中国初级卫生保健的现状与挑战

The Status and Challenges of Primary Health Care in China

本文系统梳理了我国45年来初级卫生保健发展历程,利用2010—2012年《中国卫生统计年鉴》、2013—2017年《中国卫生和计划生育统计年鉴》和2018—2022年《中国卫生健康统计年鉴》基层卫生相关数据、2023年世界银行中国和中高低收入国家婴儿死亡率、孕产妇死亡率和平均期望寿命等数据,总结我国初级卫生保健实施进展和成就。我国初级卫生保健发展历程分四个阶段,取得成效包括初级卫生保健网络逐步健全、基本医保覆盖全民、基本公共卫生服务内容经费和覆盖面逐步扩大、家庭医生签约覆盖率稳步提升、妇女和儿童健康水平持续提高,主要健康指标位居中高收入国家前列。目前仍面临基层医疗卫生体系基础设施建设发展不平衡、医保资金比重下降、运行机制缺乏活力、薪酬水平低激励不足等问题。本文总结了国际经验对中国初级卫生保健的启示,提出了未来发展方向和策略。

This paper systematically reviewed the process of primary health care development of China over the past 45 years,and summarized the achievements of primary health care based on data related to primary health care draw from 2010-2012 China Health Statistics Year book,2013-2017 China Health and Family Planning Statistical Yearbook and 2018-2022 China Health Statistics Year book.Data of the infant mortality rate,maternal mortality rate,and average life expectancy were from the World Bank in China and upper middle income countries in 2023.The development of primary health care of China was summarized into four phases,and the achievements included the improvement of the primary health care network,coverage expansion of basic health insurance,the increase of funding and coverage of basic public health services,the steady improvement of family doctor contracts,and the continuous improvement of women's and children's health,with major health indicators ranking among the top upper middle-income countries.The current challenges include the unbalanced development of infrastructure construction in the primary medical and health system,the decline in the proportion of medical insurance funds,the lack of vitality of the management system,the low level of remuneration and imperfect incentive system.This paper summarizes the enlightenment of international experience for China's primary health care,and puts forward the future development directions and strategies.