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    080031

    China. Long-term issues and options in the health transition.

    Bumgarner JR

    Washington, D.C., World Bank, 1992. xxvii, 133 p. (World Bank Country Study)

    In the early 1990s, the World Bank sent a team of specialists in demography, medicine, hospital administration, health policy, personnel, medical technology, and finance to China to examine the present health status of the population and to protect its future status. Before making any projections, however, they had to learn what demographic and epidemiologic factors would basically determine future health status. The main factors driving China's health transition included aging of the population; increased risk of developing chronic disease caused by changes in life style, dietary, environmental, and occupational risk factors; and changing morbidity and mortality patterns (i.e., shift from infectious to disabling and chronic diseases). The team mapped out specific strategies, which can indeed be achieved, to avert a health care crisis. The strategies revolved around a sustained effort of primary prevention of chronic diseases, especially circulatory diseases, which caused considerable premature mortality. The team illustrated how different formulas of total health expenditures would affect epidemiologic outcomes. The team learned that health care costs would probably increase due to unavoidable demographic trends (especially demographic aging), epidemiologic forces, and utilization and unit cost changes. Suggested primary prevention strategies alone would not be enough to control health expenditures to a level where feasible equity can be maintained. China must also greatly improve efficiency of hospital services, personnel, and technologies. The evaluation team concluded that the government needs to reassess policies for financing primary and preventive health services, the basis and conditions of insurance, and the role of prices and incentives in directing use and provision of services.
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