Our country is a developing country with the vast majority of the rural population. How to deepen the reform of the rural health system, promote the development of rural health services, and improve the health of rural residents is directly related to the realization of the strategic goals of national economic and social development, and is related to the rural society.

Stablize.

Our country has been piloting medical reform since 1994, and in 1998 the medical reform entered the organizational and implementation stage.

In July 2000, the National Working Conference on the Reform of the Basic Medical Insurance System for Urban Employees and the Medical and Health System was held, and the reform of the rural medical and health system was fully launched.

However, overall, the reform has achieved little success, and rural health work is still relatively weak, with many problems and new challenges.

1. Several issues plaguing the reform of my country’s rural medical and health care system. Since the founding of the People’s Republic of China, rural health services have made great progress. The rural health service network at the three levels of county, township and village, the cooperative medical system and the construction of rural health teams have all achieved remarkable results. It has played an important role in ensuring the health of rural residents and promoting rural economic development and social progress.

However, with the continuous deepening of my country's economic system reform and the gradual establishment of the socialist market economic system, the original rural medical and health care system based on the collective economy has lost its vitality, and farmers' medical care has seriously lagged behind my country's economic development. .

1. Rural public health investment is seriously insufficient.

The growth of rural public health expenditures is mainly driven by the growth of personnel expenses, while public expenses and business expenses have almost no growth or even declined.

Among the public and business expenses for rural public health, government expenditures have gradually declined. The public and business expenses have dropped from 258 million yuan in 1991 to 184 million yuan in 2000. Excluding price factors, the average annual growth rate is

-10.7%; causing public health institutions to "generate income" through "paid services" to solve the problem of insufficient funds for business activities (see Appendix 1 [1]).

Rural grassroots preventive health care services are severely underfunded, and preventive health care work has been weakened. Some infectious diseases, parasitic diseases, and endemic diseases that have been eliminated or controlled have rebounded in some places, and new diseases have also emerged to varying degrees.

Popularity.

Appendix 1: Analysis of trends in the structure of rural public health expenditures 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Total government public health expenditures 7.49 8.27 9.14 11.40 12.70 13.90 15.68 17.33 17.67 19.66 Personnel expenses 3.70 4.68

5.49 7.69 8.67 9.96 11.48 13.45 15.21 17.49 Official and business expenses 2.58 2.12 2.08 2.10 2.21 2.15 2.01 2.05 2.10 1.84 Project subsidies 1.21 1.48 1.58 1.61 1. 82 1.80 2.19 1.83 0.36 0.32 2. The distribution of health resources is unreasonable, and the health status of farmers is obviously lower than that of urban residents.

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The allocation of health resources in my country is seriously unreasonable. According to statistics, the total national health expenditure in 1998 was 377.65 billion yuan, of which government investment was 58.72 billion yuan, while the health expenditure in rural areas was 9.25 billion yuan, accounting for only 15.9% of the government investment. .

At that time, the urban population was about 379 million, and each person enjoyed government medical and health services equivalent to 130 yuan on average; the rural population was 866 million, and each person enjoyed government medical and health services equivalent to 10.7 yuan on average. The former was 13% of the latter.

times.

The problem of farmers lacking medical care and medicine is serious. Zhu Qingsheng, Vice Minister of Health, said that many people in rural China are indeed unable to afford medical treatment.

According to statistics and rural survey results, it is estimated that 40%-60% of people have become poor or returned to poverty due to illness because they cannot afford medical treatment.

In the central and western regions of China, it is estimated that 60%-80% of people die at home due to illness because they cannot afford to see a doctor or stay in a hospital [2].

The World Health Organization usually uses three indicators to measure the health level of residents of a country (or region), namely maternal mortality rate, infant mortality rate and average life expectancy.

According to statistics from the Ministry of Health, there is a significant gap between urban and rural maternal and child mortality rates in my country (Appendix Table 2[3]).

Urban maternal mortality rate in 2002 Appendix 2: Total maternal and child mortality rate in monitored areas Urban and rural areas 2001 2002 2001 2002 2001 2002 Maternal mortality rate (1/100,000) 50.2 43.2 33.1 22.3 61.9 58.2 Neonatal mortality rate (‰

) 21.4 20.7 10.6 9.7 23.9 23.2 Infant mortality rate (‰) 30.0 29.2 13.6 12.2 33.8 33.1 Mortality rate of children under 5 years old (‰) 35.9 34.9 16.3 14.6 40.4 39.6 The maternal mortality rate is 58.2/10

million, which is 2.6 times higher than that in urban areas; the urban infant mortality rate is 12.2‰, while the rural infant mortality rate is 33.1‰, which is 2.7 times higher than that in urban areas.