In the face of the current lack of funding for the project should be how to improve measures

The implementation of public *** health programs in rural areas and the active development of cooperative medical care used to be relatively effective in curbing the prevalence of infectious, parasitic and endemic diseases, and drastically reducing the mortality rate, especially the infant mortality rate, which led to a significant improvement in China's rural health situation. Since the 1980s, in the process of economic transition, the cooperative medical system in rural areas has basically been dismantled, and the vast majority of farmers have become self-funding medical groups. Because the growth in farmers' incomes has not kept pace with the rise in medical costs, the problem of a large number of poor farmers being unable to afford to see a doctor has become more prominent, and rural health care is facing new challenges.　　　First, four major factors affecting rural health input Since the 1990s, rural health financing has faced four new background factors: first, in 1994, the country implemented a tax-sharing reform. This reform made the central and local finances responsible only for inputs to health organizations directly under their own level. The central treasury only subsidizes localities on the basis of special transfers. Overall, the tax-sharing reform improved the central government's ability to control budget revenues and expenditures, but the growth of central financial inputs to rural health was very limited after the reform. Because of limited tax sources, county and township governments in the central and western regions have had difficulty in securing inputs for township health centers, and have been unable to meet the needs of rural residents for the most basic public **** health services. Secondly, in the mid- to late 1990s, with the restructuring of a large number of township enterprises into private enterprises, rural township health centres and village health offices lacked both government financial support and difficulty in relying on rural collective economic organizations to raise funds for rural health services. Third, after the reform of rural taxes and fees, the financial growth of county and township governments has been affected, and the growth of extrabudgetary revenues, especially at the township level, has declined sharply, further weakening the ability to support rural health. Fourth, the distribution of government health budget expenditures between urban and rural areas is unreasonable; from 1991 to 2000, the government's budgeted expenditures on rural health totaled only 69 billion yuan, accounting for only 15.9 percent of the government's total budgeted expenditures on health; from 1991 to 2000, China's budgeted expenditures on health increased by 506,271,100,000,000 yuan, while health expenditures on rural areas increased only 6,308,000,000,000 yuan, accounting for only 12.4 percent of total budgeted expenditures. This accounted for only 12.4 per cent.　　　In recent years, the central government has made it clear that the focus of health work should be on rural areas, requiring that "new health funds should be invested mainly in rural areas"; the National Rural Health Work Conference held in 2002 made it clear that by 2010, all farmers should enjoy primary health care, and that the main health indicators should reach the advanced level of those in developing countries. The key to realizing these goals is the gradual construction of a rural health-care system. The key to realizing these goals is the gradual construction of an effectively functioning medical safety net for farmers. Therefore, the first and foremost issue in building a health-care safety net for farmers is the establishment of a reasonable health-care financing mechanism.　　　Second, there is a mismatch between the government's funding investment and the rural health model The lack of government funding for the public *** health sector has forced more and more health prevention departments and maternal and child health departments to make up for the cost of their services by charging fees, which has affected the development of public *** health service programs.　　　After the mid-1990s, the incidence of certain endemic and infectious diseases that had been brought under control in rural areas rebounded or even resurfaced. Most of the less developed regions are high prevalence areas for epidemic, infectious and endemic diseases in China. Local finances in the less developed regions are unable to support investment in disease control and basic health care, and are unable to meet the basic public **** health needs of the local population, and the maternal and child health care of the rural migrant population in the cities has not been incorporated into the local health security system. The outbreak of the SARS epidemic demonstrated the weak capacity of rural areas to cope with major epidemics and public **** health emergencies. China is currently practicing a rural health management system at all levels of government in accordance with hierarchical management, with counties (municipalities) taking the lead, and county-level governments assuming full responsibility for rural public **** health work. It has proved difficult to effectively address the problem of the weakening of rural public **** health services under the current policy framework.　　　Although a three-tiered network of county, township and village health services has been established in rural areas across the country, in rural areas government funds are almost entirely invested in county and township health organizations, a situation that does not match the health consumption patterns of farmers. In rural areas, nearly 60 per cent of outpatient services are provided by village health offices or private clinics, and only one quarter are provided by township health centers. Although the State Council's decision on further strengthening rural health puts forward the idea that village health offices should take on the preventive health care tasks assigned to them by the health administration, there is currently little financial support for village health organizations. How to reposition village health centers and enhance public ****ancial support for village health offices is an issue that must be reconsidered.　　　Another problem facing the rural health system is the problem of overlapping responsibilities between county and township health organizations in terms of health services. At present, medical and family planning services at the county and township levels are organized into separate systems, with low resource utilization. How to integrate rural health institutions and maximize the benefits of scarce health resources is also an important issue facing China's rural health reform.　　　Third, the development idea: one orientation, two principles In 1997, the Central Government and the State Council, in their Decision on Health Reform and Development, proposed that they would strive to establish various forms of cooperative medical systems in most rural areas by the year 2000. In fact, the resumption of cooperative medical care has encountered many insurmountable difficulties in practice and has not achieved the planned goals.　　　For the majority of peasants, the threat of disease is mainly major illnesses, a risk they cannot afford to take, and the development of cooperative medical care for major illnesses is adapted to the demands of the peasants.In 2002 the Ministry of Health once again proposed that the establishment of a mutual aid cooperative medical care system based on the coordination of major illnesses should be a priority for improving the rural cooperative medical care system, and the Government did commit itself to subsidizing the cooperative medical care in rural areas. However, the central government's transfer payments are contingent on local government financing, which in turn is contingent on farmers' financing. For economically underdeveloped areas, it is difficult for local governments to secure funding. If the central government does not provide the start-up funds for the new cooperative medical care system in advance, it will be extremely difficult to realize the goal set by the Ministry of Health of establishing a new cooperative medical care system focusing on the coordination of major illnesses by 2010.　　　Therefore, the general idea of improving the rural medical insurance system should be: to start from the actual situation in rural areas, adhere to the policy orientation of urban-rural integration, adhere to the principle of phased and gradual improvement, adhere to the principle of regional differences, increase the government's investment in rural medical insurance, prioritize the solution of basic medical and health care services for peasants, set up a multilevel rural medical insurance system, and gradually narrow the gap between the levels of urban and rural medical insurance, so as to ultimately achieve the goal of urban-rural basic medical insurance. gradually narrowing the gap between urban and rural medical security levels, and ultimately realizing the convergence of urban and rural basic medical security systems.　　　V. Combining Economic Poverty Alleviation with Health Poverty Alleviation According to the international "poverty line" (per capita living expenses of less than US$1 per day), there are still more than 100 million poor people in China's rural areas. These people are mainly concentrated in some resource-poor mountainous areas in the interior of the country, where they are unable to bear the costs of participating in cooperative medical care or to participate in medical insurance, etc. Ensuring that these people in difficulty can enjoy basic medical and health services is of great significance in alleviating the problem of poverty. Medical assistance is an integral part of the medical security system, and strengthening the construction of the medical assistance system to provide a certain degree of welfare medical protection for the poorest rural residents is necessary to realize the goal of "health care for all", and even more importantly, to get rid of the problem of "poverty caused by illness", It is also necessary to get rid of the problem of "poverty caused by illness" and "poverty returned to the poor because of illness". We should combine economic poverty alleviation with health poverty alleviation, and gradually increase the investment in health poverty alleviation in the total national poverty alleviation funds, to help poor areas focus on solving the construction of basic sanitation facilities, improve drinking water conditions, strengthen maternal and child health care and prevention and treatment of infectious diseases, endemic diseases and other aspects of the difficulties.