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在贫困地区发展合作医疗制度是中国农村卫生工作的关键和难点。主要原因是贫困地区的农民连最基本的温饱问题都没有解决,根本谈不上享有基本的医疗卫生服务。 贫困地区要发展合作医疗,难度很大。地方财政呈现赤字,财政的支出大于收入。卫生支出占财政支出的比例不高(一般为3％～4％),又缺乏乡镇集体经济的支持,要以农民个人投入为主来筹措合作医疗经费确有很大困难。不少地区没有集体办医的条件,大部分乡村医生从事个体开业,缺乏一整套管理和监督的机制。历史的经验和现实的发展证明,要在贫困地区解决农民的疾苦,只有走集体互助的道路,建立风险共担的多种形式合作医疗制度,发展卫生扶贫计划,才能缓解贫困地区缺医少药和因病致贫的现象发生。《中共中央、国务院关于卫生改革与发展的决定》已明确提出;“力争到2000年在农村多数地区建立起各种形式的合作医疗制度”,探索贫
The development of a cooperative medical system in impoverished areas is a key and difficult issue in China’s rural health work. The main reason is that farmers in impoverished areas have not even solved the basic problem of food and clothing. They simply cannot enjoy basic medical and health services. It is very difficult for poor areas to develop cooperative medical care. Local finances show deficits, and fiscal expenditures outweigh income. The proportion of health expenditure to fiscal expenditure is not high (usually 3% to 4%), and lack of support from the township collective economy. It is indeed very difficult to raise funds for cooperative medical care based on the individual input of farmers. In many areas, there are no conditions for collective medical treatment. Most rural doctors engage in individual business and lack a complete set of management and supervision mechanisms. The historical experience and the development of reality prove that to solve the problems of farmers in poverty-stricken areas, only by taking the road of collective assistance, establishing a multi-modal cooperative medical system with shared risks, and developing a poverty alleviation plan for health, can we alleviate the lack of medical treatment in poverty-stricken areas. Poverty caused by illness and disease occurred. The “Decision of the Central Committee of the CPC and the State Council on Health Reform and Development” has been clearly put forward; “Striving to establish various forms of cooperative medical systems in most rural areas by the year 2000” to explore poverty