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中国医疗卫生体制改革的关键问题是体制建设。其核心是构建一个跨政府部门,连接政府、市场和整个社会医疗卫生体制改革的制度和机构平台,构建一个多部门和多个利益相关者参与制定改革方案的机制。为了既实现效率又保证公平,除了保障医疗服务的社会公平和筹资,政府特别要致力于建立一种由医疗卫生服务的生产、消费和购买方三方制衡的机制来提高医疗服务的效率。而在公共资源的投入方面,应当致力于建立一个多元化的医疗卫生体系。最后,作者提出的具体建议是(1)确立医疗服务购买方在医疗卫生体制三方关系中的主导地位;(2)逐步建立以家庭为基本投保单元的三级医疗卫生筹资体系;(3)充分利用现有的技术手段,加强对医疗卫生政策操作过程的监控。
The key issue of China’s medical and health system reform is institution building. At its core is the establishment of a system and institutional platform for inter-governmental departments and links with the government, the market and the health care system reform in society as a whole, and a mechanism for multisectoral and multistakeholder involvement in the formulation of reform programs. In order to achieve both efficiency and fairness, in addition to guaranteeing social equity and financing of health care services, the government is especially committed to establishing a mechanism that is balanced by the tripartite balance of production, consumption and purchase by health services to improve the efficiency of health care services. In the input of public resources, efforts should be made to establish a diversified medical and health system. Finally, the author’s specific suggestions are: (1) to establish the dominance of buyers of medical services in the tripartite relationship of the healthcare system; (2) to gradually establish a three-tier health care financing system with families as the basic unit of insurance; and (3) Use of existing technical means to strengthen the monitoring of health care policy operation process.