With the new medical reform, healthy China 2030 plan and the 13th Five-Year poverty reduction with the implementation of health assistance project,the poor counties will continue to benefit.But,in the long run, the sustainable development of the rural health system will eventually change to blood formation"hematopoiesis"rath-er than blood transfusion,which requires structural change from health planning to governance of the normal mecha -nism.With the central government fund focus on higher level of health delivery system and promote private health in -vestment in rural health,the health planning process of poverty county in 13th Five-Year is full of game,choice and adaptation.According to the study of 4 poorest counties in western area.The health planning in poor counties prefers the incremental planning of project investment, which is embodied in the incremental speculation and conservative management of resources planning.Poor counties need to balance the public interests and the sector interests, the vertical administrative control structure and introducing more private resource also lead to the poor counties,transfor-mation of health planning and promoting development.%随着新医改、健康中国2030规划以及"十三五"健康扶贫工程的推进,贫困县持续获益,但农村卫生系统可持续发展终究要变"输血"为"造血",这需要从卫生规划到治理常态机制的结构性变革.随着中央对农村卫生投资重点的抓大放小、增量发展的抑公促私,贫困县"十三五"卫生规划制定过程充满了博弈、抉择和变通.对西部4个国家级贫困县访谈调研发现,贫困县卫生规划偏好"上项目—拉投资",呈现出资源规划的增量投机和保守治理等特点.贫困县卫生规划除了要平衡公共利益和部门利益之外,纵向问责控制结构、引民资促发展思路也影响着贫困县卫生规划与治理.
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