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一、背景四川省蓬安县地属丘陵,总面积1300平方公里,交通不发达。全县分7个区,下辖50个乡(镇),599个行政村,总人口62万,是一个以种植业为主的农业县。1987年全县农业产值占国民生产总值的60％以上,农民人均收入363元。截止1984年,全县合作医疗制度基本解体,891名乡村医生有2/3弃医从耕、经商或外出行医,2/3的乡卫生院因经济上入不敷出,人心思散。刚刚步入温饱的农村居民又重蹈“就医难”的老路,“因病致贫”又成为农村居民的潜在威胁。针对这种局面,1985年县卫生局首先在柳滩乡进行了基层卫生改革试验,引进了“合医不
I. Background Peng’an County, Sichuan Province belongs to the hills, with a total area of 1300 square kilometers and underdeveloped traffic. The county is divided into 7 districts, under the jurisdiction of 50 townships (towns), 599 administrative villages, with a total population of 620,000, is an agricultural county with farming. In 1987, the county’s agricultural output value accounted for more than 60% of the gross national product, and the per capita income of farmers was 363 yuan. By 1984, the county’s cooperative medical system had basically disintegrated. Two-thirds of the 891 rural doctors had abandoned doctors to practise medicine or to go out to practise medicine. Two-thirds of the township hospitals have been unable to make ends meet because of financial difficulties. The rural residents who have just entered food and shelter have again followed the old path of “difficulty in getting medical care.” “Poverty caused by illness” has become a potential threat to rural residents. In response to this situation, the County Health Bureau first conducted a grassroots health reform test in Liutan Township in 1985 and introduced the