%), (11.4%), (9.4%), (6.5%)
.
-
34
3-7 (: %)
2005 2012
100.0 100.0 100.0 100.0 100.0 100.0
6.0 5.5 8.2 3.0 2.2 6.3
() 3.5 2.9 6.1 5.6 4.5 10.5
18.4 17.9 20.8 22.7 22.4 24.4
11.8 12.4 9.2 12.9 13.7 9.1
3.8 4.2 2.3 3.9 4.3 2.1
10.1 9.8 11.6 9.4 9.1 10.7
1.1 1.2 0.6 1.2 1.4 0.5
1.4 1.5 1.0 1.4 1.5 0.8
3.1 3.1 3.4 4.5 4.2 5.6
0.9 1.0 0.8 0.8 0.9 0.5
() 0.2 0.2 0.1 0.1 0.2 0.1
1.2 1.3 1.0 0.9 1.0 0.7
2.2 2.4 1.5 0.7 0.8 0.2
0.5 0.5 0.3 0.2 0.3 0.2
()
0.6 0.6 0.6 0.0 0.0 0.0
0.9 1.0 0.2 0.8 1.0 0.1
1.4 1.5 0.6 1.8 2.1 0.8
0.8 0.9 0.7 0.8 0.8 0.8
0.0 0.0 0.0 0.0 0.0 0.0
0.3 0.3 0.2 0.1 0.1 0.0
1.7 1.8 1.2 2.3 2.5 1.4
() 0.3 0.3 0.5 0.4 0.3 0.8
0.4 0.4 0.2 0.5 0.5 0.2
4.1 4.1 4.2 6.5 6.5 6.9
(TCM) 12.9 13.4 10.8 11.4 12.2 7.9
0.3 0.3 0.3 0.1 0.1 0.2
1.1 1.1 0.8 0.9 0.8 1.4
10.7 10.2 12.8 6.9 6.7 7.7
: , 2013
-
3 35
, ,
, 2 .
,
, 1
( 3-8).
3-8 (2011) (: )
/
()
/ /
3,705,541 1.00 1,306,835 0.35 1,627,761 0.44
2,774,611 1.04 971,022 0.36 1,247,417 0.47
498,616 1.05 190,732 0.40 186,129 0.39
378,970 0.76 124,390 0.25 174,140 0.35
3,285,989 1.01 1,157,164 0.36 1,315,027 0.41
419,552 0.91 149,671 0.32 166,805 0.36
3 1,331,532 1.09 453,700 0.37 643,860 0.53
2 1,716,850 1.00 604,858 0.35 737,979 0.43
1 245,732 0.89 95,311 0.34 89,314 0.32
: , 2012
, , 1
( 3-9).
3-9 (2012)(: )
1
3 522,294 529,762 99% 783,535 1.48
2 561,860 613,100 92% 776,460 1.27
1 82,017 101,952 80% 98,874 0.97
: , 2013
-
36
3
1.
(hospitals),
(Health Care Institution at Grass-root Level),
(Specialized Public Health Institution) .
,
, . 2012
950,297 ( 3-10).
2012 23,170 (General Hospitals)
15,021(64.8%), (Hospitals Specialized in Traditional Chinese
Medicine) 2,889(12.5%), (Specialized Hospitals) 4,665
(20.1%) . 13,384(57.8%) 9,786
(42.2%) .
2012 , (Health Care Institution at Grass-root Level)
912,620. (Urban Community
Health Service Centers) 33,562(3.7%), (Urban Health
Centers) 610(0.1%), (Township Health Centers) 37,097
(4.1%), /(Outpatient Clinics) 187,932(20.6%) ,
(Village Clinics) 653,419(71.6%) .
2012 , (Specialized Public Health Institution)
12,083, (Center for Disease Control& Prevention)
3,490(28.9%), (Specialized Disease Prevention
& Treatment Institution) 1,289(10.7%), (Women &
Children Care Agencies) 3,044(25.2%), (Health Inspection
Institution) 3,088(25.6%) ( 3-3).
-
3 37
- 950,297 5,724,775
(Hospital)
- 23,170 4,161,846
(General Hospitals)
15,021 -
(Hospitals Specialized in Traditional Chinese
Medicine)
(CTM) 2,889 -
(Specialized Hospitals)
(, , , , , , , , )
4,665 -
(Public Hospital)
13,384 3,579,309
(Private Hospital)
9,786 582,177
3 (Level 3)
500 , , . ,
1,624 1,469,737
2 (Level 2)
100~499 // . 3
6,566 1,827,240
1 (Level 1)
20~99 5,962 312,866
2011 , .
204 (36.8%), 48.5 (8.8%),
90.1 (16.3%), / 165.7 (29.9%), 50
(9.0%) . 94.78
(70.6%), 36.8 (27.4%),
2.65 (2.0%) .29)
.
3-10 (2012 )
29) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
-
38
1)
(Health Care Institution at Grass-root
Level)
- 912,620 1,324,270
(Community
Health Service Centers)
.
33,562 203,210
(Urban Health Centers)
610 -
(Township Health Centers)
37,097 1,099,262
/(Village Clinics)
( 1 )
653,419 -
(Outpatient Department)
() 187,932 -
(Specialized Public Health Institution)
- 12,083 198,198
(Center for Disease Control& Prevention)
,
3,490 -
(Specialized Disease
Prevention & Treatment Institution
, , , , , , ,
1,289 35,715
(Women & Children
Care Agencies)
, , ,
3,044 161,560
(Health Inspection Institution)
, , , /
3,088 -
1) / .
: China Statistical Yearbook(2013) (2013)
2009
.
( 3-11).
-
3 39
(%)
2005 882,206 4% 18,703 849,488 11,177
2006 918,097 4% 19,246 884,818 11,269
2007 912,263 -1% 19,852 878,686 11,528
2008 891,480 -2% 19,712 858,015 11,485
2009 916,571 3% 20,291 882,153 11,665
2010 936,927 2% 20,918 901,709 11,835
2011 954,389 2% 21,979 918,003 11,926
2012 950,297 0% 23,170 912,620 12,083
3-11 (2000-2012)
: , 2013
2006 2007 2008 2009 2010 2011 2012
31,045 1,182 1,192 1,233 1,284 1,399 1,624
10% 13% 1% 3% 4% 9% 16%
25,151 6,608 6,780 6,523 6,472 6,468 6,566
0% 28% 3% -4% -1% 0% 2%
12,738 4,685 4,989 5,110 5,271 5,636 5,962
1% 71% 6% 2% 3% 7% 6%
3 2 1
( 3-12).
3-12 (2006~2012)
: , 2013
-
40
2.
,30) ,
.
, 2005 3,220 2012
9,786 3 , 42%
( 3-1).
3-1 (2005-2012): , 2013
20%
( 3-13).
30) ( , ), ,
,
(, 2013)
-
3 41
3-13 (2006~2012)(: , %)
2006 2007 2008 2009 2010 2011 2012
236.9 244.5 261.0 279.3 301.4 324.4 357.9
3% 3% 7% 7% 8% 8% 10%
19.2 23.0 27.3 32.8 37.4 46.1 58.2
33% 20% 19% 20% 14% 23% 26%
256.0 267.5 288.3 312.1 338.7 370.5 416.1
5% 4% 8% 8% 9% 9% 12%
: , 2013
,
( 3-14).
3-14 (2012)(: , %)
%3 % 2 % 1 %
%
1,558 6.7% 5,995 25.9% 2,806 12.1% 3,025 13.1% 13,384 57.8%
66 0.3% 571 2.5% 3,156 13.6% 5,993 25.9% 9,786 42.2%
1,624 7.0% 6,566 28.4% 5,962 25.7% 9,018 39.0% 23,170 100.0%
: , 2013
.
.31)
(87%), (86%), (54%), (54%),
(83%), (99%), (67%), (66%), (82%), (93%)
( 3-15).
31) . . . 2013.12.
-
42
3-15 (2012)(: , %)
(%)
728 592 136 19%
495 63 432 87%
464 67 397 86%
344 157 187 54%
322 149 173 54%
326 55 271 83%
164 160 4 2%
124 81 43 35%
132 1 131 99%
115 38 77 67%
89 62 27 30%
70 24 46 66%
66 12 54 82%
43 3 40 93%
1,183 296 887 -
4,665 1,760 2,905 62%
:
-
3 43
3. (Hospital Accreditation)
(hospital accreditation)
1989 . (basic
and lowest) , , .
(province) (city) (health bureau)
. (MOH)
1998 .32)
2002 2005
(Hospital Management Evaluation Guide (trial))
, (province) (city)
. 3
(Hospital Management Evaluation
Guide) 2008 . 2008 , ,
3(third party) .
2011 4 3
(Class General Hospital Accreditation Standards) .
2011 9 (Interim Measures for Hospital
Accreditation) 10 .
(regional healthcare planning authorities)
240 3
. , ,
. 1 3
.
5 . ,
,
32) Feng-Jen Fan, Hospital Accreditation in China, Overview of Healthcare Accreditation from External
Evaluation Organizations, Asian Society for Quality in Health Care, 2013
-
44
,
, . 7
. 1-6 (, ,
,
). 7 (monitoring)
( 3-16).
3-16
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 76 36 (3 , ,
)
(province)
, .
.
(Hospital Accreditation Committee)
(province) (Health Administration Department)
. PDCA(Plan-Do-Check-Act) A, B, C, D, E .
A (Excellent) PDCA , B (Good)
PDC , C (Pass) PD , D
(Failed) P , E (Not applicable)
.
-
3 45
(document review), (medical data
and statistics review), (on-site investigation), (social
assessment) 4 .
( , ).
.
.
, 3
, (province)
.
. (examination) , (peer review),
(social survey) .
, , ,
CQI, () .33)
33) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
-
46
4
1978 . 2011
2.435 ($3,769.4).34) GDP
5.15%, 1 1,807($297.7)(
3-2). ,
38.89%
. 1 702.71($108.7).35)
3-2 GDP 1990 2011 20
, 1990 25% ,
(social capital) 40%, (out-of-pocket)
35% . 2000
(SARS) 2002
60% .
34) 2012 China National Health Accounts Report. China National Health Development Research Center.
35) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
-
3 47
.
2009 2011 , 2011
30.4% , 34.7%,
34.9% ( 3-3).
(2002 57.7%
2011 34.8%). 2011 7,462
6.83% , GDP 1.58%
. 2011 62% (
1.56 ).36)
3-3 , 1990-2011Source: China National Accounts, 2012
36) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
-
48
5
1. ()
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.
.
.37)
.
. ,
. .
. 38)
1950 , ,
, , , .
, , ,
.39) .
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.
.
37) , , 2010 7.
38) ,
.
39) : , , 2012
-
3 49
,
.40)
,
.41) 2009 5
.
2010 18 45
.42)
.
. (UEBMI: Urban Employees Basic Medical Insurance)
1951
1953
.43)
,
44) .45)
.
.
40) , , 2010 7.
41) : , , 2012
42) , , 2010 7.
43) , , 2010 7.
44) (the Chinese National Petroleum Company) 50 150
.
45) , , , 2013 9 3.
-
50
(Ministry of Human Resources & Social Security,
MOLSS) (Social Insurance Law)
().46) 1994
(State Council) 2
1998
. (, , , ),
, , . 2009 2011
4,583 8
.
.
()
. 6%, 2%
. () .
2 (collective fund)
(individual employee
accounts). 6% 30%
2% .
6% 70% ()
( 3-4).
. 10%, 2%
. 2% .47)
.
50%
. .48)49)
46) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
47) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
48) , , , 2013 9 3.
-
3 51
2007
.
, , , , 70.32%,
20.47%, 3.47%, 3.04% . 2011 4,821
, 3,892 , 5,525 . 2012
265 199 , 66
.50) 2011 79% 21% .51)
3-4 (UEBMI)
. (URBMI: Urban Residents Basic
Medical Insurance)
2007
(URBMI) , 2009
. (Ministry of
Human Resources & Social Security, MOLSS) .
, , , ,
49) Duckett, J. Pplictial Interests and Implementation of Chinas Urban Health Insurance Program, Social
Policy and Administration 2001;35(3):3-28.
50) China Statistical Yearbook 2013
51) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
-
52
.52)53)54)
.55)
( 3-5).
. 2007
2009
80% .56)57)
2011 (Ministry of Human Resources & Social
Security, MOLSS) 2007 43 , 2008 118
, 2009 182 , 2010 195 , 2011 221
(China Statistical Yearbook 2013 2012 272
). , 2007
,
. 2011 80%
. 2011 701.3 503.1
, 2011 539.4 .
2011 70%.58)
300 1,100
. 70,000 ,
, ,
. 50 50
52) , , , 2013 9 3.
53) Dib, H. H., Pan, X. and Zhang, H., Evaluation of the New Rural Cooperative Medical System in China:
Is it working or Not?, International Journal for Equity in Health 2008;7:1-17.
54) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
55) , , 2010 7.
56) , , 2010 7.
57) : , , 2012
58) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
-
3 53
170,000
. ,
. () 16-60 ,
16-50 , ,
. 600
100 . 300 1,100
. 700
. 70,000 .59)
3-5 (URBMI)
. (NRCMS: New Rural Cooperative Medical
Scheme)
2003 (State
Council)
.
, .
.60)
59) , : () 2009 10
60) : , , 2012
-
54
.
,
.
() (risk pooling)
.
( ) (,
).
.61)62) .
3 . ()+(),
()+(), . 2011
70% .63)
,
.64)65)
, 2012 98.3% 805 .66)
.67)68)
80% .
61) , , , 2013 9 3.
62) Liu, Y. and Rao, K. Providing Health Insurance in Rural China: From Research to Policy, Journal of
Health Politics, Policy and Law 2006;31(1):71-92.
63) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
64) , , , 2013 9 3.
65) Tsui, L. Medical Insurance in China: How is it different from India?, Medical Insurance in China Global
Conference of Actuaries. Numbai, India 2010
66) China Statistical Yearbook 2013
67) , , , 2013 9 3.
68) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
-
3 55
. 2010 150 1
2011 250 2012 308.5 .
1 2010 120 2011 200, 2013 340
. 80,000,
.69)
() 2013 . , , 20
.
(commercial insurance providers)
.
. 2011 1,975 , 1,607
824 .
[ 3-6] .
3-6 (NRCMS)
69) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
-
56
(municipal) (municipal) (county)
, , , , , , ,
19982010(2007 79
)2003(1950
)
, , ,
, , ,
252 221 832
70% 50% 30%
4,821 701.3 1,975
3,892 503.1 1,607
1
1,960 268 250
- 8%( 6% 2%)
- ( + 30%)
- ( )
- 60 (50% )(2008 )
- ( )
3-17 (2011 )
Source: WHO(2010) & China Insurance Regulatory Commission(2012) & Swedish Agency for Growth Policy Analysis(2013)
.
.
(Ministry of
Human Resources & Social Security, MOLSS) ,
(Ministry of Health) .
.
.
-
3 57
1)
,
,
, .
.
. 2011 (Central
Auditing Bureau) 547
, 9 2,300
. .
() .
2)
(, , , ). ,
(entitlement to benefits) .
.
3)
. 2009
.70) 2012 12
5
, , .71)
70) CCCP & State Council: The Opinion of Deepening Health Care System Reform, China Issue No.6,
2009
71) State Council: Deepening Healthcare System Reform in the Twelfth-Five Year Plan and Its Implementation
Program. China Issue No. 11, 2012
-
58
3 .
, (basic medical insurance systems)
(supplementary systems) (safety net) ,
, , (
, ), ,
( 3-7).72)
3-7 Source: Swedish Agency for Growth Policy Analysis, 2013
3
, 2 3 (reimbursement)
(pay up front) .
,
.
150
. ,
.
72) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
-
3 59
,
.
.
.
-
( )
- ,
- ,
- 2 3
- / -
- 3 -
- -
3-18
2. (Medical Financial Assistance, MFA)
.
(medical safety net)
. (State
Council)
.
2003 2005 , 2006
2008 .
-
60
(subsistence allowance)
.
.
3 . ,
, ()
, .
(common diseases)
.
. 2009 9,337
. 3,070 (
4.9%) , 6,267 (
8.8%) .
. (Funding)
(central) (provincial, city and
district governments) .
. 2009 ( ) 367.4
($54) . 155.3
($228) , 212.1 ($31) .
190.6 ($28) 176.8 ($26) . [
3-8] 2005 2009
. 22
131 5.8 , 55.5% .
2005 6 2009 81 ($12)
. ( ) 2005 18.2% 2009
61.5% .
-
3 61
3-8 2005-2009 Source: Yao L, 2010
. (Utilization)
2009 1,600 . 2004
232.7 7 . 5
37.9% . 2009 1,080 ( 11.6%) 520 (
5.6%) ,
. 2009 2.2
, 1.7
. 2004 3.8 2009 1,173
($172.5) .
285.5 . 42 , 185
, 46 .
-
62
. (Security Level)
,
. 2009
1 147.4($22.7) 175.4($25.8)
. 1 1,713.4($252)
1,479.4($217.6). 2009 28.8%() 23.8%
() .
.
. 2009
1 7 .
4,370 1,280
.73)
73) Sarah L Barber & Lan Yao. Health Insurance System in China: A Briefing Note. WHO, 2010
-
3 63
3.
3 90% . 2005
24% .
. 10 27%
2010 7% .
10 10 2010 677 ( 3-9).
( : 10 )
3-9 2000-2010 Source: China Insurance Regulatory Commission(CIRC)
2% ,
.
. 2008 300
2012 1,000 .
( + ) (
).
. , ,
,
.
-
64
.
. ,
(targeted cancer therapies)
(pre-dialysis) .
.
.
.
1996
.
.
.
, ,
,
.
. (instant
claim initiatives)
. , , , ,
. .
, 1997
, 10%
(53,000) 150,000 .
.
. 2009
112 (clinical guidelines)
-
3 65
.
10 10 7
. China Life 2004
2009 400 .74)
74) Helen Chen & Yanyan Lin. The Rise of Private Health Insurance, China Economic Review 2012.3.27
-
66
6
. 2011
9.95 .
9.31 . 9.31, 7.97
. , ,
(first-aid centers first-aid stations) .
.
2 ()
. , ,
.
. 2 1997
2006 .
() . 2
.
.
,
, .
.
. (over-crowding) ,
(empty) .
-
3 67
. (Henan, ) (NRCMS) .
75).
3-19 (2012 )
()(/$)
(Reimbursement Share)(%)
(Township) 100/15.48 90
(County) 2 400/61.93 80
(City) 2 700/108.38 70
(City) 3 1000/154.83 70
(Province) 2 1000/154.83 65
(Province) 3 2000/309.66 65
: WHO, 2012
.
(disease information
card) .
. (examination)
.76)
75) China Health Service Delivery Profile, WHO & China NHDR 2012
76) China Health Service Delivery Profile, WHO & China NHDR 2012
-
68
7
1.
.
. 2012
69 9.8% . 2011
1 4.6.
2012 25
10.7% .
90% .
. 3
.
.
( 3-20).
3
.
,
.
-
3 69
3-20 (2007~2012)(: , %)
2007 2008 2009 2010 2011 2012
471,913 490,090 548,767 583,762 627,123 688,833
5.7% 3.9% 12.0% 6.4% 7.4% 9.8%
163,770 178,167 192,194 203,963 225,884 250,162
11.3% 8.8% 7.9% 6.1% 10.7% 10.7%
152,650 164,911 176,890 187,381 205,254 228,867
10.2% 8.0% 7.3% 5.9% 9.5% 11.5%
11,120 13,256 15,304 16,582 20,629 25,296
30.4% 19.2% 15.5% 8.4% 24.4% 22.6%
3 55,389 62,128 68,939 76,046 89,808 108,671
22.37% 12.17% 10.96% 10.31% 18.10% 21.00%
2 74,475 83,021 88,840 93,120 99,199 105,477
28.20% 11.47% 7.01% 4.82% 6.53% 6.33%
1 14,332 15,566 14,995 14,574 15,337 16,767
39.04% 8.61% -3.67% -2.81% 5.24% 9.32%
19,574 17,453 19,419 20,223 21,541 23,248
-41.46% -10.84% 11.26% 4.14% 6.52% 7.92%
123,257 134,102 143,561 151,058 167,408 187,353
10.89% 8.80% 7.05% 5.22% 10.82% 11.91%
25,387 27,541 30,146 32,770 36,121 40,706
10.80% 8.48% 9.46% 8.70% 10.23% 12.69%
12,570 13,858 15,447 16,822 18,756 21,634
16.14% 10.25% 11.47% 8.90% 11.50% 15.34%
2,556 2,665 3,040 3,314 3,599 4,470
15.50% 4.26% 14.07% 9.01% 8.60% 24.20%
22,587 25,672 37,698 48,452 54,654 59,869
28% 14% 47% 29% 13% 10%
: , 2013
-
70
.
1 2008 .
. 2012
1 192.5. 96.9(50.3%), 35.0
(18.2%) 50% ( 3-21).
3-21 1 (2008-2012) (: )
% %
2008 138.3 71.0 51.3 24.7 17.9
2009 152.0 78.3 51.5 27.1 17.8
2010 166.8 85.6 51.3 30.0 18.0
2011 179.8 90.9 50.5 32.4 18.0
2012 192.5 96.9 50.3 35.0 18.2
: , 2013
1 2008
,
. 2012 1 193.4. 99.3
(51.3%), 36.2(18.7%) 50%
( 3-22).
3-22 1 (2008-2012) (: )
(Drug)
% %
2008 138.8 72.3 52.1 25.4 18.3
2009 152.5 80.0 52.5 27.8 18.2
2010 167.3 87.4 52.3 30.8 18.4
2011 180.2 92.8 51.5 33.4 18.5
2012 193.4 99.3 51.3 36.2 18.7
: , 2013
-
3 71
1 1
. 50%
. 2009
( 3-23).
3-23 1 (2008-2012) (: , %)
% %
3
2008 187.9 100.3 53.4 32.3 17.2
2009 203.7 109.3 53.6 34.9 17.1
2010 220.2 117.6 53.4 37.9 17.2
2011 231.8 122.0 52.6 40.2 17.3
2012 242.1 126.7 52.3 42.7 17.6
2
2008 116.7 58.9 50.5 24.0 20.5
2009 128.0 65.1 50.8 26.2 20.4
2010 139.3 70.5 50.6 28.9 20.8
2011 147.6 73.6 49.9 31.0 21.0
2012 157.4 77.9 49.5 33.3 21.1
1
2008 77.3 41.8 54.1 10.0 12.9
2009 83.9 46.3 55.1 10.5 12.5
2010 93.1 51.6 55.4 11.5 12.4
2011 103.9 56.1 54.0 13.4 12.9
2012 112.0 59.9 53.5 14.7 13.1
: , 2013
-
72
2.
.
(Utilization Rates of Beds)
. 2012 90.1%. 2005
. ,
3 ,
( 3-24).
3-24 (: %) 2005 2008 2009 2010 2011 2012
70.5 81.5 84.8 86.7 88.5 90.1
71.5 84.0 87.7 90.0 92.0 94.2
49.8 55.3 58.2 59.0 62.3 63.2
3 90.5 100.5 102.5 102.9 104.2 104.5
2 68.1 80.1 84.8 87.3 88.7 90.7
1 49.6 53.6 54.5 56.6 58.9 60.4
70.4 82.1 85.6 87.5 89.3 91.0
65.0 77.3 81.8 84.1 86.3 88.6
75.7 82.2 83.5 86.7 87.0 87.6
: , 2013
2012 1 2,728 . 2012
13 5 100 10.6 .
89.0%
. 2
53.7% .
78.4% ( 3-25).
-
3 73
3-25 (2012 ) (: , %)
12,728 100.0
11,331 89.0
1,396 11.0
3 4,726 40.7
2 6,242 53.7
1 649 5.6
9,915 78.9
1,642 13.1
1,004 8.0
: , 2013
. 2012
(length of stay) 10.0.
.
. 3
3
. ( 3-26).
3-26 (: ) 2005 2008 2009 2010 2011 2012
10.9 10.7 10.5 10.5 10.3 10.0
10.9 10.9 10.7 10.7 10.5 10.2
9.6 8.7 8.7 8.4 8.5 8.3
3 13.1 13.2 12.7 12.5 12.0 11.4
2 9.7 9.5 9.4 9.4 9.3 9.1
1 9.8 9.4 9.3 9.1 9.1 8.9
10.2 10.1 9.9 9.8 9.7 9.4
10.8 10.5 10.4 10.6 10.5 10.2
18.9 17.6 17.0 17.3 16.1 15.5
: , 2013
-
74
.
1 2008 ,
. 2012 1
6,980.4. 2,867.4 544.9
41.1% 7.6% ( 3-27).
3-27 1 (2008-2012) (: , %)
% %
2008 5,234.1 2,276.3 43.5 348.1 6.7
2009 5,684.0 2,480.6 43.6 393.7 6.9
2010 6,193.9 2,670.2 43.1 441.6 7.1
2011 6,632.2 2,770.5 41.8 492.7 7.4
2012 6,980.4 2,867.4 41.1 533.9 7.6
: , 2013
1 2008 ,
. 2012 1 7,325.1
( ) . 3,016.7
565.4 41.3% 7.7%
( 3-28).
3-28 1 (2008-2012) (: , %)
% %
2008 5,363.3 2,349.1 43.8 358.5 6.7
2009 5,856.2 2,573.0 43.9 407.7 7.0
2010 6,415.9 2,784.3 43.4 460.8 7.2
2011 6,909.9 2,903.7 42.0 515.8 7.5
2012 7,325.1 3,016.7 41.3 565.4 7.7
: , 2013
-
3 75
1 , 1 .
2012 3 1 2 1 2.4,
3.4 ( 3-29).
3-29 1 (2008-2012) (: , %)
% %
3
2008 8,969.1 3,906.8 43.6 615.1 6.9
2009 9,753.0 4,231.9 43.4 694.8 7.1
2010 10,442.4 4,440.9 42.5 765.8 7.3
2011 10,935.9 4,480.4 41.0 838.7 7.7
2012 11,186.8 4,521.0 40.4 881.1 7.9
2
2008 3,647.2 1,618.3 44.4 237.7 6.5
2009 3,973.8 1,784.0 44.9 270.1 6.8
2010 4,338.6 1,944.8 44.8 303.4 7.0
2011 4,564.2 1,999.2 43.8 332.3 7.3
2012 4,729.4 2,033.3 43.0 352.4 7.5
1
2008 2,550.4 1,111.7 43.6 146.8 5.8
2009 2,609.6 1,128.2 43.2 164.8 6.3
2010 2,844.3 1,243.7 43.7 185.9 6.5
2011 3,121.3 1,364.4 43.7 207.0 6.6
2012 3,285.0 1,411.3 43.0 236.1 7.2
: , 2013
-
4
-
4 79
1 2009 (2009-2011)
1. 77)
2009 4 6
, 4 7
2009~2011 .78)
, ,
, , 5
. 5 ,
,
.
2009-2011 8,500 , 3,318
.
4-1 2000-2011 77) Chinese Medical Association(CMA) Five Key Tasks in Health Care Reform in China
.
78) . 2009 . . ,
2009.
-
80
.
.
1)
, ,
3 90%
.
2)
(risk
pooling standards) (insurance level) ,
1 80 120
.
3)
, , 79) , ,
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. 81)
1) , ,
79) , , , , ,
, , ,
. , .
80) 2009 . . , 2009.
81) 2009 8 (National Essential Drug List)
, (western chemical and biologic drugs) 205,
(Chinese medicine drugs) 102, (traditional Chinese herbal
medicines) .
-
4 81
,
(essential medicines list, EML) .
2009 .
2)
. (unified)
.
. (province, ) , .
.
.
3)
(retail drugstores)
. 2009
,
. (formulary)
.
,
.
.
1)
3
-
82
. (county, ) 100%
3 2,000 () ( ),
() 1 . (township, )
(community health service centers)
, 2009 29,000 ()
. 5,000 ()
() 13 . (village, )
(remote areas) (clinics) 3
() 1 .
3,700 11,000
. 2,400
.
. ()
. (basic medical services)
(agencies)
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(private practice) .
2)
(GP) (licensed doctors)
. 3 360,000, 160,000, 137
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, , 2
49-100 , 1 20-99 . 2
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.
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. 2009
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.
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(service charge)
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(door-to-door) .
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84
(community gatekeeper system)
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.
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. 2009
. 65 , 3
. , ,
, HIV/AIDS,
. (health knowledge) , (CCTV)
2009
.
2)
AIDS ,
, ,
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B , (coal-burning
fluorosis hazards),
, , .
3)
, , (health inspection),
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.
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.
.
.
. 1 2009
15 , 2011 20 .
.
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.
.
. 80%
,
.
. , ,
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.
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-
86
.
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.
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(medical insurance agencies), (social appraisal
agencies), (representatives of the people),
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.
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,
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, 2 .
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4 87
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1 80120
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3 2,000 () () 1
29,000 ()
5,000 () ( 1-3 )
3 () 1
3,700 11,000
2,400
.
.
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(social-sector
run medical institution) . ,
.
. ,
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2011 .
4-1 2009
-
88
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-
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, , 36 , 16 ,137
1
3
-
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, ,
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TV(CCTV)
-
15 B
-
-
( 1 2009 15, 2011 20
)
-
4 89
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, , , ,
, , ,
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2009 , 2011
2. 2009 83)
.
2009 3
2011 13 . , 2000
15%, 2008 87%, 2011 95% .
2011 8 3,200
97.5% .
.
,
2003 20 2011 200 900%
. .
83) 2012 (State Council) (White Paper on Medical and Health
Services in China) .
-
90
70% .
. ,
(prepayment)
.
(critical illness) . 2011
230,000 , , , ,
,
65% . 2012 , ,
8
90% .
(medical aid) .
, , , ,
. 2011 (medical aid)
9,090 . 188
.
.
, ,
(unified essential drug
bidding), (procurement), (distribution) . 2009 8
(National Essential Drug
List) , (western chemical and biologic
drugs) 205, (Chinese medicine drugs) 102,
(traditional Chinese herbal medicines) .84) 2009
84) Chen Zhu. Early Results of China's Historic Health Reforms: The View From Minister Chen Zhu, Health
Affairs 2012(11):2356-2544
-
4 91
10
.85) 2011
.
,
() .
.
30%
.
(formulary)
. 80% (),
(prefectures) .
. ()
.
. ()
.
31 () . 2011 12 30
() (Essential Drug List
Purchasing Implementation Plans) , 21
() .
.
.
.
.
70% .86)
85) Chen Zhu. Early Results of China's Historic Health Reforms: The View From Minister Chen Zhu, Health
Affairs 2012(11):2356-2544
86) Chen Zhu. Early Results of China's Historic Health Reforms: The View From Minister Chen Zhu, Health
Affairs 2012(11):2356-2544
-
92
.
.
. 2009 2011
471 5 .
,
. (GP) ,
GP 9,000
GP .
GP . 5,000
,
.
(ten thousand doctors extending support to rural medical care)
. 2009 2011 1,100 3
955 () ,
2 3,600 ()
. () () .
. GP
(family doctors) . ,
.
.
.
. 2011
918,000 , 26,000,
() 38,000, () 663,000 ,
1,234,000 .
15 2008 75.6% 2011
-
4 93
80.8% , 80.3% 83.3%
( 3-11). (outpatient visits) 2011 37
8,000 2007 28.6%, (hospital stays)
3,680 2007 30.9% .87)
2008 2011 ( 4-2).
4-2 15 source: Zhu Chen, 2012
4-2 (: %)
2008 2011 2008 2011
48.3 55.5 81.7 81.8
() 24.8 24.3 57.3 57.4
() 23.5 31.2 24.4 24.4
source: Zhu Chen, 2012
87) Zhu Chen, Progress and Prospect of Health Care Reform in China, 2012
-
94
.
. 10
41 . 1
25. (health record), ,
, 6 , , ,
, ,
, .
, ,
. , B
15 , ( ),
, (sanitary toilet) ,
, , AIDS
.
2011 (National Immunization Program, PIP)
90% . 98.7% (
98.1%), ( 4-3).
72.1% , 69.2%
. 2009 100
, 2011 109
. .
-
4 95
4-3 (2009-2011)
2009-2011
()
2011
()
(%)
- 26.12 -
15 B 56.67 68.31 118.5
( ) 1.631 1.689 103.6
- 22.44 -
11.28 13.28 117.7
1 1.09 109
10 11.86 118.6
1.20 1.46 121.6
: Zhu Chen, 2012
4-3 1990-2011 (%) (1/100,000)Source: State Council, White Paper on Medical and Health Services in China, 2012
-
96
.
. 2010 745
17 37
() . , ,
, .
2012 () .
() 90%
. 2012 18
(provinces), (autonomous regions) (municipalities directly
under the central government) 600 ()
.
(case payment), (general budget
control), (capitation), (contracting and negotiation)
.
. , , ,
, ,
.
(pilot
alliance) , , , .
(vertical integration) 1 , 2 , 3
(multi-hospital system) .
,
2 3 , 1
-
4 97
.
( 4-5).88)
,
, .
()
,
.
.
() .
1980 .
.
.
.89)
(patient-
friendly) .
.
.
, , .
.90)
88) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
89) Chen Zhu. Early Results of China's Historic Health Reforms: The View From Minister Chen Zhu. Health
Affairs 2012(11):2356-2544.
90) Chen Zhu. Early Results of China's Historic Health Reforms: The View From Minister Chen Zhu. Health
Affairs 2012(11):2356-2544.
-
98
2015 20%
. 2010 (further
encouraging private capital investment in medical institutions)
. () .
.
.
.
2012 230 (joint-venture) ,
.
. ,
.91)
14 ()/(municipalities) . , ,
, 10 () . 4 () . 2015 45%
.
. 2 .
. 5
50%
. 2007
1,311 . 1,250(95.3%)
61(4.7%) .
91) Chen Zhu. Early Results of China's Historic Health Reforms: The View From Minister Chen Zhu. Health
Affairs 2012(11):2356-2544.
-
4 99
.
.92)
2011 , 8,437 165,000
38%
. , (time-
phased) , () .
, 3
, 2011 2009
8% .
4-4
(Pudong & Hongqiao
International Medical Service Areas) , 2015 10,000 100
1,500 50 , 200 , 500
. 20%
.
2011 4,500
49% . 27% 22% .
, , (),
.
92) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
-
100
(Chaoyang Hospital)
. 2012 11,
(Chaoyang Hospital Medical Alliance) 2 3, 2 2, 7
3,100
.
.
.
. .
, 2
,
.
(two-way)
. ,
3 .
.
CT MRI
. .
( 3 ).
(GP)
.
4-5
-
4 101
2 12 5 - (2012-2015)
1. 93)
17 5 2010 10 15 18
. 2011 2015(
2012-2015) 12 5 ( ) . 12 5 2009 . 12 5
,
,
. 12 5
.
.
.
1)
.
(NCD) .
. (lab test network)
93) 2012 The Twelfth Five-Year Plan for Health Sector Development
.
-
102
4-6 12 5 (2015)
()2010 1
() 12
5 () 14
(/100,000) 22
(notifiable diseases) (%) 95
HIV AIDS () 120
(HBsAg) (%) 6.5
(%) 90
(NCDs) (%)
50
(%) 40
(MCH)
3 (%) 80
(%) 85
(%) 98
(Health
inspection)1,000m3/ (%) 90
3 (%) 201 3%
(%) 75
1 () 1.88
1 () 2.07
1 () 4
2 () 9
(%) 95
(% 30
1 () 40
Source: The Twelfth Five-Year Plan for Health Sector Development, 2012
. (
)
.
-
4 103
2) (health inspection)
.
. , ,
, .
. , (radiation), ,
, .
3)
(, city) (, county) (MCH)
. , , 3
. .
(health literacy surveillance system) .
4)
.
. 2015
.
5)
(blood stations)
. 2015 (nucleic acid screening test)
. ,
.
, , .
-
104
.
1)
,
.
,
. , , , ,
. 1,000 4
. , , ,
.
, , , , , , ,
(TCM) .
.
. 2015
.
. ()
.
2)
.
.
, , , ,
,
(, , ) (private
clinics) .
-
4 105
. 2015
20%
.
3) 3
(, county)
. , 90% , , ,
, .
.
. 2015 1
1
.
4)
(entry
point)
(two-way)
. 2015 .
30,000-100,000 1
.
5)
(regional medical centers) .
(prefecture) (city)
. (specialty)
.
-
106
6)
10,000
.
. 3 . 2
.
1
.
.
.
. (NRCMS)
(URBMI) 2015 1 360
. .
. 3
. 3
() 75%
.
pooling 50%
.
.
95% .
.
.
-
4 107
2015
.
() .
. ,
(CHD), ,
.
.
.
. ,
.
, , , ,
.
.
.
.
.
.
(balanced and budget management) (clinical pathway
management) . (DRGs),
(capitation), (total payment) .
.
.
() .
.
.
-
108
.
12 5
. , ,
. , ,
,
.
(national action plan) .
.
.
. ,
,
. (national electronic drug regulatory
system) .
2015
.
, ,
.
.
,
. .
.
.
.
.
.
-
4 109
.
.
( ), , , , (NCD)
, .
1)
, , .
HIV/AIDS , , , , ,
(ARV) . , , , ,
, . ,
4 , (MDR-TB)
,
50% .
.
. B
.
. //
,
(transmission interruption) .
(kala-azar)
(echinococcosis) .
, ,
.
. 2015 // 95%
. -
.
-
110
.
. .
, , .
,
. 35
, 80%
.
. (whole-
population healthy life-style)
. 60%
. (CHD)
, .
, .
.
. 2015
70% 60% .
-
.
.
.
-
4 111
2)
/
. (national urban and
rural environment health and hygiene action) ,
.
. 2015
60% .
.
3)
, ,
. 2015 70%
.
.
. MMR
.
,
, , .
. 2015
70% . .
. (BFH)
.
(IMCI) , , ,
,
-
112
.
. 2015 5 (stunt rate)
10%, 20% .
4)
. ,
, ,
. (national
health literacy promotion initiative)
. 2015
10% .
()
, ,
(WHO Framework Convention on
Tobacco Control, FCTC) . 2015 15
2010 23% .
5)
, ,
.
, , ,
. ,
, (mental assistance)
.
,
.
-
4 113
6)
.
.
. (health inspection)
1)
12 5 (Twelfth Five-Year Plan for
Food Safety Regulatory System)
. (Food Safety Law)
.
.
.
. (CDC)
(food-borne diseases) .
(blacklist) . , ,
(catering
industry) .
2)
(dust lung), ,
(occupational diseases) .
(health risk assessment,
-
114
HRS) .
.
.
.
3)
, 2 ,
. .
.
.
, , .
.
.
(law enforcement behaviour) .
.
1)
()
good service, good quality, good ethnic and patient satisfaction
ten thousand miles of medical care quality .
,
. 3
(clinical pathway management)
, 2 80% .
(clinical
-
4 115
pharmacist system)
. (clinical nursing practice)
,
.
. 2015 1,000 10
.
. (drug
rehabilitation) .
2)
,
, ,
.
. (hospital grading system)
. 2015
. .
.
.
3)
. 2 3
, (volunteer)
(social worker services)
.
(estimation) (control)
.
.
-
116
4)
, ,
,
. ,
.
.
5)
4 (Four separation)94) ()
, .
. .
.
.
. , ,
.
.
.
, , ,
.
, ,
.
.
94) 4 1) , 2) , 3)
, 4) .
-
4 117
.
(entry point) .
.
(two-way) .
.
(Traditional Chinese Medicine, TCM)
() .
.
.
.
, , .
(TCM
masters) .
. ,
.
.
.
.
.
(GP) .
-
118
. 2015
(post-conversion training), (on-the-job training),
150,000 10,000 2
()
. . (health
teams) , ,
()
.
. () ()
(licensed physicians) (assistant physicians)
. ()
(special posts plan)
.
. . ,
, , , ,
.
.
.
, , ,
.
.
.
(MOH) . HIV/AIDS
.
-
4 119
(NCDs)
.
. .
(bio-safety) .
.
(regional information platform)
, , ,
, .
(EHR) 2015
75% . , ,
(personal health management)
. ()
,
, , .
.
(telemedicine) ( )
.
.
(EMR) .
, , , ,
.
.
-
120
.
.
(non-governmental investment)
, , , , , , ,
.
. . (standards) (norms)
.
(TCM) .
, , , , ,
(social capital)
. (favorable
taxation policies) ,
.
.
.
(medical group) .
.
.
. , , ,
. (products), ,
.
-
4 121
- ( )
-
- ()/()
- ()
-
- (/, /, /)
- (2015 20%)
- 3 ( / / )
-
- /
-
- ( 95% )
- 2015 1 360
- 75%, 50%
-
-
- (DRGs), (Capitation), (Total payment)
-
-
-
- (2015)
-
-
-
-
-
-
-
-
-
-
-
-
- (occupational diseases)
-
4-7 12 5
-
122
- ( : 3 , 2 80%)
-
-
- (, )
- (2,3 , )
- ( , , , )
- , ,
-
- (() )
(TCM)
- ()
-
-
-
-
-
-
- (GP) (2015 150,000 , 10,000
2 GP , () GP)
- () (licensed physicians) (assistant physicians)
-
-
- (TCM)
-
-
- 3 () (telemedicine)
-
-
- (non-governmental investment)
- (social capital) (favorable
taxation policies) ,
-
4 123
2. 12 5 95)
(NHFPC) 2013 12 5
.
,
,
.
(TCM) .
.
.
.
2012 10.3% 2013 9.5% 0.8% .
2012 10 24.5 2013 23.2 11.3 .
.
1) (benefit)
2013 99% 8 2
(NRCMS) , 370($59.45) 2012
62 . 75% ,
2012 11.3% 19 4 .
95) National Health and Family Planning Commission(NHFPC) of the PRC, 2014
-
124
2)
,
. 2013 (phenylketonuria) (hypospadias)
(leukemia) (congenital heart failure)
20 (reimbursable list) . 199
22 69%
. ,
(NHFPC)
. 2013 , 28 (province)
. 123
.
3)
,
. 2013 (counties), (districts),
(cities) 24% .
, .
88% (province)
. 9
(province) (province)
(inspection)
. , 80%
.
-
4 125
.
( ) 2012 1.94 2013
2.06 , 2012 1.85 2013 2.05
. 2012 4.24 2013 4.55
. 2012 26.7% 2013 28.5%
.
.
. 2013
12.6% . 2013
(general tax revenue) 30.1%, 33.9%,
33.9% . 2012
0.4% .
.
2012 14% 2013
15.6% . 2013 22.5% 8%
. 2013 12.1%
, 2012 1.1% .
-
126
3 (NPC)
1. 12 1
12 ( ) 1
2013 3 5 17 .
. , ,
, , , ,
, ,96)
. 12 1
.
. (NHFPC)
(National Health and Family Planning
Commission, NHFPC) (: ).
, ,
(State Development Planning Commission,
SDPC) .97)
96) , , . 2013 , , 2013
97) , 2013 : , ,
2013
-
4 127
(%) (%)
413.2 5.9 9.3
253.0 3.7 10.7
260.3 3.8 27.9
655.1 9.4 13.9
223.0 3.2 5.3
619.6 8.7 12.8
210.1 3.0 18.8
.
, ,
,
.98)
.
2013
. 27.9%
, 13.9% ( 4-8).99) ,
1
240 280 .
,
, .
1 25 30 ,
. .100)
4-8 2013 (: )
98) , 2013 : , ,
2013
99) , , . 2013 , , 2013
100) Report on Chinas central, local budget, China National Peoples Congress, 2013
-
128
(%) (%)
397.4 5.7 11.4
720.2 10.4 10.7
202.9 2.9 11.1
: 2013
.
.
. ,
.
.
() ,
(nongovernmental investment) .101)
.
,
,
. (TCM) (ethenic minority
medicine) . ,
. , 20
, , ,
, , , , AIDS HIV , , ,
, , , , , , , 1
, , .102)
101) Report on Chinas economic, social development plan, China National Peoples Congress, 2013
102) Report on Chinas economic, social development plan, China National Peoples Congress, 2013
-
4 129
4-9 12 1 (2013)
(NHFPC) - (: )
- , ,
,
- 27.9% .
- 1
240280
- 1 2530
-
-
-
- ()
- ()
-
-
-
- (TCM) (EMM)
-
- 20
2. 12 2
2014 3 5 12 2 2014 3 5 14
. 12 1
. 12 2
.
-
130
.
, ,
(on-the-spot settlement) .103)
, , . 12
5
() 280 320
, 70 90
.
.104)
(medical assistance) ()
. .105)
.
,
.
.
(basic medicines) ,
( )
.106) (GP) ,
.
.107)
103) Report on China's economic, social development plan, China National People's Congress, 2014
104) Report on the Work of the Government, China National People's Congress, 2014
105) Report on China's economic, social development plan, China National People's Congress, 2014
106) Report on China's economic, social development plan, China National People's Congress, 2014
107) Report on the Work of the Government, China National People's Congress, 2014
-
4 131
.
,
.108)
.109) , , ,
.
1 35 . (TCM)
.110)
.
.
. ,
.
.
,111) ()
1,000 () 5
.
.112)
108) Report on China's economic, social development plan, China National People's Congress, 2014
109) Report on China's central, local budgets, China National People's Congress, 2014
110) Report on the Work of the Government, China National People's Congress, 2014
111) Report on China's economic, social development plan, China National People's Congress, 2014
112) Report on the Work of the Government, China National People's Congress, 2014
-
132
.
.
4-10 12 2 (2014)
-
-
- 280
320 , 7090
-
-
-
- ()
- (GP)
-
-
-
-
-
- , , ,
- 1 3035
-
- ,
-
-
-
- () ( 1,000 () 5 )
-
-
-
5
-
5 135
1.
1 20% .
1 3
. 1949
. 1970
.
.
. 2012
2 1 87
, 10% 10%
1/55 .
.
. 2011 73.5
OECD 80.1 12.6 OECD 4.1
. 2010 GDP 5.2% OECD 9.3%
. 1 $432 OECD
$3,339 1/8 . 56.0% OECD
72.0% . , , OECD .
1.5 1.7 OECD 3.2
8.7 . 2.7 OECD 4.8
. MRICT 0.18 0.57
OECD 13.2 23.2 .
1970
.
.
.
90% .
.
-
136
113), , ,
.
.
, .
,
.
.
.
.
.114)
5-1 : (), , 2010
113) .
114) , , , 2011
-
5 137
90%
.
.
.
.
3 2 1
.
,
. 2005 17% 2012 42%
. .
.
.
2 . ,
,
. 1997 2006
. 2
, .
.
. 2012
1 1.94 1.98.
.
, , ,
-
138
.
. .
3
2 1 .
90%
. 1 3
2 1 . 50%
. 2009
.
.
, 3 2 1
. 2012
10.
. 3
, 3 2 1
1 .
2.
2009
(2009-2011)
. 8,500
. ,
, ,
, 5.
3
90% 1
-
5 139
80 120 .
, , ,
.
, ,
.
.
,
.
() 1
, () .
, ()
1 .
(GP)
1
. ()
3
.
.
3 65
TV(CCTV)
. 15 B ,
, ,
, . SARS
. (
1 15/2009, 20/2011).
-
140
.
.
.
, ,
.
.
2011 12 5 ( ) 2009
2011 2012 2015
.
, /
. SARS
.
, ,
2015
20%
. , , () 3
/
.
95% . 2015 1
360 . 75%,
50% .
. , ,
.
-
5 141
.
2015
.
.
.
.
12 5
.
. 3
2 80% .
.
, 2, 3
.
( , , )
()
.
(TCM) ()
.
, ,
.
. (GP)
. 2015 150,000 10,000
2 . ()
.
-
142
3
() (telemedicine)
.
(social capital)
(favorable taxation policies)
.
12 5 12
. 2013 1
.
1 240 280 ,
1 25 30
.
. ()
()
.
.
20
.
2014 2 12 5
. ,
.
280 320
70 80 .
. (GP)
-
5 143
.
, ,
1
30 35 .
.
()
. ()
.
3.
.
. . 2000
15% 2011 95% .
. 2011
8 3,200 97.5%
.
.
.
, , ,
.
.
.
30% ,
.
-
144
. (GP)
,
.
,
.
,
, 15 B , ,
, , ,
, AIDS
. .
2011 90%
98.7%( 98.1%)
. 2011 109
.
2012 18 ,
, 800 () .
, , ,
. ()
.
1980 ,
.
.
. 2012 230
(joint-venture) . 2011
38% .
, (time-phased)
-
5 145
, .
3
.
.
. , 3
.
.
.
. 2, 3 .
.
.
,
.
.
.
.
.115)
115) Lilin Liang, Public Hospital Reform in China, KHA Korea Healthcare Congress, 2012
-
146
.
.
,
.
OECD
.
.
.
.
.
4.
2020
. 2009 2011 3
5 .
, , ,
, .
.
2009 12 5 2012 2015
.
.
-
5 147
.
.
(NPC) 2013 2014 .
.
.
,
, ,
.
.
.
.
.
. (
)
.
. ,
-
148
.
.
(FTA)
.
.
.
.
.
.116)
.117)
.
.
. .
.
.
116) Chinas Healthcare System: Overview and Quality Improvements, Swedish Agency for Growth Policy
Analysis 2013.3
117) 90% .
.
.
-
5 149
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2. , ,
2010 7.
3. , 2013 :
, , 2013
4. . .
. 2013.12.
5. , , . 2013 ,
, 2013
6. . 2009 .
. , 2009.
7. , , ,
2011
8. , , , 2013
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9. , , , 2007
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