被动模仿经济改革经验:忽视了医疗服务的公平性

Imitating economic reform passively:medical reform ignored equity of medical services

在过去28年中,忽视医疗卫生的宏观改革环境,财政对医疗卫生的筹资职能逐步撤退,以及物价部门长期坚持的降价和限价政策,使得卫生行政部门没有更多的选择,总体模仿宏观经济的改革措施,并成功模仿了如承包责任制、放权让利、利改税、资金自筹、自收自支、自负盈亏等用于刺激经济增长的改革举措,这些政策固定了医院的经营模式,同时,使得医院“通过服务收费多收一点”有了制度的保障,客观结果是迫使医院亦步亦趋走向“市场”,忽视了医疗卫生服务的特殊性,刺激了医疗机构“经济(业务收入)增长”的同时,医疗费用快速增长速度远远超过GDP。如何把握医疗卫生服务的公平与效率的关系,追求医疗服务“高效率的公平和可及”,应该成为解决医疗费用畸形增长问题的切入点。

In the past 28 years, the macro environment of health reform was neglected, and government＇ s fund-raising function of health was gradually weakened. The price department always sticks to the policy of depreciation and price fixing, All of these made health administration have no more ehoiees but imitate economic reform ultimately, It imitated a series of reform measures of stimulating economic growth successfully such as contract responsibility system, decentralizing authority and reducing profits, taxes-in-lieu-of profits, self-financing, income and payout by themselves, etc. These policies fixed the business model of hospitals, and gave hospitals the system security when ＂earning more money by services＂. As a result, hospitals became market oriented step by step following economic reform, and stimulated the medical institutions＇ ＂economic （the revenue ） growth＂, but it neglected the particularity of health services, and caused the rapid growth in medical costs, the rate of which was far exceeding GDP. How to grasp the relationship between equity and efficiency of health services, and how to achieve equity and accessibility efficiendy, became the important breakthrough to solve the problem of abnormal medical cost growth.