| 引用本文：胡敏, Winnie C-M Yip, 陈文, 萧庆伦.农村通向全民健康覆盖的障碍及其原因分析——基于供需双方经济激励机制角度[J].中国卫生政策研究,2014,7(8):4-8 |
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| 农村通向全民健康覆盖的障碍及其原因分析——基于供需双方经济激励机制角度 |
| 投稿时间：2014-06-25 修订日期：2014-07-23 PDF全文浏览 HTML全文浏览 |
| 胡敏1, Winnie C-M Yip2, 陈文1, 萧庆伦3 |
1. 复旦大学公共卫生学院 上海 200032;
2. 牛津大学布拉瓦尼克政府学院 英国牛津 OX1 4JJ;
3. 哈佛大学公共卫生学院 美国波士顿 02115 |
| 摘要:以宁夏回族自治区为案例，本研究对五个样本县进行大规模家庭入户调查、乡镇卫生院和村卫生室机构调查，分析了西部农村通向全民健康覆盖之路的障碍，并从供需双方经济激励机制角度剖析其原因。分析认为西部农村面临基层门诊服务可及性不足，居民经济负担沉重；服务流向不合理，资源配置效率低下；基层供方服务技术效率和质量不佳等问题。造成这些障碍的原因包括：从需方角度来看，新农合保障“轻门诊重住院、轻基层重高层”的特点；从供方角度剖析，对村医经济激励效力低下，按项目付费提供不恰当的经济刺激，难以引导供方提高自身服务效率和质量，以及欠缺促进体系整合的激励。 |
| 关键词:农村 全民健康覆盖 障碍 原因 经济激励机制 |
| 基金项目:盖茨基金会项目（OPPGH5252）；国家社会科学基金重大项目（11&ZD176） |
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| Barriers to universal health coverage in rural areas and causes：The economic incentives of supply and demand |
| HU Min1, Winnie C-M Yip2, CHEN Wen1, William Hsiao3 |
1. School of Public Health, Fudan University, Shanghai 200032, China;
2. Blavatnik School of Government,University of Oxford, Oxford OX1 4JJ, UK;
3. Harvard School of Public Health, Boston MA 02115, USA |
| Abstract:Research conducted on a large-scale household survey of 5 sample counties, and institution surveys on township healthcare centers and village clinics in the Ningxia Hui Autonomous Region have been adopted to describe the barriers to universal health coverage in rural areas. Fundamental issues where thereby discovered from the perspectives of the economic incentives of supply and demand. Issues persist in the poor access to basic outpatient services and the heavy financial burden on patients, irrational service flows to medical institutions at different tiers, resulting in low allocative efficiency, low technical efficiency and a poor quality of basic healthcare. These issues result from a benefit package that is prioritized towards inpatient services and higher tier hospitals, low-power incentives for village physicians, perverse incentives incurred by fee-for-service plans, a lack of financial factors for improving service efficiency or quality and incentives to promote system integration. |
| Key words:Rural areas Universal health coverage Barriers Causes Economic incentives |
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