当代中国农村医疗体制的变革与发展趋向

The Reform and Developing Orientation of China's Rural Healthcare System at the Contemporary Age

当代中国农村医疗体制在六十年中经历了翻天覆地的变化。在1978年之前,中国农村的医疗服务体系由县、乡、村三级组成,县级医疗机构属于全民所有制的事业单位,乡村医疗机构属于人民公社集体所有,它们在农村医疗服务方面发挥了积极作用。改革开放以后,传统的合作医疗被新型合作医疗所取代,即嵌合在集体主义政治经济制度中的社区微型医疗保险被政府补贴的自愿性公立医疗保险所取代。依然处在行政化制度和组织中的农村各级公立医疗机构都走上了商业化道路,但民营医疗机构在农村的发展还很不充分。由于医疗保障体系还欠发展,医保机构第三方支付对于医疗机构还缺乏制约,农村公立医疗机构的医药费用上涨幅度超过了农村居民收入的上涨幅度。针对这些问题,新一轮医疗卫生体制改革为农村医疗卫生事业的发展带来了机遇。新农合的巩固、公共财政投入向农村地区的倾斜、社会资本的进入、公立医院的法人化有助于农村医疗事业的发展,但公立医疗机构的行政化则有可能对县医院和乡镇卫生院的发展前景投下了阴影。

In the past 60 years China＇ s rural heahhcare system has undergone a radical change. Before 1978 it was made up of county, township and village and played an active role in the rural healthcare service. Since the reform and opening up to the outside world, the traditional joint medical care has been taken place of by new- typed one, namely, community health insurance is taken by the public -owned hospitals subsided by government in the economic and political system of collectivism and then public -owned hospitals are going towards the commercial road and private -owned hospitals are not enough. The rapid rise of healthcare expenses is faster than the income of rural residents. To these problems, the new turn of heahhcare reform will bring new opportunities. New- typed rural joint medical care, investment from public finance towards the rural, areas, capital entry, public -owned hospitals will be beneficial to the rural healthcare, but administrative management may perhaps bring some harm.