“看病贵”问题产生的根源:政府医疗服务筹资职能的撤退

The essential cause resulting in "high personal medical expenditure":Decreasing Finance for Health Care from the Government

在社会人均收入不断增长的情况下,"看病贵"问题突显的是疾病风险的扩大化。疾病风险的扩大化一方面因为医疗费用的过快增长,加大了疾病的不确定性损失。而医疗费用的过快增长与先进医疗技术和药品的过度利用是分不开的,成为自上世纪80年代以来医疗费用过快增长的主要决定性因素,究其根源则是政府对于供方财政投入的不足和扭曲的收费定价机制下的不合理服务收费方式所引起。另一方面,疾病风险的扩大化源于基于大数法则的疾病风险分担机制不健全,即医疗保障制度的不健全。构建具备风险分担机制的医疗保障,政府起着不可推卸的责任。明确政府的供方筹资职能,改变现有支付方式,有效降低医疗费用的过快增长,合理界定政府的需方筹资职能,建立健全我国的医疗保障制度应该成为解决"看病贵"问题的关键所在。

With the development of income per capita, ＂high personal medical expenditure＂ shows the wider of disease risk, which is resulted from the increasing medical payment and imperfect risk pooling. The former that is related with the excess delivery of advance medical technology and drug has been a dominating reason since 1980. And the imperfect risk pooling means the imperfect social medical insurance, of which the government should take charge. However, influenced by the reform policies of the economic systems, similar to all the transitional economies reducing the government role in healthcare financing, China has put an increasing emphasis on the payroll tax- based social insurance system and out- pockets payment, moving away from a predominantly general revenue -based financing system under the old command economy. In a conclusion, the Chinese Government should make clear the financing function, and replace fee - for - service （ FFS） payment according to the distorted pricing system with aggregated pre -payment for patients covered by social insurance to mitigate the incentive for cost escalation. Meanwhile, the target of the new medical reform that should resolve the problem of high personal medical expenditure is demanding and perfecting the social medical insurance with wider risk pooling.