21世纪全面开展初级卫生保健的思考与建议

Policy Recommendations on the Wide Expansion of Primary Health Care in China in the 21st Century

从我国当前的国力和国际经验来看,我国在21世纪仍然特别需要采取低成本、广覆盖与高产出的卫生发展战略,需要富有远见和创新精神的卫生制度设计。通过立法保障和普及初级卫生保健,保证城乡居民公平享有基本卫生服务,保障全体公民的基本健康权利,是解决当前广大群众“看病难、看病贵”问题的可行策略,是符合我国国情、尽快改善卫生公平性、控制医疗费用过快上涨和提高人民健康水平的最佳制度选择,也是推动卫生改革和体制创新的关键举措。建议通过立法构建我国21世纪初级卫生保健体系,将卫生工作的重点从医疗服务转到疾病预防,将卫生资源从过度的医院服务转向普及基层的初级卫生保健服务,并对相关的社会、环境、行为和心理等健康危险因素进行干预。在大力控制传染病、地方病的同时,尽快建立控制慢性非传染性疾病的能力,防止国家、社会和家庭在未来付出更高的健康损失和经济代价;建议我国未来的卫生服务大体上由“两层服务体系”提供,即初级卫生保健层次和转诊服务层次,逐步实现居民人人享有的“双重健康保障”,即:所有公民享有基本卫生服务和基本医疗保险。

Based on the current national capacity and international experience it is concluded that China should take strategies for health development with low cost, wide coverage and high outcomes. This needs an innovative health institutional design with a foresight. To ensure and expand primary health care （PHC） in China through legislation is a wise policy choice suitable to the current situation of the country, in favor of health equity and cost control, and important for health status improvement for the population. The article suggests establishing a nation-wlde PHC system in China by legislation, re-orientating health priorities from curative to preventive services, shifting health resources from excessive hospital care to primary care at grassroots levels, and carrying out interventions on social, environmental, behavioral and psychological risk factors. When continuing its efforts in the control of infectious and endemic diseases China should build capacity for coping with the increasing non-communicable chronic illness in order to avoid future health loss and economical burden on family, community and the country. It is recommended that the future health system be consisted of two layers： primary health care and referral care, and all residents be assured of equal access to two-fold health safeguards, i.e. essential health care for all and universal coverage of basic health insurance. The study concluded that to promote PHC legislation for ensuring equal access to essential health care by all rural and urban residents and guaranteeing their basic health rights is a feasible solution to the existing health problems as people complained that it is difficult to seek and unable to afford health care. This will be a crucial step for health reform and system innovation. To expand PHC to all parts of China is an advisable strategy for improving health equity, responding to current health challenges and investing to the future of China. It is also the only way to realize the goal of health for all under a harmonious society.