从魏则西事件看医改认知和政策误区

Cognitive Misunderstanding of Health Care Reform and Policy from the Perspective of “Wei Zexi Incident”

魏则西事件折射出当前我国医疗改革领域的种种乱象,表明我们在医疗改革中对市场导向的医改政策等关键性问题的错误认知并未得到纠正。误区之一,是没有认识到医疗市场失灵是内置的,而这种医疗市场结构的内部失灵源于信息的不确定性和不对称性,医疗市场的国际经验与百度—莆田—武警医院肮脏利益链的形成都说明了这一点。误区之二,是不了解医学是人道的专业,即医生不能将自我利益放在第一位,医患之间是信托而非契约关系,医院不能以追求利润和增值资本为目的,引入市场机制和资本必然损害医学的核心价值,恶化医患关系,它表明决策者缺乏"利益冲突"和"财务灾难"的概念。误区之三,是不了解建立一个以初级医疗为中心并与二级三级医疗协调的医疗配送系统的重要性,且建立这一系统必须将客观需要与主观愿望分开,在系统中进行供给侧改革或控制,并以初级医疗为主而以高新技术医疗为辅。误区之四,是不了解未经证明的临床不当应用严重损害病人利益,类似莆田系医院的非法牟利行为应禁止并追责,试验性治疗需满足一定的条件。

＂Wei Zexi Incident＂reflects all kinds of chaos in current China＇s medical reform,which shows that we have not corrected the wrong cognition about the key problems in the reform of health care reform policy.The first misunderstanding is that there was no awareness of the fact that medical market failure had been built in by itself,and the internal failure of the medical market structure was due to the uncertainty and asymmetry of information. The international experience of the medical market and the nasty profiting chain of Baidu- Putian hospitals- the Armed Police Hospital illustrates this point. The second misunderstanding is that we do not understand medicine is humane and professional,in which doctors can＇t will self interests in the first place,and the relationship between doctors and patients is that of non- contractual trust. Hospitals are not in pursuit of profits and capital appreciation,and therefore,introducing the market mechanism and the capital is bound to harm the medical core values,leading to deterioration of the doctor- patient relationship. It has been shown that decision makers lack the concept of ＂conflict of interest＂and ＂financial disaster＂. The third misunderstanding is that we do not understand the importance to establish medical coordination health delivery system between a primary care center and secondary and tertiary medical services and the establishment of the system must discriminate the objective needs and subjective desire. The supply side reforms or control can be carriedout within the system,and primary medical treatments should take the priority and high- tech medical treatments can be supplemented. The fourth misunderstanding is that they do not understand the clinical improper application will do serious damage to the interests of patients. As a consequence,the illegal profit- making behavior similar to that of the Putian hospitals should be prohibited and accountable. Experimental treatment can only be done under proper conditions.