新医改背景下我国基层医疗体制存在的伦理困境及其对策

Ethical Dilemmas and Countermeasures of China's Primary Medical System under the Background of New Healthcare Reform

新医改自实施以来取得了阶段性成效,但基层医改过程中仍面临很多问题,存在诸多伦理困境。医疗资源配置失衡反映出的政府与市场关系、"三医联动"推进困难反映出的部门利益冲突、分级诊疗制度落实难反映出的医疗卫生系统各方利益主体的不同诉求,从而导致我国医疗卫生系统整体功能未充分发挥。基于伦理视角,提出以科学界定政府与市场责任为框架,构建以公平为价值取向的卫生资源配置要素投入制度;以伦理责任为框架,促成医疗、医保、医药部门联动改革的合作共识;以伦理共同体为约束,平衡各方责任利益,促进分级诊疗制度政策落地。

Since the implementation of the new healthcare reform,it has achieved some success. However,many problems still exist in the process of primary medical reform,and there are many ethical dilemmas. The unbalanced allocation of medical resources reflects the relationship between government and market,the difficult promotion of ＂three medicine＂reflects the sectoral conflicts of interest,the difficult implementation of the grading diagnosis and treatment system reflects the different demands of stakeholders in health care system. As a result,the whole function of China＇s medical and health system has not been fully played. Based on the ethical perspective,this paper put forward that taking the scientific definition of government and market responsibility as a framework,it should construct an investment system of health resource allocation taking equity as a value orientation; taking ethical responsibility as the framework,it should promote the cooperation consensus of the linkage reform of medical treatment,medical insurance and medical departments; and taking ethical community as the constraint,it should balance the interests of all parties and promote the implementation of the policy of grading treatment system.