改革开放以来中国医疗行业中政府与市场关系的演进

The Evolution of Government-Market Relationship in China's Health Care Industry Since the Reform and Opening-up

改革开放以来,与中国建立和完善社会主义市场经济体制的大进程一致,中国医疗行业供方中公立医疗机构的比例下降,民营医院数目已经超过公立医院,公立医疗机构享有的经营自主权大幅增加,因而整个医改进程是市场导向的。但是,在这一进程的某些时期,政府与市场的关系有变化,具体经历了三个阶段:1978年至1997年的"市场导向、监管缺位",1997年至2009年的"两相并重、探索前行"和2009年至今的"政府主导、干预回归"。出现这种演变模式的根本原因是市场机制无效这种观点在医疗行业盛行。十九届三中全会推行的党和国家机构改革对医改中政府与市场关系的调整提供了可能。

Since the reform and opening-up, accompanied by China＇s journey to set up and improve a socialist market economy system, the China＇s health care system reform is market-oriented on the whole, which can been seen from the following stylized facts： firstly, the share that state-owned providers take up has been rising, and the number of private hospital has surpassed that of state-owned hospital in 2015; secondly, state-owned providers have obtained more and more independence in operation. However, market dominates government in some phase of the market-oriented process, while in other phase government dominates market. Exactly, the process can be classified into three stages： Market Orientation and the Lack of Supervision between 1978 and 1997, Unbiased and Trial-and-error Progress between 1997 and 2009, and Government Orientation and Intervention Return since 2009. The primary reason lying behind this mode of evolution is that the wrong mind of ineffectiveness of market mechanism is very popular among China＇s health care industry. Due to this wrong mind, policy orientation is under the influence of the reform thought tide at the national level and the vested interest group, and as a result the mode appears. The systematic reform on state bureaucratic apparatus put on the third Plenary Session of the 19th CPC Central Committee offers opportunity for the re-adjustment of Government-Market relationship.