중국의 보건의료제도 및 최근 개혁동향image.kma.org/2015/04/2015041502.pdf ·...

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

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

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

1 3

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. 1949

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.

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OECD . 2011

73.5 OECD 80.1 1,000

12.6 OECD 4.1 . 2010 GDP

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OECD .

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2011 13 4,735 1.

20% . 14 26.5%, 15-64 74.4%, 65

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(49%).

. 100

127 .

(urbanization) ,

1949 7% 2011 51% . 56

(ethnic groups) 91.6% () . 2011

(floating population)1) 2 3 . 2011

105.18( 100.00 ) .2) ()

9,561km2 43 4 .3)

, 1949 (The People's Republic of China, PRC)

.

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1978

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. 1978 2011 (gross domestic product, GDP)

9.6%. 2012 (IMF)

1)

2) China Health Service Delivery Profile, WHO & China NHDR 2012

3) China-WHO Country Cooperative Strategy 2013-2015

10

$8 2,500 2. 100 1

, $6,071 87 .

10% 10% 55

.

.

2 11

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( )

(National People's Congress, NPC)4) (

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: , 2007

2 17

2-3

18

2-4 () : , 2012

2 19

4

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 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 .

.

. 1 ,

24, 3

.

, . ,

,

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) , ,

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21) (4)- . . 2006.11.17

3 29

,

. (Township Health Centers)

.

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. ()

(, , , )

. , , 4

1 , 2 4 (60 )

( )

. , , (),

, () . () () () ,

() ()

. , , . (

), ()

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3-3).23)

22) . . . 2013.12.

23) . . . 2013.12.

30

( )

(/, Mediastinus) -

(, Resident) - , 1

(, Attending Physician) - 4~5() -

(, Associate Senior Doctor)

- 7

(, Chief Physician) - 5

3-3

.

: , 2013

.

1) (BME)

, , , , , ,

, 8 16 .

.24)

3 () -

5/6

()2 + ()2 (6 1 )

( )

7 5 +( ) +

8 ( ) ++

3-4

: , 2013

24) . . . 2013.12.

3 31

2) (GME)

5 , 1

.

, .

, , .25)

3) (CME)

, (,

, , ) ,

.26)

2.

, ,

.

. ,

, ()

.

. , ,

.

. .27)

,

.

. .

25) . . . 2013.12.

26) . . . 2013.12.

27) (6)-, , 2006

32

.

,

. ,

.

.

. .28)

3.

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 )


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)


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.


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


Analysis 2013.3

48

5

1. ()

1970

.

.

.37)

.

. ,

. .

. 38)

1950 , ,

, , , .

, , ,

.39) .

. 1953

.

.

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)


Analysis 2013.3


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


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.


Analysis 2013.3

55) , , 2010 7.

56) , , 2010 7.

57) : , , 2012


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.


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.


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)


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

. ,

.


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)



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 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) , ,

.80)

. 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)

() . (practitioner)

(private practice) .

2)

(GP) (licensed doctors)

. 3 360,000, 160,000, 137

() , , ()

. . 382)

82) 3 , 3 500 () ,

, , 2

49-100 , 1 20-99 . 2

1 3 , ,

.

4 83

3 () ()

. 10,000

. ()

. (CDC)

, (senior qualification)

1 .

. 2009

() 3

.

3)

(service charge)

(government subsidies) .

.

, .

.

.

4)

, , . (Chinese traditional medicines) -

. ()

(mobile)

.

(door-to-door) .

84

(community gatekeeper system)

.

.

1)

. 2009

. 65 , 3

. , ,

, HIV/AIDS,

. (health knowledge) , (CCTV)

2009

.

2)

AIDS ,

, ,

. 2009 : 15

B , (coal-burning

fluorosis hazards),

, , .

3)

, , (health inspection),

4 85

.

, .

.

, , ,

.

4)

, ,

.

.

.

. 1 2009

15 , 2011 20 .

.

.

1) ( )

.

.

. 80%

,

.

. , ,

,

.

.

86

.

. , , ,

. ,

.

,

(medical insurance agencies), (social appraisal

agencies), (representatives of the people),

. - ,

.

(supervision) .

2)

,

, 3 ,

, 2 .

(infrastructure), , (discipline) ,

. (preferential investment policies) ,

, , ,

. , ,

.

.

(pharmaceutical service fees) , ,

.

.

.

,

4 87

-

3 90%

-

1 80120

-

, , , ,

- , ,

-

-

-

3 2,000 () () 1

29,000 ()

5,000 () ( 1-3 )

3 () 1

3,700 11,000

2,400

.

.

3)

(social-sector

run medical institution) . ,

.

. ,

. 2009

2011 .

4-1 2009

88

()

(private practice)

-

(GP)

, , 36 , 16 ,137

1

3

-

-

, ,

-

3 65

TV(CCTV)

-

15 B

-

-

( 1 2009 15, 2011 20

)

4 89

- ( )

-

, , , ,

, , ,

-

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)


Affairs 2012(11):2356-2544


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)


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.


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%) .


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% .

, , (),

.


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




4 131

.

,

.108)

.109) , , ,

.

1 35 . (TCM)

.110)

.

.

. ,

.

.

,111) ()

1,000 () 5

.

.112)


109) Report on China's central, local budgets, China National People's Congress, 2014




132

.

.

4-10 12 2 (2014)

-

-

- 280

320 , 7090

-

-

-

- ()

- (GP)

-

-

-

-

-

- , , ,

- 1 3035

-

- ,

-

-

-

- () ( 1,000 () 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)

.

.

. .

.

.


Analysis 2013.3

117) 90% .

.

.

5 149

1. , : () 2009 10

2. , ,

2010 7.

3. , 2013 :

, , 2013

4. . .

. 2013.12.

5. , , . 2013 ,

, 2013

6. . 2009 .

. , 2009.

7. , , ,

2011

8. , , , 2013

9 3.

9. , , , 2007

10. : , , 2012

11. 2009 . .

, 2009.

12. (4)- . . 2006.

11.17

13. (6)-, , 2006

14. , , 2012.1.3.

15. 2012 China National Health Accounts Report. China National Health

Development Research Center.

16. Bloom G. Primary health care meets the market in China and Vietnam.

Health Policy 1998;44:232-52.

150

17. CCCP & State Council: The Opinion of Deepening Health Care System

Reform, China Issue No.6, 2009

18. Chen Zhu. Early Results of China's Historic Health Reforms: The View

From Minister Chen Zhu, Health Affairs 2012(11):2356-2544

19. China Health Service Delivery Profile, WHO & China NHDR 2012

20. China Statistical Yearbook 2013

21. Chinas Healthcare System: Overview and Quality Improvements,

Swedish Agency for Growth Policy Analysis 2013.3

22. China Health Statistics 2013

23. China-WHO Country Cooperative Strategy 2013-2015

24. 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.

25. Duckett J. Political interests and the implementation of Chinas urban

health insurance reform. Social Policy and Administration 2001;

35:290-306.

26. Duckett J. Polictial Interests and Implementation of Chinas Urban

Health Insurance Program, Social Policy and Administration

2001;35(3):3-28.

27. Feng-Jen Fan, Hospital Accreditation in China, Overview of Healthcare

Accreditation from External Evaluation Organizations, Asian Society

for Quality in Health Care, 2013

28. Five Key Tasks in Health Care Reform in China, Chinese Medical

Association(CMA)

29. Helen Chen & Yanyan Lin. The Rise of Private Health Insurance, China

Economic Review 2012.3.27

30. Hsiao WC, Jamison DT, McGreevey WP, Yip W. Financing Health Care:

5 151

Issues and Options for China. Washington, DC: World Bank.1997.

31. Hsiao WC. The Chinese Health Care System: lessons for other nations.

Social Science and Medicine 1995;41:1047-55.

32. Hsiao WC. The political economy of Chinese health reform. Health

Economics, Policy and Law 2007;2: 241-9.

33. Huang Y. An institutional analysis of Chinas 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.

34. Liberthal K, Lampton D.Bureaucracy, Politics and Decision Making in

Post-Mao China. Berkeley, CA: University of California Press. 1992.

35. 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.

36. M.Ramesh, Xun Wu, Alex Jingwei He. Health governance and healthcare

reforms in China. Health Policy and Planning 2013;1-10

37. Report on Chinas central, local budget, China National Peoples

Congress, 2013

38. Report on Chinas economic, social development plan, China National

Peoples Congress, 2013

39. Report on Chinas central, local budgets, China National Peoples

Congress, 2014

40. Report on Chinas economic, social development plan, China National

Peoples Congress, 2014

41. Report on the Work of the Government, China National Peoples

Congress, 2014

42. Sarah L Barber & Lan Yao. Health Insurance System in China: A

Briefing Note. WHO, 2010

152

43. State Council, White Paper on Medical and Health Services in China,

2012

44. State Council: Deepening Healthcare System Reform in the Twelfth-

Five Year Plan and Its Implementation Program. China Issue No. 11,

2012

45. 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.

46. The Twelfth Five-Year Plan for Health Sector Development, China,

2012

47. Tsui, L. Medical Insurance in China: How is it different from India?,

Medical Insurance in China Global Conference of Actuaries. Numbai,

India 2010

48. Zhu Chen, Progress and Prospect of Health Care Reform in China, 2012

/ 2015 3

/

/

46 33 () (:140-721)

TEL : 02)6350-6663 / FAX : 02)795-2900

.

.

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Transcript of 중국의 보건의료제도 및 최근 개혁동향image.kma.org/2015/04/2015041502.pdf ·...