对我国卫生体制改革的思考与建议

Some Thoughts and Recommendations for Chinese Future Health System Reform

医疗保障体制不健全,服务效率低、费用高和质量差是卫生体制问题的主要表现;我国公共卫生的问题是疾病预防控制功能的弱化。为此,应给所有医疗机构相同的政策和法律环境,人为地划分为营利性和非营利性、实行不同的法律和政策是不合适的;"以大病为主"的医疗保障原则是对的,但参保对象应该扩大至以家庭为单位;在卫生领域,政府的职责是搞好保险和管好服务提供。在未来的改革中,建议:公私立机构都可以提供基本医疗服务,要一视同仁;对公立医疗机构,不应过分强调参照行政机构的方式管理,强调政府的责任不等于政府包办一切;要发挥地方政府政策研究的主动性问题;要按照社会公平原则,建立覆盖城乡全民的医疗保障体系。

Lacking of universal health insurance coverage, low efficiency in health care delivery system, high cost and low quality of medical care, and weakening of disease prevention and control are main problems in Chinese health sector. The author preferred that the policy of dividing hospitals into for-profit and non-for-profit and implementing different laws and regulations are not helpful to develop non-public-sector; the health insurance should be based on whole households rather than individuals; the responsibility of the government is to build up health insurance for all citizens and insure the health care delivery. For the future, public hospitals should not be managed as government organizations financially; local government should play more roles in policy research and making; and a universal health insurance should be established as soon as possible.