——基本公共衛(wèi)生服務均等化水平明顯提高。國家免費向全體居民提供國家基本公共衛(wèi)生服務包，包括建立居民健康檔案、健康教育、預防接種、0—6歲兒童健康管理、孕產婦健康管理、老年人健康管理、高血壓和II型糖尿病患者健康管理、重性精神疾病患者管理、傳染病及突發(fā)公共衛(wèi)生事件報告和處理、衛(wèi)生監(jiān)督協(xié)管等10類41項服務。針對特殊疾病、重點人群和特殊地區(qū)，國家實施重大公共衛(wèi)生服務項目，對農村孕產婦住院分娩補助、15歲以下人群補種乙肝疫苗、消除燃煤型氟中毒危害、農村婦女孕前和孕早期補服葉酸、無害化衛(wèi)生廁所建設、貧困白內障患者復明、農村適齡婦女宮頸癌和乳腺癌檢查、預防艾滋病母嬰傳播等，由政府組織進行直接干預。2011年，國家免疫規(guī)劃疫苗接種率總體達到90%以上，全國住院分娩率達到98.7%，其中農村住院分娩率達到98.1%，農村孕產婦死亡率呈逐步下降趨勢。農村自來水普及率和衛(wèi)生廁所普及率分別達到72.1%和69.2%。2009年啟動“百萬貧困白內障患者復明工程”，截至2011年，由政府提供補助為109萬多名貧困白內障患者實施了復明手術。

圖71990—2011年全國農村住院分娩率(%)與孕產婦死亡率(1/10萬)變化趨勢

Access to basic public health services has become more equitable. The state provides all residents with a free package of 41 basic public health services in ten categories, including health record, health education, preventive inoculation, healthcare for children under six, healthcare for pregnant and lying-in women, healthcare for elderly people, treatment for hypertension and type II diabetes patients, healthcare for severe psychosis patients, reporting and handling of infectious diseases and public health emergencies, and healthcare supervision and coordination. Targeting special diseases, key groups and special areas, the state has launched key public health service programs, including subsidizing rural pregnant women for hospitalized childbirth, re-vaccinating people under 15 against hepatitis B, eliminating fluorosis caused by coal burning, supplementary taking of folic acid by rural women before pregnancy and in the early stage of pregnancy, building sanitary toilets, cataract removal for poor patients, cervical and breast cancer tests for rural women within eligible age, and preventing mother-to-child transmission of AIDS. In 2011, the inoculation rate of the National Immunization Program (NIP) exceeded 90%; the rate of hospitalized childbirth nationwide reached 98.7% (98.1% in rural areas); and the maternity mortality rate in rural areas kept going down. In the rural areas, 72.1% of the population had access to tap water and 69.2% had access to sanitary toilets. In 2009, the government launched a program to provide cataract operations for a million poor patients, and by 2011 more than 1.09 million such people had had such operations with government subsidies.

　　Medical and Health Services in China-Figure 7: Rural hospitalized childbirth rate (%) and rural maternal mortality rate (one in 100,000) from 1990 to 2011, according to a white paper released by the Information Office of the State Council on Dec. 26, 2012. (Xinhua)

    ——公立醫(yī)院改革有序推進。從2010年起，在17個國家聯(lián)系試點城市和37個省級試點地區(qū)開展公立醫(yī)院改革試點，在完善服務體系、創(chuàng)新體制機制、加強內部管理、加快形成多元化辦醫(yī)格局等方面取得積極進展。2012年，全面啟動縣級公立醫(yī)院綜合改革試點工作，以縣級醫(yī)院為龍頭，帶動農村醫(yī)療衛(wèi)生服務體系能力提升，力爭使縣域內就診率提高到90%左右，目前已有18個省(自治區(qū)、直轄市)的600多個縣參與試點。完善醫(yī)療服務體系，優(yōu)化資源配置，加強薄弱區(qū)域和薄弱領域能力建設。區(qū)域醫(yī)學中心臨床重點?？坪涂h級醫(yī)院服務能力提升，公立醫(yī)院與基層醫(yī)療衛(wèi)生機構之間的分工協(xié)作機制正在探索形成。多元化辦醫(yī)格局加快推進，鼓勵和引導社會資本舉辦營利性和非營利醫(yī)療機構。截至2011年，全國社會資本共舉辦醫(yī)療機構16.5萬個，其中民營醫(yī)院8437個，占全國醫(yī)院總數(shù)的38%。在全國普遍推行預約診療、分時段就診、優(yōu)質護理等便民惠民措施。醫(yī)藥費用過快上漲的勢頭得到控制，按可比價格計算，在過去三年間，公立醫(yī)院門診次均醫(yī)藥費用和住院人均醫(yī)藥費用增長率逐年下降，2011年比2009年均下降了8個百分點，公立醫(yī)院費用控制初見成效。

    新一輪醫(yī)改給中國城鄉(xiāng)居民帶來了很大實惠?；竟残l(wèi)生服務的公平性顯著提高，城鄉(xiāng)和地區(qū)間衛(wèi)生發(fā)展差距逐步縮小，農村和偏遠地區(qū)醫(yī)療服務設施落后、服務能力薄弱的狀況明顯改善，公眾反映較為強烈的“看病難”、“看病貴”的問題得到緩解，“因病致貧”、“因病返貧”的現(xiàn)象逐步減少。

The reform of public hospitals has been carried on in an orderly way. In 2010, the Chinese government started pilot reforms of public hospitals in 17 state-designated cities and 37 province-level districts; and positive progress has been witnessed in improving services, innovating institutions and mechanisms, strengthening internal management and speeding up the creation of a situation in which hospitals are established and run in diversified forms. In 2012, the government launched a pilot comprehensive reform of county-level public hospitals, aiming to improve rural system of medical services with the county hospitals playing the leading role, and enabling 90% of the population in a county to see doctors. So far, over 600 counties in 18 provinces, autonomous regions and municipalities directly under the central government have been included in this reform. The government has worked hard to improve medical services, optimize the allocation of medical resources, and enhance the medical capabilities of weak areas and weak fields. The capabilities of key clinical specialties in regional medical centers and county-level hospitals to deliver medical services have been enhanced, and the mechanism of division of responsibilities and cooperation between public hospitals and community-level medical institutions is being studied and formed. The government has intensified efforts in the creation of a situation of establishing and running hospitals in diversified forms, encouraging and guiding non-governmental funds to establish both for-profit and non-profit medical institutions. By 2011, there were 165,000 medical institutions established with non-governmental investment, including 8,437 private hospitals, accounting for 38% of the national total. Doctor-appointment service, time-phased outpatient service and high-quality nursing service that bring benefits and convenience to the people have been introduced nationwide. The fast price growth of medicine has been contained. In comparable prices, the growth rates of average outpatient and inpatient costs in public hospitals has decreased year by year in the past three years, and that of 2011 went down by eight percentage points from that of 2009, reaping initial results in expense control for public hospitals.

The new round of medical reform has brought substantial benefits to both urban and rural residents. Access to basic public health services has become much more equitable; the gap between urban and rural areas and between regions has been narrowed in medical development; medical services in rural and remote areas with backward facilities and weak capabilities have been remarkably improved; medical services have become more affordable and accessible; and fewer and fewer people are becoming poor or return to poverty because of illness.