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自1997年《中共中央国务院关于卫生改革与发展的决定》以来,中央政府几乎每年都出台重大的改革推进措施,体现了政府决策层顺乎民意的改革决心。然而我们仔细学习近年来的医改文件,不难发现中央政府改革的思路是:先是企图建立医保制度控制飞涨的城镇医药费用,以缓解传统公费医疗和劳保以及城市新增非医疗保险人群医疗支出的压力;后来发现如果医疗机构的补偿不足,就难以实现降低医疗费用的目标,于是又明确提出医疗卫生体制和药品生产流通体制的改革,希望扭转以药养医的机制,从而降低医疗费用。但遗憾的是,所有这些改革措施的收效并不十分理想。除极少数大城市外,基本医疗保险的覆盖面推广缓慢,目前还不足30％;药品价格居高不下;大型医院和专科教学医院人满为患,而一二级医院机构和非卫生系统的医院诊所却门庭冷落。
Since the “Decision of the Central Committee of the Communist Party of China on Health Reform and Development” in 1997, the central government has introduced major reforms and measures to push forward almost every year, reflecting the government’s decision-making reforms that are commensurate with public opinion. However, when we carefully study the medical reform documents in recent years, it is not difficult to find that the central government’s reform idea is: First, it intends to establish a medical insurance system to control the soaring costs of urban medicine so as to relieve the medical expenses of traditional public medical care and labor insurance and urban non-medical insurance populations. Pressure; It was later discovered that if medical institutions did not make enough compensation, it would be difficult to achieve the goal of reducing medical expenses. Therefore, the reform of the medical and health system and the production and distribution system of pharmaceuticals was clearly proposed, and it was hoped that the mechanism for taking drugs to support medicine would be reversed, thereby reducing medical expenses. Unfortunately, the effectiveness of all these reform measures is not very satisfactory. Except for a few major cities, the coverage of basic medical insurance is slow, and it is still less than 30%; drug prices remain high; large hospitals and specialist teaching hospitals are overcrowded, while hospital clinics of first- and second-tier hospital institutions and non-health systems are doorways. Coldly.