《柳叶刀》：近十年中国医疗保健的现况调查

toto

十年以前，中国政府开始启动医疗保健计划，预期将在2020年建立起完整的全民医疗保健体系。最近，一篇由国家卫生部信息统计部门主持的题为“Trends in access to health services and financial protection in China between 2003 and 2011 ，a crossse ctional study”的调查性论文发表在最新一期的《The Lancet》上。文章中就中国从2003年到2011年间的医疗保健的发展情况进行了深入分析探讨。

我们选取了2003、2008、2011年三个年份中国卫生服务调查（NHSS）结果的数据信息。在中国31个省市自治区和直辖市中的2859个县市中采用多阶段分层整群随机抽样的方法抽取了94个县市作为中心进行调查。由于在2009年4月，中国宣布了旨在扩大医疗服务、促进医疗公平、提高医疗质量的医改计划。因此我们采用了2011年期间具有代表性的NHSS调查的数据与03和09年进行统计学上的对比。

主要的三个衡量趋势的指标为——医保覆盖率 ，医保使用率和医疗支出。相关的统计结果也按照农村与城市；东部，中部与西部；还有家庭社会经济地位的区别分别进行了统计学上的分析。参加此次调查的家庭数目如下：2003年57023户，2008年56456户，2011年为18822户；应答率分别为98.3%， 95.0%和95.5%；总计调查人数情况如下：2003年193689人，2008年177501人，2011年59835人。

结果表明，这近十年间，医保的覆盖率从29.7%上升到95.7%（p<0.0001）。报销医疗费用的平均值从从03年的14.4元（13.7-15.1）上涨到2011年的46.9 （44.7-49.1） （p<0.0001）患者的住院率也从从2003年的3.6%增加到2011年的8.8%，十年增加2.5倍（P <0.0001）。在2011年，12.9% 的家庭购买了灾难性卫生支出的保险。另外，这十年间，剖宫产率也从19.2%增加至36.3%（P <0.0001）。

文章最后总结，伴随着医保使用率的增加，住院率和保险报销也是水涨船高。目前国家也已经出台了关于异地报销等实际问题的的一些重要措施，中国医疗保健体系未来更应该关注的是高效率和更优质的医疗质量。

xiaochen23216

什么都在涨，就是没涨过工资，牢骚一下哈！

cxx80_0

有些因为没钱好多拖了好多年的病，之前一直在熬，因为有了医保才勉强能应付过去。

金陵

希望老百姓将来能享受到更优质的医疗资源。

倚天屠龙

这篇文章很好呀，有没有原文呢？
我想看看，正好我的毕业论文估计会用得到的。这个算是很权威的数据了。

倚天屠龙

Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study.

Meng Q, Xu L, Zhang Y, Qian J, Cai M, Xin Y, Gao J, Xu K, Boerma JT, Barber SL.


Source

Centre for Health Statistics Information, Ministry of Health, People's Republic of China.


Abstract

BACKGROUND:

In the past decade, the Government of China initiated health-care reforms to achieve universal access to health care by 2020. We assessed trends in health-care access and financial protection between 2003, and 2011, nationwide.

METHODS:

We used data from the 2003, 2008, and 2011 National Health Services Survey (NHSS), which used multistage stratified cluster sampling to select 94 of 2859 counties from China's 31 provinces and municipalities. The 2011 survey was done with a subset of the NHSS sampling frame to monitor key indicators after the national health-care reforms were announced in 2009. Three sets of indicators were chosen to measure trends in access to coverage, health-care activities, and financial protection. Data were disaggregated by urban or rural residence and by three geographical regions: east, central, and west, and by household income. We examined change in equity across and within regions.

FINDINGS:

The number of households interviewed was 57,023 in 2003, 56,456 in 2008, and 18,822 in 2011. Response rates were 98·3%, 95·0%, and 95·5%, respectively. The number of individuals interviewed was 193,689 in 2003, 177,501 in 2008, and 59,835 in 2011. Between 2003 and 2011, insurance coverage increased from 29·7% (57,526 of 193,689) to 95·7% (57,262 of 59,835, p<0·0001). The average share of inpatient costs reimbursed from insurance increased from 14·4 (13·7-15·1) in 2003 to 46·9 (44·7-49·1) in 2011 (p<0·0001). Hospital delivery rates averaged 95·8% (1219 of 1272) in 2011. Hospital admissions increased 2·5 times to 8·8% (5288 of 59,835, p<0·0001) in 2011 from 3·6% (6981 of 193,689) in 2003. 12·9% of households (2425 of 18,800) had catastrophic health expenses in 2011. Caesarean section rates increased from 19·2% (736 of 3835) to 36·3% (443 of 1221, p<0·0001) between 2003 and 2011.

INTERPRETATION:

Remarkable increases in insurance coverage and inpatient reimbursement were accompanied by increased use and coverage of health care. Important advances have been made in achieving equal access to services and insurance coverage across and within regions. However, these increases have not been accompanied by reductions in catastrophic health expenses. With the achievement of basic health-services coverage, future challenges include stronger risk protection, and greater efficiency and quality of care.

FUNDING:

None.

Copyright &Acirc;&copy; 2012 Elsevier Ltd. All rights reserved.


Comment in
Lancet. 2012 Mar 3;379(9818):782-3.
Lancet. 2012 Mar 3;379(9818):777.