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一、医疗制度的根本困境医疗制度改革是世界各国政界、舆论界和经济学界的热门话题。世界各国都普遍面临医疗费用大幅度超支和快速飚升问题。医疗费用的高速增长既有保障过度和医疗供给方引致过度医疗需求的原因,也有医疗行业对高费用医疗技术、医疗方案追捧的原因。从表面上看,这是医疗过程中有关各方的信息不对称问题,进一步分析,其中更涉及到医疗产业的发展问题。自现代社会保障制度建立以来,医疗产业普遍处在政府的严密监督与控制之下。这主要是出于珍视生命的伦理要求和保障社会公平的价值取向,但医疗的特点导致了政府监控的低效率。首先,医疗过程的高度专业化造成了医疗质量和费用的隐性特征;其次,医疗费用与医疗技术的强相关性以及医疗技术的不断创新给政府控制医疗费用带来困难;最后,政府监督和控制是建立在一系列的技术
I. The Fundamental Predicament of the Medical System The reform of the medical system is a hot topic in the political, media, and economic circles of the world. All countries in the world are facing the problem of significant overspending and rapid increase in medical expenses. The rapid growth of medical expenses has both over-protection and causes of over-supply of medical supplies, as well as medical industry’s pursuit of high-cost medical technology and medical solutions. On the surface, this is the problem of information asymmetry among relevant parties in the medical process. It is further analyzed. It also involves the development of the medical industry. Since the establishment of the modern social security system, the medical industry has generally been under the close supervision and control of the government. This is mainly due to the ethical requirements of cherishing life and the value orientation of safeguarding social fairness, but the characteristics of medical treatment have led to the low efficiency of government monitoring. First, the high degree of specialization of the medical process has caused the hidden characteristics of medical quality and cost; Second, the strong correlation between medical costs and medical technology and the continuous innovation of medical technology have brought difficulties to the government in controlling medical expenses; finally, government supervision and Control is built on a series of technologies