我国农村卫生改革政策系统回顾及绩效评价研究  

Performance Evaluation on Healthcare Reform Policy in Rural China: A Systematic Review

作　　者：黄玉珊[1,2] 曾林淼[2] 李幼平[1] 周新伟[2] 刘鹏[2] 钟大可[1] 

机构地区：[1]四川大学华西医院中国循证医学中心,成都610041 [2]井冈山大学医学院,江西吉安343000

出　　处：《中国循证医学杂志》2012年第3期293-304,共12页Chinese Journal of Evidence-based Medicine

基　　金：美国中华医学基金会(CMB)西部卫生政策循证研究中心项目;江西省科技厅科技支撑项目(编号:20111BBG70029-2)

摘　　要：目的系统回顾和总结我国建国62年农村卫生改革政策,评价各阶段改革绩效。方法采用PICOS要素构建研究问题,系统收集我国农村卫生改革的国、部级政策文件,分阶段分析每一阶段的主要卫生问题和采取的主要改革措施,并以人群健康指标、农村卫生人力和基础设施指标、卫生费用指标及全国卫生服务调查结果为标准,评价各阶段的改革绩效。结果共纳入与我国农村卫生改革相关的国家级政策法规396篇。按照文献计量结果,参照我国经济体制改革阶段性特点,结合医疗改革实际进展情况,可将我国农村卫生改革进程划分为国民经济恢复和经济调整时期(1949～1965)、文化革命时期(1966～1976)、经济体制转型初期(1978～1984)、医改初期(1985～1996)、医改中期(1997～2001)和新农合实施期(2002～2011)等6个阶段。除文革阶段外,其余5个阶段年均政策量均逐年递增,提示政府关注农村医疗卫生改革的力度逐年增大,但整体呈现"重医轻药、最轻医保"的分布特点。人群健康指标、农村每千人口医院床位数和卫技人员数持续增长,有逐渐改善的趋势。但市场机制的引入和国际经济形势的影响,导致卫生保健服务公益性下降,个人支出占卫生总费用比例上升,部分政策内容出现反复。结论公益性导向是健全和完善农村医疗卫生服务体系的基本原则,需科学总结前期政策绩效,结合当前国情、未来需求,循证决策,并在执行过程中提升绩效。Abstract Objective To systematically review and conclude the healthcare reform policy in rural China through- out the past 62 years. Method This study was applied with PICOS structure to formulate research issues. National/min- istry policies and documents on healthcare reform in rural China were systematically collected. The primary healthcare issues and healthcare reform measures carried out at each stage were studied, and, the criteria as population healthcare indicators, indicators for healthcare workforce and infrastructure in rural areas, healthcare expenditure indicators, and the results of national surveys for healthcare service were used to evaluate the reform performance achieved at each stage. Re- sult A total 396 national policies on healthcare reform in rural China were included through comprehensive search. In accordance with the results of quantitative analysis on literatures, characteristics of economy system reform at each stage as well as actual advancement on healthcare reform, the reform courses of healthcare system in rural China in this study were divided into six periods as follows： national economy recovery and adjustment period, cultural revolution period, early stage of economy system transition, initial stage of healthcare reform, middle stage of healthcare reform, and imple- ment stage for new rural cooperative medical system （NRCMS）. The average policies of each period increased year by year, which generally showed as features as laying more emphasis on medical services than medicine, and thinking little of medical insurance. The population health indicators, sickbeds per thousand rural population and medical practitioners kept improving gradually. Yet the import of market mechanism and influence of international economy condition led to the decline in public welfare of healthcare system, increase of personal expenditure proportion among general healthcare cost, and duplicate content among some po!ices. Conclusion Commonwealth orientation is the fundamental principal to fu

关 键 词：中国 农村卫生 政策研究 绩效评估 

分 类 号：R197.1[医药卫生—卫生事业管理]