中国医改的几个理论问题

Theoretical Problems of China’s Health Care Reform

西方经典公共产品理论不能解释药品、医生、医院和医疗服务是不是公共产品的问题。社会对于某种产品产生了超越个人需求的共同需要，就会把这种产品当成公共产品来提供，因而药品、医生、医院和医疗服务的性质取决于一定社会的医疗卫生体制。充分肯定公共卫生的公益性，并不意味着医疗卫生普遍具有公益性。混淆医疗与公共卫生的性质区别，就发生用公益性命题绑架我国医疗卫生体制改革的理论错误。医疗的市场属性决定了世界上大多数国家医疗体制的主流是“社会保险模式”。我国医疗体制在从“福利国家模式”走向“社会保险模式”过程中形成了具有四大缺陷的体制模式，这就是我国现行医疗体制既不利于公平又缺乏效率的根本原因，故重构医保体制是我国医改的大方向。

Western classical theories concerning public goods cannot help to explain whether drugs, doctors, hospitals as well as medical services are public issues. Once there is a public need rather than an individual need in the society for a particular product, it will then be deemed as a public issue. Hence, the nature of drugs, doctors, hospitals as well as medical services are determined by the health care system of that society. Besides, it is important to note that public welfare, fully reflected in public health, may not be frequently exhibited in health care. Failure to recognize the differ- ences between medical health and public health may result in theoretical errors in that the issue of public welfare may exert a strong influence on health care reform. The fact that health care shares the same characteristics as market deter- mines that social insurance program is the mainstream in the health care system in most of the countries. Undergoing the changes from the national welfare pattern to the social insurance pattern, health care system in China is distorted, rendering unfairness and inefficiency. Therefore, it is of vital importance to head towards reconstructing the health in- surance system.