再论医保在医改中的基础性作用——基于分级诊疗的视角

Further Discussion on the Basic Role of Medical Insurance in Health Care Reform

本文从分级诊疗的视角,讨论"三医联动"中医保和医疗的关系。第一,医保能否引导患者基层首诊,取决于医生资源在各级医疗机构之间配置是否均衡,事实上,我国各级医疗机构资源配置严重不均衡,这就导致医保通过向基层倾斜难以引导患者基层首诊。第二,医保能否引导医生向基层下沉,取决于医生是否能够自由流动,公立医院的行政化属性和编制,严重阻碍了医生的自由流动。第三,医保通过支付方式改革,只能推动医院加强内部管理,而不能推动医疗卫生体制改革,不能推动"政事分开、管办分开",不能推动公立医院去编制、去行政化,因此,无力推动医生自由流动。

This paper discusses the relationship between medical insurance and medical treatment.Firstly,the balanced allocation of doctors'resources will aff ect patients'choice of medical treatment.In fact,the resource allocation of medical institutions at all levels in China is seriously unbalanced.Second,it depends on whether doctors can move freely or not,which will aff ect the direction of doctors'practice.The administrative nature and organization of public hospitals have seriously hindered the free fl ow of doctors.Thirdly,through the reform of payment mode,medical insurance can only promote the internal management of hospitals,but can not promote the reform of medical and health system,and can not promote the establishment and de-Administration of public hospitals.Therefore,it can not promote the free fl ow of doctors.