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2009年中国启动新医改以来,我国医药卫生体制改革深入进行,取得了令人瞩目的成就,然而“看病贵、看病难”问题还没有根本缓解,尤其是“看病难”的问题。我国社会医疗保险体系占据医疗保障体系中的绝大部分比重,私立医疗发展相对缓慢。同时“看病难”问题并未得到有效的衡量和测算。因此,鲜有学者从私立医疗发展的角度讨论上述问题。国内目前还没有文献给出私立医疗发展与“看病难”之间的关系的实证证据。文章采用加拿大公共医疗等待时间的病人个体数据,试图为我国医疗改革中通过发展私立医疗缓解“看病难”问题寻找他国的经验和启发。研究发现:加拿大私立医疗发展对公共医疗所产生的医疗服务需求的分流效应要大于医疗资源供给的挤占效应,能够缩短公共医疗等待时间。我国可以从加拿大医疗体制改革中得到医疗保险制度本身、私立医疗发展这两个方面的启发。我国应全面推进公立医院改革,鼓励私立医疗发展,从供给侧入手对医疗服务市场进行结构性改革,缓解结构性“看病难”的问题。
Since China started the new medical reform in 2009, the medical and health system reform in our country has been carried out in depth and made remarkable achievements. However, the problem of “getting expensive medical care and seeing a doctor hard” has not been fundamentally alleviated, especially the problem of “seeing a doctor hard” . China’s social medical insurance system occupies the vast majority of the medical security system, private medical development is relatively slow. At the same time “difficult to see a doctor” problem has not been effectively measured and measured. Therefore, few scholars discussed the above issues from the perspective of private medical development. There is still no literature in the country to give empirical evidence on the relationship between private medical development and “difficult medical treatment”. This article uses the individual data of patients waiting for public health care in Canada to try to find the experience and inspiration of other countries through the development of private medical relief in the medical reform in our country. The study found that the diversion effect of private medical development in Canada on the demand for medical services generated by public health care is greater than the crowding-out effect of the supply of medical resources, which can shorten the waiting time for public health care. Our country can get inspiration from two aspects of the medical insurance system itself and private medical development from Canadian medical system reform. China should comprehensively promote the reform of public hospitals, encourage the development of private medical services, start from the supply side to carry out structural reforms in the medical service market, and ease the structural problem of “difficult access to medical treatment.”