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  • Title: Health care in China: a rural-urban comparison after the socioeconomic reforms.
    Author: Shi L.
    Journal: Bull World Health Organ; 1993; 71(6):723-36. PubMed ID: 8313490.
    Abstract:
    This article provides an overview of the current Chinese health care system with particular emphasis on rural-urban differences. China's post-1978 economic reforms, although they improved general living standards, created some unintended consequences, as evidenced by the disintegration of the rural cooperative medical system and the sharp reduction in the number of "barefoot doctors", both of which were essential elements in the improvement of health status in rural China. The increase in the elderly population and their lack of health insurance and pensions will also place enormous pressure on services for their care. These changes have disproportionately affected the rural health care system, leaving the urban system basically intact, and have contributed to the rural-urban disparity in health care. Based on recent data the article compares current rural-urban differences in health care policy, systems, resources, and outcomes, and proposes potential solutions to reduce them. China has made significant achievements in reducing mortality, increasing life expectancy, and providing primary health care. Hospital medical costs show an increase of 30-50% annually during 1978-90. Charges include 29-63% of actual costs of services for outpatients, in-patients, and operations. This paper portrays a view of the Chinese health care system and urban-rural differences. An overview and statistical support is given for health care resources of personnel and beds during 1949-87. Current major problems are identified as funding variability between local and provincial areas and urban-rural disparity in health outcomes and access to care. The most adversely affected are the rural elderly. The cost of medical services has increased, and many rural populations lack health insurance or pensions. A major policy change occurred in 1978 with a shift to a fee for service system rather than a barefoot doctor supported cooperative medical system. The health system now is comprised of a State Council which controls 30 provinces. County governments, which supervise township governments or the former people's communes, are lower units followed by the village unit (the former brigade). Each province has about 71 counties. Each county has about 25 townships. Each township has about 14 villages of about 1000 population. Every level of government has hospitals and other specialized health units, but the main levels are care are at the village, township, and county levels. Provincial and lower levels are responsible for their own finances. A reward-penalty system operates in urban hospitals. Health care spending, resource allocation, and distribution of facilities and professionals varies widely between rural and urban areas. Differences in health outcomes are apparent, and urban residents have a better health status. Health insurance coverage is assured for most of urban government employees, college communities, and state enterprises with over 100 employees, which means most working people in urban areas. The rural elderly are the most affected by the changes. There is a need for a new elderly support system, a universal and compulsory system of financing, and evaluation of health professional needs.
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