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近年来,在市场运作的基础上,由于优胜劣汰,导致大医院和一批专科医院技术水平越来越高,设备条件越来越高尖,优秀人才越来越集中,而基层医疗机构,尤其是乡镇医院、城市社区及部分二级医院受到各种制约和得不到政府支持,发展缓慢,逐渐萎缩,甚至到了无法生存的地步。有人统计,目前全国80%以上的医疗资源集中在城市,其中30%以上集中在大城市。医疗卫生服务出现两级分化,公平性大降。有数据显示:2000年WHO在成员国卫生筹资和分配公平性的排序中,中国位居第188位(共191成员,排倒数第4位)。2003年卫生部组织卫生调查结果显示,每年有接近48.9%的病人应就诊而不就诊,29.6%的病人应住院而不住院。不言而喻,看病贵是低收入人群无力求医的主要症结[1]。
In recent years, based on the operation of the market, due to the survival of the fittest, the technical level of large hospitals and a number of specialized hospitals has become higher and higher, the conditions of equipment have become more and more sophisticated, and excellent talents have become more concentrated. The primary medical institutions, especially Township hospitals, urban communities, and some secondary hospitals are subject to various constraints and lack of government support. The development is slow and gradually shrinking, even to the point where they cannot survive. According to statistics, more than 80% of medical resources in the country are concentrated in cities, and more than 30% of them are concentrated in big cities. There are two levels of differentiation in medical and health services, and fairness is greatly reduced. According to statistics, in the ranking of WHO’s equity in health financing and distribution in member countries in 2000, China ranked 188th (191 members, 4th lowest). The results of a health survey organized by the Ministry of Health in 2003 showed that nearly 48.9% of patients should visit the hospital each year without visiting the clinic, and 29.6% of the patients should be hospitalized without hospitalization. It is self-evident that expensive medical care is the main cause of low-income people’s inability to seek medical care [1].