健康中國(guó)深度報(bào)告：深化中國(guó)的醫(yī)療給個(gè)

1、Part TitleHealthy ChinaPart TitleHealthy China: Deepening Health Reform in ChinaBuilding High-Quality and Value-Based Service DeliveryA copublication of the World Bank and the World Health OrganizationContents HYPERLINK l _bookmark248 Prefacexiii HYPERLINK l _bookmark249 Acknowledgmentsxv HYPERLINK

2、l _bookmark250 Abbreviationsxix HYPERLINK l _bookmark251 Executive Summary1 HYPERLINK l _bookmark251 Chinas Health System1 HYPERLINK l _bookmark255 Report Background and Structure5T HYPERLINK l _bookmark256 he Recommendations6 HYPERLINK l _bookmark258 Implementation of Health Care Reforms13 HYPERLIN

3、K l _bookmark259 Notes15 HYPERLINK l _bookmark262 Introduction17 HYPERLINK l _bookmark263 Chinas Road to Health Care Reform17 HYPERLINK l _bookmark266 Report Objectives and Audience20 HYPERLINK l _bookmark268 Report Structure21 HYPERLINK l _bookmark269 References24 HYPERLINK l _bookmark270 Impressiv

4、e Gains, Looming Challenges25 HYPERLINK l _bookmark271 Introduction25 HYPERLINK l _bookmark273 Chinas Changing Health Care Needs26 HYPERLINK l _bookmark279 Health System Reform in China: A Brief Overview30 HYPERLINK l _bookmark295 Meeting Chinas Health Care Needs: Key Challenges35 HYPERLINK l _bookm

5、ark311 Impact of Selected Policy Changes on Health Expenditures45 HYPERLINK l _bookmark318 Conclusion47 HYPERLINK l _bookmark320 Notes49 HYPERLINK l _bookmark343 References50 HYPERLINK l _bookmark344 Lever 1: Shaping Tiered Health Care Delivery with People-Centered HYPERLINK l _bookmark344 Integrate

6、d Care55 HYPERLINK l _bookmark345 The People-Centered Integrated Care (PCIC) Model55 HYPERLINK l _bookmark348 Benefits of Adopting PCIC56H E A L T H Y C H I N AvviH E A L T H Y C H I N A : D E E P E N I N G H E A L T H R E F O R M I N C H I N A HYPERLINK l _bookmark350 Challenges to PCIC Implementat

7、ion in China57 HYPERLINK l _bookmark354 Core Action Areas and Implementation Strategies61 HYPERLINK l _bookmark369 Moving Forward on the PCIC Core Action Areas83 HYPERLINK l _bookmark371 Annex 2A Summary of PCIC Impact Findings by Case Studies84 HYPERLINK l _bookmark373 Annex 2B Methodology and Summ

8、aries of 22 PCIC Performance HYPERLINK l _bookmark373 Improvement Initiatives Described in the Case Studies85 HYPERLINK l _bookmark375 Annex 2C Characteristics of Care Integration Initiatives Involving Hospitals88 HYPERLINK l _bookmark377 Notes89 HYPERLINK l _bookmark387 References90 HYPERLINK l _bo

9、okmark388 Lever 2: Improving Quality of Care97 HYPERLINK l _bookmark389 Introduction97 HYPERLINK l _bookmark390 Conceptualizing, Assessing, and Improving the Quality of Care99 HYPERLINK l _bookmark392 QoC Challenges in China101 HYPERLINK l _bookmark395 Chinas Health Care Regulatory and Policy Enviro

10、nment104 HYPERLINK l _bookmark401 International Experience in Improving Health System Quality107 HYPERLINK l _bookmark411 Recommendations to China for Improving the Quality of Care114 HYPERLINK l _bookmark425 Conclusion124 HYPERLINK l _bookmark424 Notes124 HYPERLINK l _bookmark448 References125 HYPE

11、RLINK l _bookmark449 Lever 3: Engaging Citizens in Support of the PCIC Model131 HYPERLINK l _bookmark450 Introduction131 HYPERLINK l _bookmark454 Challenges to Engaging Citizens133 HYPERLINK l _bookmark455 Two Routes to Engage People to Improve Health Outcomes and Restore Trust134 HYPERLINK l _bookm

12、ark459 Recommendations: Strengthening Patient Engagement in the HYPERLINK l _bookmark459 Patient-Provider Relationship138 HYPERLINK l _bookmark477 Notes155 HYPERLINK l _bookmark486 References155 HYPERLINK l _bookmark487 Lever 4: Reforming Public Hospital Governance and Management161 HYPERLINK l _boo

13、kmark488 Introduction161 HYPERLINK l _bookmark492 Overview and Trends162 HYPERLINK l _bookmark503 Public Hospital Governance: Challenges and Lessons from Reform in China and HYPERLINK l _bookmark503 Internationally164 HYPERLINK l _bookmark521 Hospital Managerial Practices: Challenges and Lessons fro

14、m China and Internationally179 HYPERLINK l _bookmark527 Recommendations for Moving Forward with Public Hospital Reform185 HYPERLINK l _bookmark537 Notes194 HYPERLINK l _bookmark570 References196 HYPERLINK l _bookmark571 Lever 5: Realigning Incentives in Purchasing and Provider Payment203 HYPERLINK l

15、 _bookmark571 Introduction203 HYPERLINK l _bookmark572 Evolution of Health System Incentives204 HYPERLINK l _bookmark575 Challenges and Lessons Learned From Selected Case Studies208 HYPERLINK l _bookmark580 Provider Payment Reforms in China: Lessons From Recent Pilots212 HYPERLINK l _bookmark588 Cor

16、e Action Areas and Implementation Strategies to Realign Incentives217 HYPERLINK l _bookmark597 Notes231 HYPERLINK l _bookmark610 References231 HYPERLINK l _bookmark611 Lever 6: Strengthening the Health Workforce235 HYPERLINK l _bookmark612 Introduction235 HYPERLINK l _bookmark613 The Chinese Health

17、Labor Market: Trends and Challenges236 HYPERLINK l _bookmark637 Recommendations for Human Resources Reform246 HYPERLINK l _bookmark650 An Implementation Road Map262 HYPERLINK l _bookmark652 Annex 7A Supplementary Tables266 HYPERLINK l _bookmark658 Notes275 HYPERLINK l _bookmark674 References276 HYPE

18、RLINK l _bookmark675 Lever 7: Strengthening Private Sector Engagement in Health HYPERLINK l _bookmark675 Service Delivery279 HYPERLINK l _bookmark676 Introduction279 HYPERLINK l _bookmark678 Evolution of Policies on the Private Health Sector280 HYPERLINK l _bookmark683 Scope and Growth of Chinas Pri

19、vate Health Sector283 HYPERLINK l _bookmark698 Key Challenges289 HYPERLINK l _bookmark707 Recommendations for Strengthening Private Sector Engagement295 HYPERLINK l _bookmark726 Annex 8A Supplementary Tables309 HYPERLINK l _bookmark729 Notes315 HYPERLINK l _bookmark752 References316 HYPERLINK l _boo

20、kmark753 Lever 8: Modernizing Health Service Planning to Guide Investment319 HYPERLINK l _bookmark754 Introduction319 HYPERLINK l _bookmark755 Capital Investment Challenges in Chinas Health Sector320 HYPERLINK l _bookmark768 Recommendations to Modernize Service Planning327 HYPERLINK l _bookmark779 N

21、otes342 HYPERLINK l _bookmark786 References342 HYPERLINK l _bookmark787 Strengthening the Implementation of Health Service HYPERLINK l _bookmark787 Delivery Reform345 HYPERLINK l _bookmark788 Introduction345 HYPERLINK l _bookmark790 Implementation Challenges346 HYPERLINK l _bookmark792 A Four-Part A

22、ctionable Implementation Framework348 HYPERLINK l _bookmark794 Moving Forward: Effective, Sustainable Local Implementation350 HYPERLINK l _bookmark807 Toward a Sequential Plan for Full-Scale Reform Implementation in China362 HYPERLINK l _bookmark813 Annex 10A Case Examples of Transformation Learning

23、 Collaboratives (TLCs)366 HYPERLINK l _bookmark815 Annex 10B Plan-Do-Study-Act Cycles of Change369 HYPERLINK l _TOC_250000 Annex 10C Example of a Detailed Implementation Pathway371 HYPERLINK l _bookmark822 Notes377 HYPERLINK l _bookmark831 References377 HYPERLINK l _bookmark832 ASupplementary Tables

24、381Boxes HYPERLINK l _bookmark264 What is value in health care?18 HYPERLINK l _bookmark265 Communist Party of Chinas endorsement of “Healthy China” strategy19 HYPERLINK l _bookmark347 People-centered integrated care (PCIC) defined56 HYPERLINK l _bookmark351 Potential benefits of people-centered inte

25、grated care58 HYPERLINK l _bookmark402 Institutional arrangements for quality improvement in France, HYPERLINK l _bookmark402 Germany, and the Netherlands107 HYPERLINK l _bookmark405 The Ambulatory Care Project of the National Quality Forum109 HYPERLINK l _bookmark408 U.K. National Health Service ou

26、tcomes indicator set, 2013/14111 HYPERLINK l _bookmark409 An innovative U.K. model to improve care for stroke patients112 HYPERLINK l _bookmark456 Understanding citizen mistrust: Perspectives from patients and providers135 HYPERLINK l _bookmark457 Defining empowerment, engagement, and coproduction o

27、f health136 HYPERLINK l _bookmark458 Individual and public routes to patient engagement137 HYPERLINK l _bookmark460 Effects of patient engagement strategies138 HYPERLINK l _bookmark463 Social marketing in China: Prevention and control of hepatitis B142 HYPERLINK l _bookmark464 The Million Hearts Cam

28、paign142 HYPERLINK l _bookmark467 Self-management of COPD in the U.S. veterans population145 HYPERLINK l _bookmark470 Encouraging self-management of health: Examples from India and the HYPERLINK l _bookmark470 United Kingdom147 HYPERLINK l _bookmark472 Improving patient involvement at Beth Israel De

29、aconess Medical HYPERLINK l _bookmark472 Center, United States149 HYPERLINK l _bookmark473 Decision aid for stable coronary heart disease by the Informed Medical HYPERLINK l _bookmark473 Decisions Foundation150 HYPERLINK l _bookmark474 Health coaching to coordinate care in Singapore151 HYPERLINK l _

30、bookmark475 Changshu: One example of a Chinese Healthy City153 HYPERLINK l _bookmark520 5.1Impacts of public hospital reform in China179 HYPERLINK l _bookmark585 A typology of health care provider payment methods213 HYPERLINK l _bookmark590 Examples of provider payment reforms in China219 HYPERLINK

31、l _bookmark594 Bundled payment models223 HYPERLINK l _bookmark595 Quality-compatible modified global payment systems in the United States225 HYPERLINK l _bookmark634 History of the Physician Dual Practice Policy in China245 HYPERLINK l _bookmark645 Sanmings comprehensive public hospital compensation

32、 reform256 HYPERLINK l _bookmark646 GP pay-for-performance incentives in the United Kingdom257 HYPERLINK l _bookmark684 Hospital ownership categories in China: Public, PNFP, and PFP283 HYPERLINK l _bookmark706 Difficult market conditions for Yunnan Kidney Disease Hospital294 HYPERLINK l _bookmark717

33、 Use of indirect policy tools in Germanys hospital market301 HYPERLINK l _bookmark719 Use of indirect policy tools in primary care in Denmark303 HYPERLINK l _bookmark720 Chinese experiences in purchasing community services from private and HYPERLINK l _bookmark720 public providers304 HYPERLINK l _bo

34、okmark723 Swedens “Choice” reforms: From government direct delivery to HYPERLINK l _bookmark723 indirect governance of the primary care market306 HYPERLINK l _bookmark724 Health care quality assurance and the role of fair competition307 HYPERLINK l _bookmark725 Hospital quality measures at Germanys

35、Helios group308 HYPERLINK l _bookmark758 Distinguishing features of an effective health service planning approach321 HYPERLINK l _bookmark771 Horizons three-step CIP model for eldercare in the Netherlands330 HYPERLINK l _bookmark776 Physical redesign of Northern Irelands health system model339 HYPER

36、LINK l _bookmark798 Government administrative reforms and international experience355 HYPERLINK l _bookmark800 Evidence supporting the use of TLC methodology357 HYPERLINK l _bookmark810 Example of a master reform pathway: primary care enhancement for HYPERLINK l _bookmark810 patients with complex ne

37、eds364Figures HYPERLINK l _bookmark252 ES.1Life expectancy relative to per capita health expenditure, selected countries, HYPERLINK l _bookmark252 early 2010s3 HYPERLINK l _bookmark254 ES.2Main drivers of projected health expenditure in China, 2015354 HYPERLINK l _bookmark256 ES.3Eight interlinked l

38、evers to deepen health care reform in China6 HYPERLINK l _bookmark274 1.1Aging of the population in China compared with selected countries, 1950205026 HYPERLINK l _bookmark276 Prominence of NCDs in the burden of disease and causes of mortality27 HYPERLINK l _bookmark277 Smoking and alcohol consumpti

39、on, international comparisons28 HYPERLINK l _bookmark278 Prevalence of hypertension and diabetes in China and selected other HYPERLINK l _bookmark278 countries, early 2010s29 HYPERLINK l _bookmark281 Coverage of social health insurance in China, 20031331 HYPERLINK l _bookmark284 Trends in health ser

40、vice use in China, by visit type, 20031332 HYPERLINK l _bookmark296 Hospital beds in China and selected OECD countries, 2000 and 201336 HYPERLINK l _bookmark297 Trends in the number and use of health care facilities in China, by level37 HYPERLINK l _bookmark301 Composition of health spending in Chin

41、a, 1997201339 HYPERLINK l _bookmark303 Pharmaceutical spending in China and international comparisons40 HYPERLINK l _bookmark304 Composition of health spending in China, by provider type, 1990 and 201341 HYPERLINK l _bookmark305 Percentage of outpatient visits in hospitals, China and selected countr

42、ies, 201341 HYPERLINK l _bookmark306 Trends in out-of-pocket health care payments in China, by insurance HYPERLINK l _bookmark306 type, 20031342 HYPERLINK l _bookmark307 Life expectancy trends in China relative to total spending on HYPERLINK l _bookmark307 health, 1995201343 HYPERLINK l _bookmark308

43、 Performance (life expectancy) relative to health spending and income, HYPERLINK l _bookmark308 international comparisons44 HYPERLINK l _bookmark310 Management of hypertension and diabetes in China, circa 201045 HYPERLINK l _bookmark315 Main drivers of projected health expenditure increases in China

44、, 20153546 HYPERLINK l _bookmark316 Hospital discharge rates, selected countries and economies, 20001447 HYPERLINK l _bookmark319 Life expectancy relative to per capita health expenditure, selected HYPERLINK l _bookmark319 countries, early 2010s48 HYPERLINK l _bookmark356 Frequency of PCIC intervent

45、ions in commissioned case studies, HYPERLINK l _bookmark356 by core action area62 HYPERLINK l _bookmark357 Illness burden scorecard for patient risk stratification65 HYPERLINK l _bookmark358 Responsibilities of PACT members, U.S. Veterans Health Administration67 HYPERLINK l _bookmark363 Sample healt

46、h pathway for COPD, Canterbury Health Services Plan, HYPERLINK l _bookmark363 New Zealand76 HYPERLINK l _bookmark364 Sample responsibilities for dual referrals in Xi County77 HYPERLINK l _bookmark366 PACE continual feedback loop79 HYPERLINK l _bookmark367 Types of data collected by PACE centers80 HY

47、PERLINK l _bookmark465 B4.6.1 Million Hearts targets143 HYPERLINK l _bookmark491 Growth in total health and hospital spending in China, 200513162 HYPERLINK l _bookmark495 Trends in hospital beds per 1,000 population in China and HYPERLINK l _bookmark495 selected OECD countries, 200013163 HYPERLINK l

48、 _bookmark496 Growth in number of hospitals in China, by ownership type, 200513163 HYPERLINK l _bookmark498 Growth in number of hospital beds in China, by ownership type, 200513164 HYPERLINK l _bookmark499 Trends in average number of beds in Chinese secondary and tertiary HYPERLINK l _bookmark499 ho

49、spitals, 200814164 HYPERLINK l _bookmark504 Growth in admissions to Chinese tertiary and secondary hospitals, 200614165 HYPERLINK l _bookmark525 Average managerial practice scores of Chinese hospitals, 2015182 HYPERLINK l _bookmark574 6.1Composition of total health expenditure in China, by facility

50、or HYPERLINK l _bookmark574 provider type, 19902012207 HYPERLINK l _bookmark616 Numbers of medical students and faculty and faculty-student HYPERLINK l _bookmark616 ratios in China, 19982012237 HYPERLINK l _bookmark617 Ratio of nurses to physicians in OECD countries, 2012 (or nearest year)238 HYPERL

51、INK l _bookmark618 Number of health professionals per 1,000 population in China, 200313239 HYPERLINK l _bookmark620 Health professionals per 1,000 population in China, by rural or urban HYPERLINK l _bookmark620 location, 200313240 HYPERLINK l _bookmark621 Proportion of health professionals in the pr

52、ivate sector, 200513240 HYPERLINK l _bookmark624 Annual average wages of urban employees in China, HYPERLINK l _bookmark624 by sector, 2005 and 2012241 HYPERLINK l _bookmark626 Health worker compensation across levels of care, China 2013242 HYPERLINK l _bookmark640 Community health agents coverage i

53、n Brazils Family HYPERLINK l _bookmark640 Health Strategy, 19982014251 HYPERLINK l _bookmark642 Ratio of hospital specialist pay to primary GP pay, selected HYPERLINK l _bookmark642 countries and years254 HYPERLINK l _bookmark643 Ratio of health professionals pay to average income per HYPERLINK l _b

54、ookmark643 capita of 10th richest decile, China and selected countries255 HYPERLINK l _bookmark687 Number of Chinese hospitals, by ownership type, 200512285 HYPERLINK l _bookmark689 Market share of inpatient admissions in China, by hospital HYPERLINK l _bookmark689 ownership type, 2005 and 2012285 H

55、YPERLINK l _bookmark690 Trends in hospital use in China, by ownership type, 200512286 HYPERLINK l _bookmark692 Number of beds in Chinese hospitals, by ownership type, 200512287 HYPERLINK l _bookmark693 Composition of Chinese public and private hospitals, by number of HYPERLINK l _bookmark693 beds, 2

56、012287 HYPERLINK l _bookmark695 Correlation between private hospital share of outpatient visits HYPERLINK l _bookmark695 and per capita income across provinces, 2012288 HYPERLINK l _bookmark697 Growth in Chinese PHC facilities, by ownership type, 200512289 HYPERLINK l _bookmark712 Composition of hos

57、pital beds in OECD countries, by ownership HYPERLINK l _bookmark712 type, 2012 or latest data298 HYPERLINK l _bookmark761 Growth rates of health facilities, Sichuan province, 200809 to 201112322 HYPERLINK l _bookmark762 Distribution of total capital expenditures in health, Sichuan province, 20091232

58、3 HYPERLINK l _bookmark764 Growth rate of health facilities, Hubei province, 200809 to 201213324 HYPERLINK l _bookmark765 Distribution of health capital expenditures, Tianjin municipality, 200013324 HYPERLINK l _bookmark769 Translating health services to costs in OECD countries328 HYPERLINK l _bookm

59、ark772 Delivering a new approach to health sector planning in HYPERLINK l _bookmark772 New South Wales, Australia332 HYPERLINK l _bookmark774 Certificate of Need application and approval process in Maine, HYPERLINK l _bookmark774 United States336 HYPERLINK l _bookmark777 The integrated health servic

60、es model in Northern Ireland340 HYPERLINK l _bookmark796 Proposed oversight, coordination, and management for implementation and HYPERLINK l _bookmark796 scaling up of health service delivery reform352 HYPERLINK l _bookmark801 The TLC model in three different arrangements358 HYPERLINK l _bookmark802