中国城市医疗卫生体制的演变逻辑

The Evolutionary Logic of Urban Health Care Systems in China

通过建立一个综合性理论框架,阐释中国城市医疗卫生体制的演变逻辑发现,新中国成立后形成的城市医疗卫生计划体制与当时的外部环境相适应,且内部各组成要素之间协调互补。改革开放以来,整体社会经济制度走向市场体制,人口特征与疾病谱显著改变,居民收入水平显著提高且差距拉大,医疗卫生人员素质普遍提高,外部环境这些不可逆转的变化,内在地要求城市医疗卫生事业走出传统计划体制。这期间发生的诸多问题,源于体制转变期的冲突,是渐进式改革难以避免的。因此,不能以"改革"之名退回传统计划体制,应该逐步完善新体制,使其既与外部环境相适应,又能实现内部要素间的协调互补。

Establishment of a comprehensive theoretical framework enables us to explain the evolutionary logic of Chinese urban medical care systems.It indicates that the planned system of urban medical care that came into being after the founding of New China in 1949 suited the external conditions of the times and had internal elements that were coordinated and complementary.Since reform and opening to the outside world in 1978,the whole socioeconomic system has become marketized;China's demographic character has undergone a marked change,as has the spectrum of diseases;residents' incomes have risen considerably but there is a larger gap between them;and the qualifications of health care professionals have improved everywhere.All of these irreversible changes in external conditions by their nature require a break with the traditional planned system.The many problems that have arisen over these years originate in the conflicts of a period of systemic transition;they are inevitable in an incremental reform.Therefore,we cannot retreat to the traditional planned system in the name of'reform';rather,we should gradually improve the new system so that it suits external conditions and also achieves the coordination and complementarity of various internal elements.