《中國(guó)的醫(yī)療衛(wèi)生事業(yè)》白皮書(shū)
White Paper: Medical and Health Services in China
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調(diào)整字號(hào)大小: 
| 二、醫(yī)藥衛(wèi)生體制改革 | II. Reform of Medical and Healthcare Systems |
| 經(jīng)過(guò)多年努力，中國(guó)衛(wèi)生事業(yè)取得顯著發(fā)展成就，但與公眾健康需求和經(jīng)濟(jì)社會(huì)協(xié)調(diào)發(fā)展不適應(yīng)的矛盾還比較突出。特別是隨著中國(guó)從計(jì)劃經(jīng)濟(jì)體制向市場(chǎng)經(jīng)濟(jì)體制的轉(zhuǎn)型，原有醫(yī)療保障體系發(fā)生很大變化，如何使廣大公眾享有更好、更健全的醫(yī)療衛(wèi)生服務(wù)，成為中國(guó)政府面臨的一個(gè)重大問(wèn)題。從20世紀(jì)80年代開(kāi)始，中國(guó)啟動(dòng)醫(yī)藥衛(wèi)生體制改革，并在2003年抗擊傳染性非典型肺炎取得重大勝利后加快推進(jìn)。2009年3月，中國(guó)公布《關(guān)于深化醫(yī)藥衛(wèi)生體制改革的意見(jiàn)》，全面啟動(dòng)新一輪醫(yī)改。改革的基本理念，是把基本醫(yī)療衛(wèi)生制度作為公共產(chǎn)品向全民提供，實(shí)現(xiàn)人人享有基本醫(yī)療衛(wèi)生服務(wù)，從制度上保證每個(gè)居民不分地域、民族、年齡、性別、職業(yè)、收入水平，都能公平獲得基本醫(yī)療衛(wèi)生服務(wù)。改革的基本原則是?；?、強(qiáng)基層、建機(jī)制。 | With years of effort, China has made remarkable achievements in the development of its healthcare undertakings, which, however, still fall far short of the public's demands for healthcare as well as the requirements of economic and social development. Especially when China turned from a planned economy to a market economy, the old medical care system has undergone great changes. So it became an issue of major importance for the Chinese government to provide better and more accessible medical and health services to the public. In the 1980s, the Chinese government initiated reform of the medical and healthcare systems, and speeded up the reform in 2003 after a success was won in the fight against the SARS. In March 2009, the Chinese government promulgated the "Opinions on Deepening Reform of the Medical and Health Care Systems," setting off a new round of reform in this regard. The basic goal of this reform was to provide the whole nation with basic medical and health services as a public product, and ensure that everyone, regardless of location, nationality, age, gender, occupation and income, enjoys equal access to basic medical and health services. And the basic principles to be followed in the reform were to ensure basic services, improving such services at the grass-roots level and establishing the effective mechanisms. |
| 醫(yī)改是一項(xiàng)涉及面廣、難度大的社會(huì)系統(tǒng)工程，在中國(guó)這樣一個(gè)人口多、人均收入水平低、城鄉(xiāng)區(qū)域差距大的發(fā)展中國(guó)家，深化醫(yī)改是一項(xiàng)十分艱巨復(fù)雜的任務(wù)。三年多來(lái)，中國(guó)政府大力推進(jìn)醫(yī)藥衛(wèi)生服務(wù)與經(jīng)濟(jì)社會(huì)協(xié)調(diào)發(fā)展，積極破解醫(yī)改這一世界性難題。通過(guò)艱苦努力，中國(guó)的新一輪醫(yī)改取得積極進(jìn)展。 | Medical reform is a social program that covers a wide range and involves difficult tasks. And it is a hard and complicated task to deepen this reform in China, a developing country with a large population, low per-capita income and a wide gap between urban and rural areas. For over three years, the Chinese government has worked hard to strike a balance between improving medical and health services on one hand and economic and social development on the other, trying to find a solution to this worldwide problem. Thanks to the persistent efforts made, China has made positive progress in this new round of medical reform. |
| ——基本醫(yī)療保障制度覆蓋城鄉(xiāng)居民。截至2011年，城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)、城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)、新型農(nóng)村合作醫(yī)療參保人數(shù)超過(guò)13億，覆蓋面從2008年的87％提高到2011年的95％以上，中國(guó)已構(gòu)建起世界上規(guī)模最大的基本醫(yī)療保障網(wǎng)。籌資水平和報(bào)銷比例不斷提高，新型農(nóng)村合作醫(yī)療政府補(bǔ)助標(biāo)準(zhǔn)從最初的人均20元人民幣，提高到2011年的200元人民幣，受益人次數(shù)從2008年的5.85億人次提高到2011年的13.15億人次，政策范圍內(nèi)住院費(fèi)用報(bào)銷比例提高到70％左右，保障范圍由住院延伸到門診。推行醫(yī)藥費(fèi)用即時(shí)結(jié)算報(bào)銷，居民就醫(yī)結(jié)算更為便捷。開(kāi)展按人頭付費(fèi)、按病種付費(fèi)和總額預(yù)付等支付方式改革，醫(yī)保對(duì)醫(yī)療機(jī)構(gòu)的約束、控費(fèi)和促進(jìn)作用逐步顯現(xiàn)。實(shí)行新型農(nóng)村合作醫(yī)療大病保障，截至2011年，23萬(wàn)患有先天性心臟病、終末期腎病、乳腺癌、宮頸癌、耐多藥肺結(jié)核、兒童白血病等疾病的患者享受到重大疾病補(bǔ)償，實(shí)際補(bǔ)償水平約65％。2012年，肺癌、食道癌、胃癌等12種大病也被納入農(nóng)村重大疾病保障試點(diǎn)范圍，費(fèi)用報(bào)銷比例最高可達(dá)90％。實(shí)施城鄉(xiāng)居民大病保險(xiǎn)，從城鎮(zhèn)居民醫(yī)?；?、新型農(nóng)村合作醫(yī)療基金中劃出大病保險(xiǎn)資金，采取向商業(yè)保險(xiǎn)機(jī)構(gòu)購(gòu)買大病保險(xiǎn)的方式，以力爭(zhēng)避免城鄉(xiāng)居民發(fā)生家庭災(zāi)難性醫(yī)療支出為目標(biāo)，實(shí)施大病保險(xiǎn)補(bǔ)償政策，對(duì)基本醫(yī)療保障補(bǔ)償后需個(gè)人負(fù)擔(dān)的合規(guī)醫(yī)療費(fèi)用給予保障，實(shí)際支付比例不低于50％，有效減輕個(gè)人醫(yī)療費(fèi)用負(fù)擔(dān)。建立健全城鄉(xiāng)醫(yī)療救助制度，救助對(duì)象覆蓋城鄉(xiāng)低保對(duì)象、五保對(duì)象，并逐步擴(kuò)大到低收入重病患者、重度殘疾人、低收入家庭老年人等特殊困難群體，2011年全國(guó)城鄉(xiāng)醫(yī)療救助8090萬(wàn)人次。 | The basic medical care systems cover both urban and rural residents. By 2011, more than 1.3 billion people had joined the three basic medical insurance schemes that cover both urban and rural residents, i.e., the basic medical insurance for working urban residents, the basic medical insurance for non-working urban residents, and the new type of rural cooperative medical care, with their total coverage being extended from 87% in 2008 to 95% in 2011. This signaled that China has built the world's largest network of basic medical security. Medical care financing and the reimbursable ratio of medical costs have been raised, and the government subsidy standards for the new rural cooperative medical care system were increased from 20 yuan at the beginning to 200 yuan per person per year in 2011, benefiting 1.315 person/times in 2011 as against 585 person/times in 2008. The reimbursement rate for hospitalization expenses covered by relevant policies has been raised to around 70%, and the range of reimbursable expenses has been expanded to include outpatient expenses. Real-time reimbursement has been adopted for medical expenses, making it more convenient for people to have their medical costs settled. Reform has been carried out in respect of the forms of payment to include payment by person, payment by disease and total amount pre-payment, enabling medical insurance to play a better restrictive role over medical institutions as well as to control expenses and compel the medical institutions to improve their efficiency. Critical illness insurance has been included in the new type of rural cooperative medical care system. By 2011, some 230,000 patients of congenital heart disease, advanced rental diseases, breast cancer, cervical cancer, multidrug-resistant tuberculosis and childhood leukemia had been granted subsidies for major and serious diseases, with the actual subsidies accounting for 65% of their total expenses. In 2012, lung cancer, esophagus cancer, gastric cancer and eight other major diseases were included in the rural pilot program of insurance for the treatment of major diseases, and the reimbursement rate reached as high as 90%. Critical illness insurance has been introduced for both urban and rural residents, in which certain amounts of money are earmarked in the medical insurance fund for non-working urban residents and that of the new type of rural cooperative medical care to buy critical illness insurance policies from commercial insurance companies, aiming to relieve urban and rural families of the heavy burden of catastrophic medical spending. The policy of subsidy for critical illness insurance, which covers no less than 50% of the actual medical costs, provides a guarantee for the compliance costs to be shouldered by the individual after reimbursement from the basic medical insurance. This has effectively reduced the financial burden of individuals. An urban-rural medical assistance system has been established and improved, which at first covered urban and rural subsistence allowance recipients and childless and infirm rural residents who receive the so-called "five guarantees," and is now extended to cover those who are severely ill and have low comes, the severely disabled, senior citizens from low-income families, and some other groups with special difficulties. In 2011, the urban-rural medical assistance was granted to 80.90 million cases across the country. |
| ——基本藥物制度從無(wú)到有。初步形成了基本藥物遴選、生產(chǎn)供應(yīng)、使用和醫(yī)療保險(xiǎn)報(bào)銷的體系。2011年，基本藥物制度實(shí)現(xiàn)基層全覆蓋，所有政府辦基層醫(yī)療衛(wèi)生機(jī)構(gòu)全部配備使用基本藥物，并實(shí)行零差率銷售，取消了以藥補(bǔ)醫(yī)機(jī)制。制定國(guó)家基本藥物臨床應(yīng)用指南和處方集，規(guī)范基層用藥行為，促進(jìn)合理用藥。建立基本藥物采購(gòu)新機(jī)制，基本藥物實(shí)行以省為單位集中采購(gòu)，基層醫(yī)療衛(wèi)生機(jī)構(gòu)基本藥物銷售價(jià)格比改革前平均下降了30％。基本藥物全部納入基本醫(yī)療保障藥品報(bào)銷目錄。有序推進(jìn)基本藥物制度向村衛(wèi)生室和非政府辦基層醫(yī)療衛(wèi)生機(jī)構(gòu)延伸。藥品生產(chǎn)流通領(lǐng)域改革步伐加快，藥品供應(yīng)保障水平進(jìn)一步提高。 | A basic system of drugs has been developed from scratch. A system for the selection, production, supply and use of basic drugs, and cover of them in medical insurance has been put into place. In 2011, the coverage of this system was extended to all grass-roots medical and health-care institutions run by the government, where these drugs were sold at zero profit, practically eliminating the practice of hospitals subsidizing their medical services with drug sales. A national guideline for the clinical application of basic drugs and a formulary have been drawn up to ensure that basic drugs are used according to due procedures at grass-roots medical institutions. A new mechanism has been established for the procurement of basic drugs, under which the basic drugs are to be purchased by provinces. As a result, the prices of basic drugs at grass-roots medical and healthcare institutions have dropped by 30% on average, as compared with those before the reform. The basic drugs have all been included in the list of reimbursable drugs covered by basic medical insurance. Also, efforts have been made to supply basic drugs in an orderly way to village clinics and non-governmental medical institutions at the grass-roots level. The steps of reform have been quickened in drug production and circulation, and the supply of drugs has been better ensured. |
| ——城鄉(xiāng)基層醫(yī)療衛(wèi)生服務(wù)體系進(jìn)一步健全。加大政府投入，完善基層醫(yī)療衛(wèi)生機(jī)構(gòu)經(jīng)費(fèi)保障機(jī)制，2009—2011年，中央財(cái)政投資471.5億元人民幣支持基層醫(yī)療機(jī)構(gòu)建設(shè)發(fā)展。采取多種形式加強(qiáng)基層衛(wèi)生人才隊(duì)伍建設(shè)，制定優(yōu)惠政策，為農(nóng)村和社區(qū)培養(yǎng)、培訓(xùn)、引進(jìn)衛(wèi)生人才。建立全科醫(yī)生制度，開(kāi)展全科醫(yī)生規(guī)范化培養(yǎng)，安排基層醫(yī)療衛(wèi)生機(jī)構(gòu)人員參加全科醫(yī)生轉(zhuǎn)崗培訓(xùn)，組織實(shí)施中西部地區(qū)農(nóng)村訂單定向醫(yī)學(xué)生免費(fèi)培養(yǎng)等。實(shí)施萬(wàn)名醫(yī)師支援農(nóng)村衛(wèi)生工程，2009—2011年，1100余家城市三級(jí)醫(yī)院支援了955個(gè)縣級(jí)醫(yī)院，中西部地區(qū)城市二級(jí)以上醫(yī)療衛(wèi)生機(jī)構(gòu)每年支援3600多所鄉(xiāng)鎮(zhèn)衛(wèi)生院，提高了縣級(jí)醫(yī)院和鄉(xiāng)鎮(zhèn)衛(wèi)生院醫(yī)療技術(shù)水平和管理能力。轉(zhuǎn)變基層醫(yī)療服務(wù)模式，在鄉(xiāng)鎮(zhèn)衛(wèi)生院開(kāi)展巡回醫(yī)療服務(wù)，在市轄區(qū)推行社區(qū)全科醫(yī)生團(tuán)隊(duì)、家庭簽約醫(yī)生制度，實(shí)行防治結(jié)合，保障居民看病就醫(yī)的基本需求，使常見(jiàn)病、多發(fā)病等絕大多數(shù)疾病的診療在基層可以得到解決。經(jīng)過(guò)努力，基層醫(yī)療衛(wèi)生服務(wù)體系不斷強(qiáng)化，農(nóng)村和偏遠(yuǎn)地區(qū)醫(yī)療服務(wù)設(shè)施落后、服務(wù)能力薄弱的狀況明顯改變，基層衛(wèi)生人才隊(duì)伍的數(shù)量、學(xué)歷、知識(shí)結(jié)構(gòu)出現(xiàn)向好趨勢(shì)。2011年，全國(guó)基層醫(yī)療衛(wèi)生機(jī)構(gòu)達(dá)到91.8萬(wàn)個(gè)，包括社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)2.6萬(wàn)個(gè)、鄉(xiāng)鎮(zhèn)衛(wèi)生院3.8萬(wàn)所、村衛(wèi)生室66.3萬(wàn)個(gè)，床位123.4萬(wàn)張。 | Urban and rural grass-roots level medical and health services have been further improved. The government has invested more to ensure the funding for grass-roots medical and healthcare institutions. From 2009 to 2011, the central government invested 47.15 billion yuan to support the building and development of grass-roots level medical institutions. Diverse forms have been adopted to strengthen the ranks of healthcare workers at the grass-roots level, and preferential policies have been made to train and introduce competent personnel for rural and community healthcare. A system of general practitioners (medical workers with sufficient knowledge in all branches of medicine) has been established, under which general practitioners are trained in the regular way; grass-roots medical and healthcare workers are enrolled in training courses for upgrading them to general practitioners; and medical students are specially trained for the needs of central and western urban areas, for which they do not have to pay their tuition fees. A project, known as "ten thousand doctors extending support to rural medical care," has been launched. From 2009 to 2011, over 1,100 Grade-III urban hospitals extended support to 955 rural county-level hospitals every year, and urban medical institutions above Grade II in central and western China granted aid to over 3,600 township hospitals every year, thus helping improve the overall technological level and management of the county and township hospitals. Meanwhile, the mode of medical services has been changed. Touring medical services have been provided in township hospitals; and in the urban districts ranks of general practitioners have been formed and a system of family doctors has been set up. Prevention has been combined with the treatment, measures have been taken to ensure basic needs of the residents to see doctors and make it possible that the diagnosis and treatment of most commonly seen and frequently occurring diseases are performed at the community level. After years of effort, community-level medical and healthcare system has been strengthened; marked changes have taken place to the situation of backward facilities and poor services in rural and remote areas; community-level medical workers have increased in number, and their educational background and knowledge have improved. In 2011, the number of grass-roots medical and healthcare institutions across the country reached 918,000, including 26,000 urban community service centers, 38,000 township hospitals and 663,000 village clinics, and the number of hospital beds reached 1,234,000. |
| ——基本公共衛(wèi)生服務(wù)均等化水平明顯提高。國(guó)家免費(fèi)向全體居民提供國(guó)家基本公共衛(wèi)生服務(wù)包，包括建立居民健康檔案、健康教育、預(yù)防接種、0—6歲兒童健康管理、孕產(chǎn)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(bào)告和處理、衛(wèi)生監(jiān)督協(xié)管等10類41項(xiàng)服務(wù)。針對(duì)特殊疾病、重點(diǎn)人群和特殊地區(qū)，國(guó)家實(shí)施重大公共衛(wèi)生服務(wù)項(xiàng)目，對(duì)農(nóng)村孕產(chǎn)婦住院分娩補(bǔ)助、15歲以下人群補(bǔ)種乙肝疫苗、消除燃煤型氟中毒危害、農(nóng)村婦女孕前和孕早期補(bǔ)服葉酸、無(wú)害化衛(wèi)生廁所建設(shè)、貧困白內(nèi)障患者復(fù)明、農(nóng)村適齡婦女宮頸癌和乳腺癌檢查、預(yù)防艾滋病母嬰傳播等，由政府組織進(jìn)行直接干預(yù)。2011年，國(guó)家免疫規(guī)劃疫苗接種率總體達(dá)到90％以上，全國(guó)住院分娩率達(dá)到98.7％，其中農(nóng)村住院分娩率達(dá)到98.1％，農(nóng)村孕產(chǎn)婦死亡率呈逐步下降趨勢(shì)（見(jiàn)圖7）。農(nóng)村自來(lái)水普及率和衛(wèi)生廁所普及率分別達(dá)到72.1％和69.2％。2009年啟動(dòng)“百萬(wàn)貧困白內(nèi)障患者復(fù)明工程”，截至2011年，由政府提供補(bǔ)助為109萬(wàn)多名貧困白內(nèi)障患者實(shí)施了復(fù)明手術(shù)。 | 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. |
| ——公立醫(yī)院改革有序推進(jìn)。從2010年起，在17個(gè)國(guó)家聯(lián)系試點(diǎn)城市和37個(gè)省級(jí)試點(diǎn)地區(qū)開(kāi)展公立醫(yī)院改革試點(diǎn)，在完善服務(wù)體系、創(chuàng)新體制機(jī)制、加強(qiáng)內(nèi)部管理、加快形成多元化辦醫(yī)格局等方面取得積極進(jìn)展。2012年，全面啟動(dòng)縣級(jí)公立醫(yī)院綜合改革試點(diǎn)工作，以縣級(jí)醫(yī)院為龍頭，帶動(dòng)農(nóng)村醫(yī)療衛(wèi)生服務(wù)體系能力提升，力爭(zhēng)使縣域內(nèi)就診率提高到90％左右，目前已有18個(gè)省(自治區(qū)、直轄市)的600多個(gè)縣參與試點(diǎn)。完善醫(yī)療服務(wù)體系，優(yōu)化資源配置，加強(qiáng)薄弱區(qū)域和薄弱領(lǐng)域能力建設(shè)。區(qū)域醫(yī)學(xué)中心臨床重點(diǎn)?？坪涂h級(jí)醫(yī)院服務(wù)能力提升，公立醫(yī)院與基層醫(yī)療衛(wèi)生機(jī)構(gòu)之間的分工協(xié)作機(jī)制正在探索形成。多元化辦醫(yī)格局加快推進(jìn)，鼓勵(lì)和引導(dǎo)社會(huì)資本舉辦營(yíng)利性和非營(yíng)利醫(yī)療機(jī)構(gòu)。截至2011年，全國(guó)社會(huì)資本共舉辦醫(yī)療機(jī)構(gòu)16.5萬(wàn)個(gè)，其中民營(yíng)醫(yī)院8437個(gè)，占全國(guó)醫(yī)院總數(shù)的38％。在全國(guó)普遍推行預(yù)約診療、分時(shí)段就診、優(yōu)質(zhì)護(hù)理等便民惠民措施。醫(yī)藥費(fèi)用過(guò)快上漲的勢(shì)頭得到控制，按可比價(jià)格計(jì)算，在過(guò)去三年間，公立醫(yī)院門診次均醫(yī)藥費(fèi)用和住院人均醫(yī)藥費(fèi)用增長(zhǎng)率逐年下降，2011年比2009年均下降了8個(gè)百分點(diǎn)，公立醫(yī)院費(fèi)用控制初見(jiàn)成效。 | 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. |
| 新一輪醫(yī)改給中國(guó)城鄉(xiāng)居民帶來(lái)了很大實(shí)惠?；竟残l(wèi)生服務(wù)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(nóng)村和偏遠(yuǎn)地區(qū)醫(yī)療服務(wù)設(shè)施落后、服務(wù)能力薄弱的狀況明顯改善，公眾反映較為強(qiáng)烈的“看病難”、“看病貴”的問(wèn)題得到緩解，“因病致貧”、“因病返貧”的現(xiàn)象逐步減少。 | 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. |
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