回归医疗服务本质:从“医药分开”看医疗服务供给

Return to the Nature of Medical Services: an Analysis of Medical Services Supply from the Perspective of “Medical Separation”

本文在构建中介变量模型并实证分析"医药分开"对医疗服务供给影响的基础上,研究了优化医疗服务供给的政策建议。研究发现,医疗服务供给中存在的问题源自两个分离:一是医方剩余控制权与剩余索取权的分离;二是需求者与支付者角色的分离。前者解释了效率不高的问题,后者解释了费用较高的问题。进一步研究表明,优化医疗服务供给亟需回归医疗服务本质:把握关键要素,将改善医院和医生收入作为突破口;树立正确导向,将理顺医疗服务价格体系作为长久之策;平衡各方利益,将财政补贴作为医药分开的主要手段;扫除制度障碍,逐步消除不合理的合约形式。

This paper analyzes the policy proposals about medical services optimization on the basis of the construction of intermediary variable model and the empirical analysis of the impact of 'medical separation'on medical services supply. It shows that the problems of medical service supply originate from two separations. The first is the separation of residual control right and claim right of the medical side. The second is the role separation of the demander and the payer. The former explains the cause of low efficiency and the later shows the cause of high costs. The further study demonstrates that medical services optimization needs to return to the nature of medical services. The critical elements should be emphasized,and the breakthrough relies on the improvement of hospital and doctor income. We should find the correct direction to rationalize the medical price system for the long time,and balance the interests of all sides,and make financial subsides the primary means to carry out medical separation,so as to remove institutional obstacles,and eliminate unreasonable contract terms.