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| 个人信息 |
| 姓 名： |
申译员 [编号]:1482 |
性 别： |
女 |
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| 擅长专业： |
商务 |
出生年月： |
1986/3/1 |
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| 民 族： |
汉族 |
所在地区： |
广东 广州 |
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| 文化程度： |
硕士 |
所学专业： |
商务英语 |
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| 毕业时间： |
40724 |
毕业学校： |
广东外语外贸大学 |
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| 第一外语： |
英语 |
等级水平： |
专业八级 |
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|
| 口译等级： |
高级 |
工作经历： |
1 年 |
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|
| 翻译库信息 |
| 可翻译语种： |
英语、法语 |
|
|
| 目前所在地： |
广东 广州 |
| 可提供服务类型： |
笔译、口译、家教 |
| 每周可提供服务时间： |
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| 笔译案例信息 |
| 案例标题： |
我国公共卫生和医疗体系初探 |
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| 原文： |
目录
摘要
感谢信
声明
导论
第一章 公共卫生和医疗体制的理论分析
1、公共卫生和医疗体制的定义
2。 我国公共卫生和医疗体系概述
第二章 我国公共卫生和卫生医疗体系现状和改革
1、农村公共卫生和医疗服务体系建设中亟待解决的问题
2 .公共卫生和卫生医疗改革重点以及目标
2．1． 解决“难”和“贵”
2．2、医改目标
2．3、政府的责任
3 .完善农村公共卫生医疗服务体系的对策和建议
第三章 美、英两国医疗卫生体系概述
1、美国医疗卫生体系解析
2．英国医疗卫生体系解析
2．1．英国国家医疗服务体系
2．2．我国香港地区
3． 借鉴美英模式对我国卫生医疗体系进行比较
第四章 我国医疗卫生体系改革的建议以及成效
1 。 医疗卫生体系改革的建议
2 . 医疗卫生体制变革的主要成效
结论
参考文献
摘 要
医疗卫生的改革与发展是我国构建社会主义和谐社会的重要内容之一，关乎民生是我国经济发展和社会稳定的基础。
在今天，医疗卫生体制是否适应本国的经济发展，是否能够基本满足国民的医疗需求，是体现一个国家执政能力与社会和谐程度的重要方面。从我国情况看，建国以来政府将医疗卫生工作的重点放在预防和消除传染病等基本公共卫生服务方面，确保了基本卫生保健服务的广泛性和公平性，使广大居民尤其是农村居民无需支付高额费用就能享受到基本卫生保健服务。然而。随着经济体制改革的推进传统医疗保障制度，因其无法适应市场经济的新形式，中国传统医疗保障制度迅速解体。八十年代以后，国家只是给医院政策，医院自负盈亏，财政经常性补偿只能勉强维持医疗机构的人头开支。医院逐步被推向市场.但是配套的机制没有建立和完善，经济效益的推进使医疗卫生资源的分配和分布畸形发展。
本文以我国公共卫生医疗体系为主线，系统研究了医疗体制的内涵，清晰的描述了我国公共卫生医疗体制的现状，全面的分析了美英发展国家的卫生体制与我国的区别，并在上述研究的基础上，提出了提高我国医疗体制推进医疗改革健康发展，促进医疗改革稳定发展的政策建议。
关键词：公共卫生 医疗体制 医疗平等权 医疗改革
导 论
进入二十一世纪，世界各国的经济都在和平、稳定的主题下发生着变化，共同目的是发展和进步，努力强国，使国民的生活富裕，生存保障和生活质量进一步提升，走国富民强的发展之路。
在今天，医疗卫生体制是否适应本国的经济发展，是否能够基本满足国民的医疗需求，是体现一个国家执政能力与社会和谐程度的重要方面。从我国情况看医疗卫生的改革与发展是我国构建社会主义和谐社会的重要内容之一，关乎民生是我国经济发展和社会稳定的基础。然而，近些年来，随着经济的发展和人民生活水平的提高，我国医疗卫生服务水平的滞后是无法否认的事实。比较美国和英国我国医疗体制的发展任重而到远。美国是最具市场导向的医疗卫生体制，医疗卫生的供给和需求由市场决定。政府除了严格监管外，还负责为穷人、老人提供医疗保险和公共卫生服务。英国是由政府主导的医疗卫生体制，全民医疗服务体系，公立医院由政府全额投入，老百姓看病是免费的，有钱人需要特殊服务，可以到私立医院去。 英国国家医疗服务体系（NHS）总目标是结合市场和政府干预两者的优点，使国家医疗服务体系既有政府干预的公平性和成本可控性，又具有市场的高效性和灵敏性的制度，在这种模式下，英国实现了全民免费医疗，普及面广，费用也较低。
在此前提下，我翻阅，收集了各种文章之后，以我自身的视角写了这篇文章此文一共囊括了四个部分的内容以我国公共卫生医疗体系为主线，系统研究了医疗体制的内涵，清晰的描述了我国公共卫生医疗体制的现状，全面的分析了美英发展国家的卫生体制与我国的区别，并在上述研究的基础上，提出了提高我国医疗体制推进医疗改革健康发展，促进医疗改革稳定发展的政策建议。
第一章 公共卫生和医疗体制的理论分析
1、公共卫生和医疗体制的定义
进入二十一世纪，世界各国的经济都在和平、稳定的主题下发生着变化，共同目的是发展和进步，努力强国，使国民的生活富裕，生存保障和生活质量进一步提升，走国富民强的发展之路。医疗卫生体制是否适应本国的经济发展，是否能够基本满足国民的医疗需求，是体现一个国家执政能力与社会和谐程度的重要方面。
（1）．公共卫生是通过疾病预防控制，重点人群健康防护、健康促进来解决人群中间的疾病和健康问题，达到提高人民健康水平的目的。公共卫生的实质是公共政策，而公共政策的主角一定是国家，公共政策的有效性依赖于社会各阶层的参与。
（2）．医疗体制包括三个方面的内容：医疗保障制度（医疗保险、医疗救助体系），医疗服务提供体系（疾病的预防，健康教育，医院或者是诊所这样的服务体系），医疗服务的监管体系【1】 。
（3）所谓医疗平等权，乃指每位病人对医疗资源（包括机构设备与人力）所享有之权利，不因男女、老幼、贫贱富贵而有所不同，应一律平等。可从实质与形式意义两方面来探讨。因此，每位国民都有一律平等地享受相同医疗资源的权利；而且对医疗资源之运用与分配，都有参与决策之权利。政府之所以实施全民健康保险与推行台湾地区医疗网之政策，都是为了全民能够藉平等地普遍享受医疗资源【2】。
2。 我国公共卫生和医疗体系概述
建国以来中国政府将医疗卫生工作的重点放在预防和消除传染病等基本公共卫生服务方面，确保了基本卫生保健服务的广泛性和公平性，使广大居民尤其是农村居民无需支付高额费用就能享受到基本卫生保健服务，中国人口的健康状况得到了显著改善。随着经济体制改革的推进，中国在“平均主义”卫生政策和低水平经济基础上建立起来的传统医疗保障制度，因其无法适应市场经济的新形式，中国传统医疗保障制度迅速解体【3】。八十年代以后，国家只是给医院政策，医院自负盈亏，财政经常性补偿只能勉强维持医疗机构的人头开支。医院逐步被推向市场.但是配套的机制没有建立和完善，医院要维持运行，就必须趋向于开大处方，让病人多住院，多接受高新设备检查，开展新特项目，这种激励机制导致过度用药、过度服务、过度检查，造成卫生资源的巨大浪费。经济效益的推进使医疗卫生资源的分配和分布畸形发展，医疗卫生工作实际的重点从农村移向城市、从“重预防”移向“重医疗”，从低成本移向高科技－高成本. 【4】
【1】 www.zhong xin.comcn19/9<<公共卫生就是人人将卫生吗》第二节第一段
【2】 李圣隆•「全民健保与病人权利」（律师通讯第194期）页28。
【3】 邱清华•在高品质、高效率的医疗要求下---病人权益保障的权衡（医事法学第三卷第6、7、8期合刊）页20：消费者的五大权利、应用於医疗上。
【5】
【4】王绍光《比较》第七期（2003年）《中国公共卫生的危机与转机》
【5】王维 苏州大学商学院 《江苏省城乡医疗卫生的不平等性研究》
然而高昂的医疗费用使得很多患者"小病扛、大病拖"其后果往往是小病拖成大病，大病导致劳动力丧失，甚至倾家荡产。一场大病，可以使原本殷实的小康之家陷入困境，使原本贫困的一贫如洗。所以，农村因病致贫的比例平均为22%每一千农村人口乡村医生和卫生员的人数从1985年的1.55降到2001年的1.41【6】。除了医疗费用过高，卫生人员相对数量减少外，医务人员的素质也令人担心。村级卫生人员中相当多的人只在30年前合作医疗高潮期接受过短期培训。虽然他们或多或少参加过一些后续培训，但在市场化的大环境下，他们要么不乐意、要么没有能力承担农村基本医疗保健的任务，如预防保健、传染病报告等【7】。世界卫生组织2000年对其191个成员国的卫生系统做了调查，并根据健康改善、政府责任、医疗提供的公平性等做了排名，中国的排名为第144位。中国的公共卫生体系已经成为可持续发展和全面建设小康社会的“软肋”【8】。
第二章 我国公共卫生和卫生医疗体系现状和改革
1、农村公共卫生和医疗服务体系建设中亟待解决的问题
近些年来，随着经济的发展和人民生活水平的提高，我国医疗卫生服务水平的滞后是无法否认的事实
（如图二）【9】。在城市中，人们普遍反映的看病难、看病贵的现象一直未能得到解决；在广大农村，农民患病得不到及时医治的状况还很普遍。据统计中国卫生事业费用约占国内生产总值的5%，公共卫生事业费约占总卫生事业费的12%。而多数发达国家公共卫生事业费占总卫生事业费的比例已达50%左右。更令人担忧的是，中国农村卫生投入严重不足，公共卫生应急体系几乎一片空白，农民抵御重大疾病灾害的能力十分脆弱【10】。
【6】http://finance.sina.com.cn 2004年08月22日 《动员全社会的资源重建公共卫生体系》第二节
【7】《中国改革》2002年第4期p13
【8】王绍光《比较》第七期（2003年）《中国公共卫生的危机与转机》p78
【9】周雁翎 差异悬殊：中国卫生保健事业面临严峻挑战第四段第三行
【10】博萃文库—中国体制改革文章汇集（www.blogtree.net）医疗体系改革的四种模式
（1）医疗费用过高，导致农民因病返贫、因病致贫。由于医疗费用的大幅上升和新型农村合作医疗规定的报销比例偏低，致使农民医疗负担过重。
（2）乡镇卫生院发展资金严重不足。在地方财政困难的情况下，财政对医疗卫生工作的支持无法保障，应拨付乡镇卫生院的资金不能足额到位，国家给予农村卫生机构的优惠政策也难以落实。许多乡镇卫生院工资无法保证，设备无法更新，吸纳人才缺乏市场竞争力。
（3）村卫生室医疗管理有待加强。随着农村卫生体系的不断变化，村卫生室的服务功能也将随之改变，将由原来的分散式服务逐步过渡到以社区卫生服务为主的服务模式上来。近年来随着卫生领域市场化发展，在村卫生室管理上出现了弱化的现象，亟待进一步加强。
（4）违法行医阻碍了农村医疗卫生建设。一些无行医资格，不具备行医条件的人由于利益驱动，无照无证行医，严重扰乱了正常医疗市场秩序，损害人民了的身体健康，阻碍着农村医疗卫生事业的发展。
2 。公共卫生和卫生医疗改革重点以及目标
1． 解决“难”和“贵”
截至二○○五年十二月，中国参加基本医疗保险的人员数达一亿三千万，仅占城镇全体从业人员的三分之一。飞速上涨的医疗费用，成为众多城镇无医保人员的就医之痛。看病难主要难在医疗资源配置不合理和医疗服务不到位，看病贵主要贵在费用之高，超出了老百姓的承受力。在农村，要加强乡镇医院建设规划，由政府筹资，改善医疗卫生条件，推行新型农村合作医疗制度，提高农民医疗保障水平。在城市大力发展社区卫生服务。
（1）. 在城镇街道和农村乡镇设立社区医疗站,医疗站的布点应科学合理,方便广大群众就医;同样这些医疗站的设立和费用完全由国家和当地政府负责。
（2）.社区医师的任务主要是预防疾病、宣传防病知识和社区人群常见病的诊疗。只要社区医院工作到位,许多患者能够在社区医院得到诊治,这样既方便了百姓,又能彻底改变当前社区医院无事可做,医疗资源浪费的局面,同时也缓解了大医院的压力,使大医院能够真正发挥其重点解决复杂危重病的功能。只有这样,才能合理利用现有的医疗卫生资源,使患者合理分流,同时也能提高医疗质量。
（3）. 加强全科医师的培养,提高社区医师业务及服务水平,是确保医疗质量,吸引患者就医的关键。目前社区医师业务水平不高,适应不了当前社区医院发展的需要。因此对现有的工作人员要实行在岗轮训。在培训 过程中应加强对预防保健实用性技能的培养。另外,也要在医学院校开设全科医师专业,让一批人从大学开始接受正规化全科医师教育,毕业后从事此项工作。
（4）. 如果国家和当地政府能够对社区医院医疗费用予以补贴或免费,就能真正解决老百姓看病难,看病贵的问题。同时,国家提高社区医院医务人员待遇,或允许大医院的医务人员到社区医院兼职,也是解决当前社区医院人员不足和水平不高的办法之一。
2、医改目标
保障全民健康 ，建设覆盖城乡居民的不同形式的医疗保险制度中，既要扩大城市职工的基本医疗保险，推行农民的合作医疗制度，城市里一些没有参加职工医疗保险的人员，还要建立以大病统筹为主的城市居民医疗保险制度。
3、政府的责任
全民医保是实现和谐社会的发展目标，彻底解决看病难、看病贵难题，长久之策还需要建立由国家、社会群体、个人等多方促成的医疗风险分担机制，即建立一个适应全社会不同年龄、不同群体、不同层次需要的全民医疗保障体系。政府应使所有社会成员都能获得大致公平的医疗服务。扩大城镇医保覆盖面，增加报销比例。政府承担公共卫生和维护居民健康权益的责任不能变，增加卫生投入、提供公共服务、加强医疗卫生监管是各级政府的重要职责。
3 .完善农村公共卫生医疗服务体系的对策和建议
（1）进一步完善新型农村合作医疗制度，大力解决农民因病致贫，因病返贫的问题。在逐步增加省、市、县财政投入的同时，尽快建立医疗救助制度，加强对合作医疗基金的使用管理，公开帐目，取信于民。
（2）建立政府和社会共同投入的机制，解决乡镇卫生院资金缺乏问题。政府对农村医疗卫生事业最大限度地给予资金上的支持，千方百计落实国家规定的优惠政策，并通过立法等手段将农村卫生经费的投入纳入法制轨道。根据实际情况采用多种灵活方式吸引民间资本进入乡镇卫生院等公立卫生机构，既可以合资入股方式进行产权制度改革，也可以设备租赁收入分成等方式吸引民间资本，有效解决公立卫生机构的发展资金问题，消除公立卫生机构人浮于事、成本不合理上升等弊端，充分发挥其相对于民办医疗机构在人员素质和医疗水平上的比较优势。在引入民间资本的过程中，应注意保持防保队伍的相对独立，避免公立机构社会公共卫生职能削弱的情况。
（3）鼓励大医院培训乡村卫生人员，提高农村卫生技术人员的业务水平。充分利用上级医院的人员、设备等优势，对下级医务人员进行培训，通过行政手段鼓励大型国有医院医务人员到卫生院短期工作，切实落实城市卫生技术人员晋升中高级职称前必须有半年乡镇卫生院工作经历的要求。
（4）加强对村卫生室的扶持与管理，规范村卫生室的诊疗服务行为。一方面加强乡镇卫生院对村卫生室的行政联系，在村卫生所人员的资格确认、管理及专业能力培训方面给予乡镇卫生院一定职权，增强乡镇卫生院的向心力，有效提高村卫生室人员的专业素质。另一方面在业务及药品采购方面推动村卫生室与乡镇卫生院之间的互利合作，业务上进行合理分工，药品采购上由乡镇卫生院集中采购，以利获得优惠价格，保证药品质量。严通过经济和行政手段，逐步加强村一级卫生系统的建设，增强农村应对突发卫生事件的能力。
（5）加强对农村医疗市场的监督力度，规范医疗市场秩序。加大对无照行医，特别是由此引发的致死致残事件的处罚力度，打击非法行医，净化农村医疗市场，促进农村卫生事业健康发展。
（6）建立和完善社区卫生服务的功能。逐步建立适应当前社会发展需要的卫生服务体系，着重在社区卫生服务的内涵上下功夫，以社区居民的医疗健康需求为导向，不断拓展服务功能，为广大社区居民提供经济、有效、方便的综合性卫生服务。
如此，医疗体制再不加快改革的步伐，必将影响社会的稳定和经济的发展。尽管大多数国家在一些方面有现行健康系统的解决方案，但没有一个国家拥有彻底解决问题的方案。我们需要跨越民族主义和保护主义的障碍，吸取其他国家和部门的教训，以便 设计出最佳的方案。
第三章 美、英两国医疗卫生体系概述
1、美国医疗卫生体系解析
美国是最具市场导向的医疗卫生体制，医疗卫生的供给和需求由市场决定。政府除了严格监管外，还负责为穷人、老人提供医疗保险和公共卫生服务。由于政府在穷人和老年人医疗保险的负担过重，政府在控制医疗费用方面采取了各种措施来控制医疗费用的上涨，如1983年美国实行了按病种付费（DRG）制度，即按照疾病种类确定固定的费用，医院根据病人的病症依此标准收费；无论患者住院时间多长，医生都是按照固定费用收费。相对于按服务项目付费，此方法对控制医疗费用有一定的效果【11】。然而，医疗市场有信息不对称的问题。
（1）医生有赚钱的激励机制，政府很难控制医生的行为。比方说，一个普通感冒，医生可以说是重感冒，这样“固定”的费用就很难固定了。 医疗卫生的特殊性之一就是在患者和医生医院之间有第三者：医疗保险（政府或商业保险），医疗保险所衍生的道德危险使医院和患者均有过度消费医疗服务的倾向，导致医疗服务的费用不断上升。病人看病只从医院的知名度考虑问题，到名院，看名医。在这种情况下，各个医院都竞相引进好医生、引进好设备，其最终的结果是医院服务量的扩张与整体医疗费用的上升，造成医疗体系资源配置的无效率，形成社会浪费。
（2）到了90年代，美国所倡导的管理保健制度是一个创新的医疗制度。管理保健把医疗保险和医疗服务的功能结合起来。管理保健就相当于保险公司和医院医生的选择性合约：保险公司将一定数量的参保者包给某医院或医疗集团，参保者的医疗费用超过约定的数额，由医院自己承担；数额没用完，医院保留余额。其机制是节支收益，医院节约的越多结余的就越多；弊端是医院为了省钱，可能会抑制病人的合理需求，该做的检查也不做了，该开的药也不开了【12】。 管理保健制度是支付者主导的竞争：病人把权力交给其选择的保险公司了，委托保险公司与医院签定合同。保险公司有更多的网络、更多的信息，在与医院的谈判中比病人拥有更大的筹码。这种竞争确实有效，它控制了医疗成本。这种制度带来的结果是每个医院竞相压低成本，因为只有压低成本，医院才可能生存。所以管理保健制度很有效地控制了医疗费用的上涨，而且医院的效率也提高了。但是我们国家现在不具备实行这种模式，因为我们的医疗保险覆盖率只有20％左右。
2． 英国医疗卫生体系解析
英国是由政府主导的医疗卫生体制，全民医疗服务体系，公立医院由政府全额投入，老百姓看病是免费的，有钱人需要特殊服务，可以到私立医院去。
（1） 英国国家医疗服务体系（NHS）总目标是结合市场和政府干预两者的优点，使国家医疗服务体系既有政府干预的公平性和成本可控性，又具有市场的高效性和灵敏性的制度，在这种模式下，英国实现了全民免费医疗，普及面广，费用也较低。从事社区卫生服务的全科医师是这个市场中的关键人物。全科医师的报酬按照其服务的人口数量按人头定额预付。全科医师吸引的服务人口数量越多，费用控制的越好，其收入就越高；医院在给病人治疗前需要和病人注册的全科医师协商，医院的治疗方案需要征得全科医师的同意,没有全科医师的同意，医院治疗的费用不能到卫生局报销。如果全科医师不能够认真地和医院的专科医师讨价还价节省医疗经费，那么卫生局也就不会继续聘用他。故此全科医师承担起医疗质量顾问和费用的守门人的责任，这种方式可以比较有效地控制费用【13】
（2）英国的这种模式在我国香港地区运用得比较好。香港的医院主要都是政府的，政府承担了95%以上的专科和住院诊疗。医院管理的职责由政府委派的医院管理局来担任。医管局是一个独立机构，医院管理局推行以病人为本的服务，引进现代管理技术，采用绩效评估、成本会计、统一临床记录等管理信息
【11】张力山《美国的医疗系统和政策》第三节
【12】博萃文库—中国体制改革文章汇集（www.blogtree.net）医疗体系改革的四种模式
【13】 李玲 《红旗文稿》杂志2004年第21期 p77
系统，在医院建立了公司治理的结构。香港的普通门诊体系是完全市场化的，由千千万万个小诊所组成，有的诊所的面积只有几平方米。但门诊看病很便宜，连医带药平均150块钱（香港人均收入是国内20倍以上），小病在门诊就可以完全解决了。门诊为什么这么便宜呢？因为门诊与门诊之间是一个充分竞争的市场，竞争的结果是低价。病人必须先到这些门诊去看病，门诊看不了了，才能转诊看专科或住院。这时门诊就起到了一个守门人的作用，有效地控制了医疗费用的上涨，香港的医疗卫生系统以其低成本、高效益见称【14】。
美、英、中三国卫生医疗体制对比分析表
国家 医疗卫生
体系模式 医疗保障制度 医疗服务提供体系 医疗服务的监管体系
美国 市场主导型：只为穷人、老人医疗埋单，服务越好价格越高
政府健康保险计划、私营健康保险计划和管理型医疗保险(ＭａｎａｇｅｄＣａｒｅ)的结合体。
美国医疗体制以私营为主，医疗消费以个人为主。医院以私立医院、私人诊所为主要形式，医生以家庭医生为主 美国联邦政府在整个医疗体制中的作用只是提供部分医疗保障机制和资金，以公立形式为老年、病残、穷困和失业人口提供医疗保障，另外也以立法和管理的形式，规范高度市场化的医疗体制。
英国 政府主导型：公立医院免费，但看病便宜、普及面广、效率低下
英国全民公费医疗体系（National Health Service简称NHS） 国家医疗服务体系由英国各级公立医院、各类诊所、社区医疗中心和养老院等医疗机构组成
国家医疗服务体系大致可分三级。第一级：基本护理机构。第二级：地区医院。第三级：教学医院。
政府在各地区创立了“战略医疗保健责权机构”，由内政大臣直接监管，主要监督NHS执行情况，其主要职责是：（1）负责发展所在地区的医疗保健服务计划；（2）负责评估本地区医疗保健机构是否达到高水平和良性运转标准；（3）负责增强本地医疗保健机构的服务能力，使之提供更广泛的服务；（4）监督地医疗保健机构是否将诸如改进癌症治疗等国家优先计划落实到实处。
中国 社会主导型：为了更好地兼顾公平与效率，我们主张采用社会主导模式，即在医疗卫生的筹资方式上强调公共和公平，而在生产方式上则突出竞争和效率。 改革试点中：
1、职工基本医疗保险、
2、城镇居民基本医疗保险、
3、新型农村合作医疗制度 改革试点中：
1、农村：县（地区医院）、乡（卫生服务中心）、村（卫生服务站）三级转诊。
2、城市：社区服务站、社区服务中心、教学医院（综合医院）三级转诊 卫生行政部门虽然是其直接管理者，但是它对医疗机构的监督、约束不力，造成了对医疗机构的软约束。
【14】张力山 《 美国的医疗系统和政策》
3． 借鉴美英模式对我国卫生医疗体系进行比较
我国改革开放及经济改革的最终目的是为了提高人们生活水平，让人们活的更健康、更长久、更幸福。良好的医疗卫生体制能有效地提高人民健康水平，健康的劳动力能促进经济发展，经济发展又能进一步改善医疗卫生和人民健康，可是改革开放以来政府对医疗卫生的重视和投入减少，卫生事业费占国家财政支出的比重不断下降。在目前，中国卫生事业费主要来自地方财政，而不是中央财政。这种格局就决定了各省人均卫生事业费的高低取决于其财政实力以及对医疗卫生的重视程度。然而，在美国这样一个非常市场化的医疗体系下，政府支出占卫生总费用的比重在逐年上升，而私人支出占卫生总费用的比重在下降。美国以市场为主导的医疗制度确实提供了优质的服务。而英国以政府为主导的医疗体制虽然效率和服务不如美国，但资源的有效利用、公平上远胜美国，老百姓的满意度也远高于美国。英国的社区卫生服务体制使每个社区公民都有专门的家庭医师,负责其基本医疗服务。家庭医师的角色就如同国内社区医院及乡镇卫生院和单位医务室保健医生。
第四章 我国医疗卫生体系改革的建议以及成效
1 。 医疗卫生体系改革的建议
(1)实现政府与市场机制的有效结合。在现阶段，我国必须实现政府调控和市场机制的有效结合，通过市场竞争机制的引入，提高现有医疗卫生体系的运作效率，增加医疗服务的供给量，同时政府能腾出更多的精力来进行宏观的调控，保证医疗服务提供的公平性。
(2)继续深化医疗机构的分类管理。借鉴国际典型医疗卫生体系中私立(非营利性和营利性)医疗机构在医疗服务提供中的重要作用，结合中国各地区的实际情况，从政策和具体操作 中公平对待私立医疗机构(比如允许进入医疗定点机构等)，让私立医疗机构能够健康成长，最终让各类医疗机构能互相竞争起来，通过竞争的作用提高医疗机构的微观效率。
(3)明晰公立医院的产权，允许产权的流动。明晰公立医院的产权，确立医院的独立法人地位。政府出资者所有权与医院法人财产权实行分离。政府机构作为出资者，只享有财产所有权，其职能由“办”医院转为“管”医院。医疗机构作为独立的法人实体，依法自主经营、自负盈亏、自我约束、自我发展。这样，医院的责权利得以明晰，医院将不能滥用自身的权力损害患者，追求过度的利益。同时要允许产权的流动，为市场机制作用的更好发挥打好基础。
(4)依靠市场机制，探索实行医院集团化等途径。医院经营的集团化、社会化等是国外医院降低经营成本、提高经营效率的常用途径。在我国一些地区也开始实行集团化经营(比如上海的瑞金医院集团等)。但是现在我国的集团化更多的是政府行为，不是市场行为，所以集团化的效果尚未能尽如人意。在深化改革中，必须更多的依靠市场机制来进行医院的强强联合或优势互补，这样才能真正发挥医院集团化的威力，提高医疗服务提供的效率。
(5)建立权威性的独立评审机构来对医疗机构进行考核监督。缺乏约束和监督是我国医疗机构不能健康发展的一个重要原因。我国的医疗机构长期处于政府的保护伞下，卫生行政部门虽然是其直接管理者，但是它对医疗机构的监督、约束不力，造成了对医疗机构的软约束。因此，在深化改革中，有必要建立一个权威性的独立评审机构来对医疗机构进行独立的评估，从而真正对医疗机构形成有效的监督、约束和考核。
2 医疗卫生体制变革的主要成效
近20年来，公共健康状况也随着经济的发展有所提高。商业化、市场化走向的体制变革带来的成效主要表现为：通过竞争以及民间经济力量的广泛介入，医疗服务领域的供给能力全面提高。医疗服务机构的数量、医生数量以及床位数量都比计划经济时期有了明显的增长，技术装备水平全面改善，医务人员的业务素质迅速提高，能够开展的诊疗项目不断增加。此外，所有制结构上的变动、管理体制方面的变革以及多层次的竞争，明显地提高了医疗服务机构及有关人员的积极性，内部运转效率有了普遍提高。
医改是一道世界性难题。中国人口众多，国情特殊，解决中国的医疗保障问题，绝不能依赖外国的“药方”。英国模式也好，美国模式也好，我们只能借鉴其经验和教训，取其长，补其短。因为医改是关系国计民生的重大决策，必须以科学发展观为指导，以求真务实的精神，扎扎实实搞调研，让那些真正事关医改新方案制度设计的关键问题，都能经过深入细致的研讨，保证医改建立在科学民主的基础上，并最终有效服务于公众的健康福祉。
相关文献
【1】www.zhong xin.comcn19/9<<公共卫生就是人人将卫生吗》第二节第一段
【2】李圣隆•「全民健保与病人权利」（律师通讯第194期）页28。
【3】邱清华•在高品质、高效率的医疗要求下---病人权益保障的权衡（医事法学第三卷第6、7、8期合刊）页20：消费者的五大权利、应用於医疗上。
【4】王绍光《比较》第七期（2003年）《中国公共卫生的危机与转机》
【5】王维 苏州大学商学院 《江苏省城乡医疗卫生的不平等性研究》
【6】http://finance.sina.com.cn 2004年08月22日 《动员全社会的资源重建公共卫生体系》第二节
【7】《中国改革》2002年第4期p13
【8】王绍光《比较》第七期（2003年）《中国公共卫生的危机与转机》p78
【9】周雁翎 差异悬殊：中国卫生保健事业面临严峻挑战第四段第三行
【10】博萃文库—中国体制改革文章汇集（www.blogtree.net）医疗体系改革的四种模式
【11】张力山《美国的医疗系统和政策》第三节
【12】博萃文库—中国体制改革文章汇集（www.blogtree.net）医疗体系改革的四种模式
【13】 李玲 《红旗文稿》杂志2004年第21期 p77
【14】张力山 《 美国的医疗系统和政策》
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The study of China's public health and medical system
Catalogue
Abstract
Statement
Introduction
Acknowledgements
Statement
Introduction
Chapter 1 Theoretical analysis of public health and medical system
1. Definitions of public health and medical system
2. Summary of China's public health and medical system
Chapter 2 Present situation and reformation of China's public health and health care system
1. Problems to be solved in construction of rural public health and medical service system
2. Reform focus and objective in public health and health care
2．1． Solving the "difficulty" and "expense" to see a doctor
2．2、 Health reform objective
2．3、 The responsibility of government
3. Countermeasures and recommendations to improve medical services in rural public health system
Chapter 3 Summary of medical health system in both America and British
1. Analysis of America medical health system
2. Analysis of British medical health system
2.1. National health service system in British
2.2. Health service system in China′s Hong Kong region
3. Comparison on China's health care system with models from the United States and Britain
Chapter 4 Reform proposals and the effectiveness of China's medical health system
1. Proposals to reform of medical health system
2. The main effectiveness in the changes of medical health system
Conclusion
References
Abstract
The medical health reform and development is one of the important contents in building a socialism harmonious society in China. It relates to the people's livelihood and is the base of China's economic development and social stability.
Today, whether the medical and public health system adapts to the country's economic development and meets the people's basic medical need is one important aspect to embody the ability of governing a country and the degree of social harmony. Judging from China's conditions, since the founding, the government has focused medical and health work on prevention and elimination of infectious diseases, such as basic public health services, to ensure the basic health-care services′breadth and fairness. So the majority of people, especially rural residents will be able to enjoy basic health services, needing not to pay high fees. However, with the advance of economic reform, traditional medical security system is unable to adapt to the new form of market economy. Traditional Chinese medical security system disintegrates quickly. Since the 1980s, the state policy is to hospitals and hospitals are self-financing. Regular financial compensation can barely maintain poll expenditure of medical institutions. The hospital has gradually been on the market. But matching mechanism has not been established and perfected. The advance of economy benefit makes the allocation and distribution of resources develop lopsided.
This assay is with our public health medical system as the main line to systematically study the content of medical system, to clearly describe China's public health situation of the medical system, and to wholly analyze the differences between China and the US-British development of each country's health system. And on the basis of the above-mentioned study, it comes up with the policy recommendations to improve health care system, to advance the healthy development of health care reform and to promote the stable development of health care reform.
Key words: public health medical treatment system equal right to medical treatment medical treatment reform
Introduction
Entering the 21st century, economy of every country in the world is changing under the peace and stable theme. The common objective is to develop and progress, to strive to great power, and to allow a rich civil life. The protection of the survival and the quality of life can be further improved, making the country develop rich and strong.
Today, whether the medical and public health system adapts to the country's economic development, and meets the people's basic medical needs is one important aspect to embody the ability of governing a country and the degree of social harmony. Judging from China's conditions, the reform and development of medical treatment health is one of the important contents for China to build a socialism harmonious society and it relates to the people's livelihood and is the base of China's economic development and social stability. However, in recent years, with the economic development and improvement of people's lives, China's medical and health services lag is an undeniable fact. Compared with the United States and the United Kingdom, our health care system and the development still have a long way to go. The United States is the most market-oriented health care system; the supply and demand of health care is determined by the market. In addition to strict supervision of the government, it is also responsible to provide health care insurance for the poor, the old and public health services. Britain is led by the government's health care system, universal health care system. Public hospitals are in full input by the government. Common people’s treatment is free and the rich can go to private hospitals in need of special services. The overall objective of The British National Health Service (NHS) is to combine the benefits of both the market and government to make the national health care system both at the governmental intervention in the fairness and cost control, and at the efficiency of market and sensitivity of the system. In this mode, the British gains an achievement of universal free medical care, universal wide area and relatively low costs.
Under this premise, I flipped through a collection of articles and wrote the article in my own perspective. This article includes a total of four parts: it is with our public health medical system as the main line to systematically study the content of the medical system, to clearly describe China's public health situation of the medical system, and to wholly analyze the differences between China and the US-British development of the country's health system. And on the basis of the above-mentioned study, it comes up with the policy recommendations to improve the health care system, to advance the healthy development of health care reform and to promote the stable development of health care reform.
Chapter 1 Theoretical analysis of public health and medical system
1. Definitions of public health and medical system
Entering the 21st century, economy of every country in the world is changing under the peace and stable theme. The common objective is to develop and progress, to strive to power, and to allow a rich civil life. The protection of the survival and the quality of life can be further improved, making the country rich and strong development. Whether the medical and public health system adapts to the country's economic development, and meets the people's basic medical need is one important aspect to embody the ability of governing a country and the degree of social harmony.
(1).Public health deals with diseases and health problems among the crowd by putting diseases under prevention and control, focusing on human health protection, to address health promotion to achieve the purpose of improving people's standard of health. Public health is, in essence, public policy. But the protagonist of public policy is certainly the state and public policy depends on the effectiveness of all segments of society participate.
(2).The medical system consists of three aspects: the medical security system (medical insurance, medical assistance system), medical services system (disease prevention, health education, hospitals or clinics such service system), medical services in the supervision system 【1】 。
(3) The so-called right to equal medical care, refers to the right for each patient to enjoy medical resources (including equipment and manpower agencies), not vary for men and women, young and old, poor and rich, but should be treated equally. It can be explored from two aspects of the real meaning and the form. Therefore, every citizen has equal access to the same medical resources and the right to participate in decision-making on the medical use of resources and allocation. The reason for the government to implement universal health insurance and the implementation of Taiwan's policy of the health care network, all are to be able to take equal universal access to health care resources 【2】。
2. Summary of China's public health and medical system
Since the founding, the government has focused medical and health work on the prevention and elimination of infectious diseases, such as basic public health services, to ensure the basic health-care services’ breadth and fairness. So the majority of people, especially rural residents will be able to enjoy basic health services needing not to pay high fees. China's population health status has been significantly improved. Along with economic reform, traditional Chinese medical security system built on the "egalitarian" health policies and low economic falls in a rapid disintegration because it is unable to adapt to the new form of market economy【3】。Since the 1980s, the state policy is to hospitals and hospitals are self-financing. Regular financial compensation can barely maintain poll expenditure of medical institutions. The hospital has gradually been on the market. But matching mechanism has not been established and perfected. Hospitals have to open the prescription, allowing patients to more hospitalization, more high-tech equipment checks and new special projects in order to maintain operations. This incentive mechanism leads to over-medication and over-service, excessive inspections and health resources are wasted. The promotion of cost-effective health care makes the allocation and distribution of resources develop lopsided. The actual focus of medical and health work turns from rural to urban areas, from the "re-prevention” to “emphasis treatment” and shifts from low-cost to the high-tech-high costs. 【4】
【1】www.zhongxin.comcn19/9<> Section two the first paragraph
【2】Li Shenglong. "Universal health care and patient rights" (counsel section 194), p.28.
【3】Qiu Qinghua ¡ The high-quality, high-efficiency requirements of medical patients -- to protect the interests of balance (a medical jurisprudence Volume III 6,7, eight combined issue), p. 20: Five consumer rights, applied to medical services.
图一：医疗费用的涨幅 Figure 1 : medical costs rise
平均每一诊疗人次医疗费（元）fee-for-service of average medical clinics (Yuan)
出院者平均每天住院医疗费（元）fee-for-service for daily average hospital care (Yuan)
城镇居民人均可支配收入disposable income of Urban residents per capita
农村居民纯收入 Net income for rural residents
【5】
表一：城乡按家庭收入分组的收入及支出构成
Table 1: revenue and expenditure constitute of urban and rural area by household income grouping
收入分组revenue grouping
人口比例Population proportion
平均收入Average income
平均支出Average expenditure
其中医药卫生 proportion of medicine and health
城市Urban, 农村rural
【4】Book "more" Seventh (2003) <>
【5】Wang Wei? Suzhou University Business School, << Inequality studies of medical health in Jiangsu Province urban and rural areas>>
However, the high cost of health care makes many patients "minor ailments bearers, serious illness delaying”. The consequences tend to be small trailer into more serious diseases, labor lost causes serious illness, or even go bankrupt. A serious illness can make a well-off standard of the original homes in jeopardy, making it the destitute poverty. Therefore, the case in the proportion of the rural averages is 22%. The number of rural doctors and rural health workers per 1000 in rural area has dropped from 1.55 in 1985 to 1.41 in 2001【6】。In addition to too high medical costs, relative decrease in the number of health personnel, the quality of the medical staff is also worrying. Village health personnel have considerable number of people who received short-term training only 30 years ago during the cooperative medical climax. Although they participated in some more or less follow-up training, but in a market-oriented environment, they are not happy either, or can not afford basic rural health care tasks, such as preventive health care, infectious disease reports【7】. The World Health Organization in 2000 did a survey of the health system to its 191 member countries and made a rank based on the health improvement, the responsibility of the government, the health care provider, such as the fairness of the rankings done, with China ranking No. 144. China's public health system has become an "Achilles heel" in building the sustainable development and a well-off society【8】。
Chapter 2 Present situations and reformation of China's public health and health care system
1. Problems to be solved in construction of rural public health and medical service system
In recent years, with the economic development and improvement of people's lives, China's medical and health services lag behind the level that can not be denied (figure 2) 【9】。In cities, the phenomenon that it is difficult and expensive to see a doctor in the medical care has not been solved; In the vast rural areas, it is still prevalent situation that sick farmers can not get timely treatment. According to statistics, costs about Chinese health care takes 5% of the GDP, public health expenditure in the total health expenditure accounted for about 12%. While most developed public health expenditure in the total health expenditure in the ratio has reached 50%. What is more worrying is that China's rural health serious shortage of inputs, public health emergency response system is almost a blank. farmers capacity of resisting major diseases is in vulnerability 【10】。
图二：疾病损伤致贫的比例 Figure 2 : proportion of poverty with disease and injury
大城市Big cities 中城市 middle Cities 小城市Small cities
一类农村rural category one 二类农村 Rural category two
三类农村 rural category Three 四类农村rural category Four
【6】http : / / finance.sina.com.cn August 22, 2004, <>section2【7】<>in 2002 the first four p13
【8】Wang Shaoguang book <>Seventh (2003) "China's public health crisis and turnaround" p78
【9】Zhou Yan Ling the disparity between difference : China's health cause faces severe challenges the third line of the fourth paragraph
【10】[library -- Bo and Crafts-China articles pooling system ( www.blogtree.net)the fourth model of the health care system reform
(1) Medical costs are too high, resulting in farmers’ illness and a serious insufficiency. High increase of medical costs and low percentage of reimbursement of new type of rural cooperative medical provisions leads to farmers’ too heavy medical burden.
(2)The development of township hospitals is in a serious shortage of funds. Financial difficulties at the local circumstances, the financial health of the support can not be guaranteed. The township funds hospitals allocated can not be delivered in full and preferential policies to rural health agencies are difficult to implement. Many township hospitals can not guarantee wages, equipment can not be updated, and have the lack of market competitiveness to attract talents.
(3) Medical management in Village Health Room needs to be strengthened. With the rural health system evolving, village health and emergency service function will also change. It will be a gradual transition from decentralized services to community-based health services onto service model. In recent years, with market-oriented health development, the weakening of the phenomenon appeared in the management of village health Room needs further strengthening.
(4)Illegal practice of rural hinders the health building. Because of the benefits drive, some people practice without qualification, and do not have the conditions to practice. To practice medicine without a license seriously disrupts the normal market order, damages people's health and hampers rural medical and health service development.
2. Reform focus and objective in public health and health care
2.1. Solving the "difficulty" and "expense" to see a doctor
As of December 2005, the number of China participating in the basic of medical insurance has reached up to 130 million, only one third of all urban practitioners. Rapid rising medical costs have become the pain of medical treatment for many towns’ people without medical insurance. Medical care is difficult because the major medical irrational allocation of resources and medical services are not in place and it is expensive because costs are so high that beyond the ability of ordinary people to afford. In rural areas, to strengthen the construction plan of the hospital is financing by the government to improve health conditions, the implementation of the new rural cooperative medical system and to improve the rural medical security level. In cities, the community health services should be energetically developed.
(1). In urban streets and rural township establishment of community health stations, the station layout should be scientific and rational, and to facilitate the broad masses of medical treatment; those same stations and the establishment are fully funded by the national and local government.
(2).The main task of Community Doctors is preventing disease, disease prevention information and community groups’ diseases clinics. As long as the community hospitals work, and many patients in community hospitals can get treatment, both for the convenience of the people, and the current situation of community hospitals doing nothing and a waste of medical resources can be thoroughly changed, and also reduce a great of pressure on hospitals. So that hospitals will be able to truly play its function focusing on resolving complex and critical illnesses. Only in this way can the available health resources be made rational use of. Patients can get a reasonable triage, and quality of care can also be improved.
(3). Enhancing the training of doctors, community physicians and business services, is the key to ensure medical quality and to attract patients seeking medical treatment. At present the quality of community physicians is not high enough. This can not meet the need of the current development in community hospitals. So the existing staff should get training in the post rotation. During the training process, practical training skills to prevent health should be strengthened. In addition, medical schools should set up the major in professional doctors to let a group of people begin receiving regular general practitioners education from the university. So they can do such work after graduation.
(4). If the state and local government can make the costs of community hospital medical subsidized or free, the problem that it is difficult and expensive for people to see a doctor will be able to be really solved. Meanwhile, to improve medical treatment of staff in community hospitals, or to allow the medical staff in big hospitals to do part-time job in community hospitals, is also one of the ways to solve the current shortage of staff and the not high enough level in community hospitals.
2.2.Health reform objective
To protect public health and to build different forms of medical insurance system covering urban and rural residents, it is necessary to expand the basic medical insurance of the urban workers, the implementation of the farmers’ cooperative medical system, some workers who haven’t participated in the medical insurance in cities. We should also establish a medical insurance system with serious illness planning as a whole for urban residents.
2.3. The responsibility of the government
The government's responsibility is to achieve the development goals of building a harmonious society and solving the problem of hard and expensive medical care. A long-term solution needs to establish a medical risk-sharing mechanism by the state, social groups and individuals, that is, to build a national health security system adapting to different age groups, different groups, and different levels of a society. Government should make all members of society have gotten generally fair medical services. To expand Medicare coverage of Towns, to increase rates of reimbursement, the responsibility of Government's commitment to safeguard public health and the health interests of residents should not be changed. Increasing health input, providing public services, and strengthening health monitoring is an important duty at all levels of government.
3. Countermeasures and recommendations to improve medical services in rural public health system
(1)Further improve the new type of rural cooperative medical care system, make efforts to solve problems of cases in farmers’ illness. As a gradual increase in the provincial, city and county financial input, at the same time, establish a medical aid system to strengthen cooperation in the use of medical funds management and open accounts to win people’s hearts.
(2) Establish input mechanism of government and community to resolve township hospitals problems of lack of funding. The government support rural medical and health services to the maximum grant funding, do everything possible to implement the preferential policies set by the state, and put rural health funding into a legal track through legislation and other means. Using a variety of flexible ways to attract private capital into the township hospitals and other public health institutions according to the actual situation, can both reform the system by means of joint venture equity and also attract private capital through revenue sharing of equipment rental. This effectively resolves the issue of public health agencies’ financing for development, eliminating overstaffing in public health agencies, and problems of unreasonable costs rise. This also gives full play of comparative advantage to their relative to the private medical institutions and medical personnel quality level. In the process of the introduction of private capital, preventive ranks should be relatively independent, avoiding the situation of public institutions’ social functions being weakened.
(3) Encourage hospitals to train rural health personnel and improve the professional level of rural health technical personnel. Take full advantage of the higher level of hospital personnel, equipment and other advantages to train lower medical personnel. Encourage large state-owned hospital staff to hospitals in the short term through administrative means and carry out the requirements that urban health staff promotion senior technical titles must have a six-month work experience in township hospitals.
(4)Strengthen village health support and management; standardize village health clinics and services. While strengthening administrative liaison on township hospitals for village clinic, give certain authority to township hospitals on staff’s qualifications, managerial and professional training and enhance the cohesion of township hospitals. This will effectively improve the professional quality of village health staff. On the other side, drugs in business and procurement promote village and township hospitals Room of mutually beneficial cooperation, business reasonable division of labor, centralized purchasing on the purchase of drugs from the township hospital for the benefit of the concession prices, to get pharmaceutical quality assurance. Through economic and administrative means to gradually strengthen the building of a village’s health system and the empowerment of rural respond to health emergencies incidents.
(5) Strengthen supervision of the rural medical market and standardize medical market order. Increase the punishment on medicine practice without license, particularly arising from the death penalty maimed incident, and cracking down on the illegal practice to purify rural medical market and promote health development of rural service.
(6) Establish and improve functions of community health service. Gradually establish the community health service system meeting the needs of current development, focusing on the content of community health services. With residents of a community health as needs-driven, continuously expand the service functions, to provide the majority of community residents an effective, economical and convenient comprehensive health services.
So, the health care system does not accelerate the pace of reform, which will certainly affect the social stability and economic development. While most countries have some solutions on aspects of their health system, but no country has the complete solution to the problem program. We need to leap nationalist and protectionist barriers and lessons of other countries to design the best solution.
Chapter 3 Summary of medical health system in both America and British
1. Analysis of America medical health system
The United States is the most market-oriented health care system; the supply and demand of health care is determined by the market. In addition to strict supervision of the government, it is also responsible to provide health care insurance for the poor, the old and public health services. As the government burdens of the poor and the elderly, health insurance are too heavy, government takes various measures to control the rising of medical costs, as practiced in the United States in 1983 by the disease pay (DRG) system, to determine a fixed fee according to the types of diseases. Hospital charges patient with the disease on standard; no matter the length of time, doctors are charging a fixed cost. In relation to costs paid by services, this method has a certain effect on controlling medical costs【11】。 However, the medical market has the problem of asymmetry information.
(1)Doctors have an incentive mechanism to make money. It is very difficult for the government to control the conduct of medical practitioners. For example, a common cold, doctors can be described as cold, so “fixed” costs are difficult to fix. Health care is one of the special natures between patients and doctors as a third part: medical insurance (government or commercial insurance). Medical insurance generated by the moral hazard of hospitals and patients were excessive consumption of medical services orientation, leading that the cost of medical services has been rising. Patients who come to hospitals for treatment only consider the visibility of the issue, from hospital to see doctors. In such circumstances, all hospitals are competing to introduce good doctors, introduce good equipment. Its ultimate result is the volume of hospital services and the overall expansion of the rising health care costs, causing the inefficient health care system and forming a social waste.
(2) In the 1990s, the United States initiated by the management of the health system is an innovative medical system. Medical management combines functions of the health insurance and medical services together. Management is equivalent to the selective contract of health insurance companies and hospital doctors: insurance companies will be a certain number of participants in a hospital or medical group. If medical costs exceed the amount, it will be agreed by the hospitals themselves; no amount spent the hospitals to retain balance. Its mechanism is the savings income, hospitals, the more savings, the more balances; Drawback is that the hospital to save money, patients may inhibit the legitimate needs of the examination which should be done, and the medication which should be opened【12】。 Management of the health system is the competition dominated by payer: Patients give their power to the insurance companies of their choice. The insurance company commissioned the signing of a contract with the hospital. Insurance companies have more networks, more information and they have more chips than patients in the negotiations with the hospital. This competition is really effective, which control the cost of health care. Such a system will result in each competing hospitals to lower the costs, because only lower the costs could the hospital survive. Therefore, management of the health system is very effective in controlling the rising cost of health care, but hospitals efficiency is also improved. But we do not have the national implementation of this model, because our medical insurance coverage rate is only 20%.
2. Analysis of British medical health system
Britain is led by the government's health care system, universal health care system. Public hospitals are in full input by the government. Common people’s treatment is free and the rich can go to private hospitals in need of special services.
（1）The overall objective of The British National Health Service (NHS) is to combine the benefits of both the market and government to make the national health care system both at the governmental intervention in the fairness and cost control, and at the efficiency of market and sensitivity of the system. In this mode, the British gains an achievement of universal free medical care, universal wide area and relatively low costs. General practitioners engaged in community health services is the key in this market. General practitioners are fixed prepaid based on the number of population in accordance with the remuneration of their services. The more population general practitioners of services attract the better cost they control, the higher income they earn; before treatment hospital needs consultations with general practitioners in whom patients have registered. General practitioner and hospital treatment programs need the consent of all the doctors. Without the full consent of the doctors, hospital treatment costs can not be reimbursed from the Bureau of Health. If general practitioner can not bargain seriously with specialist physicians in hospital to save medical expenses, then the Bureau of Health will not continue to employ him. So general practitioners shoulder the responsibility as consultants of medical quality and gatekeepers of the cost. This approach can be more effective in controlling costs【13】
(2)This model is in good use in Hong Kong. The hospitals in Hong Kong mainly belong to the government, which assume more than 95% of specialist and hospital clinics. Hospital management of the government-appointed serves as the Hospital Authority. The Hospital Authority is an independent body, which implements patient-centered services, introduces the modern management techniques and manages information with use of performance evaluation, cost accounting and unified management of clinical records and others.
【11】Zhang Lishan<> III
【12】Bo and Crafts library-article Department of the Chinese reform Set (www.blogtree.net), the four models of the medical system reform
【13】? Li Ling?? <>magazine in 2004 the period 21, p77
System, the hospital established a corporate governance structure. The system is fully market-oriented and composed of hundreds of thousands of small clinics. Some clinics are in an area of only a few square meters. But outpatient treatment is very cheap, even an average of 150 Yuan with drug treatment (domestic income per capita is more than 20 times). Indisposition can be completely resolved. Why is outpatient so cheap? The reason is that there is a fully competitive market between out-patients. The result of competition is low price. These patients must go out-patient treatment first. If out-patient department can not cure, they can refer to specialist or hospitalization. Then the out-patient department plays a gatekeeper role in the effective control of medical costs rise. Hong Kong's health system is known for low-cost and high-efficiency【14】。
Comparative Analysis Table among the United States, Britain, and China on health care system
country Health system model
The medical security system
medical services Providing system Medical service monitoring system
America Market-oriented : only for the poor, the elderly pay for health care, better services to higher prices
Combination of The government health insurance plans, private health insurance plans and managed care insurance (Managed Care).
The United States health care system is mainly by the private sector, medical consumption mainly by individuals. Hospital is with private hospitals, private clinics as the main form, doctors are most family doctors
The federal government is the role of providing some of the medical safeguard mechanism and funding in the entire medical system, providing medical protection with a public form of old age, invalidity, unemployment and poverty, and also criteria highly market-oriented health care system with forms of legislation and management.
Britain Government-led : free public hospital, but medical treatment cheaper, popularization wide, inefficiency
The British system of universal public health (National? Health? Service referred NHS)
State medical service system is composed of the British public hospitals at all levels, various clinics, community medical centers and nursing homes and other medical institutions. To form a national health care system can be largely classified into three. The first level: basic care institutions. Second level: The district hospitals. Third grade : teaching hospitals.
The government creates "strategically select the right to health care institutions" in regional areas, under the direct supervision of Minister of the Interior, overseeing the implementation of the NHS, its main functions are : (1) developing the region's health services; (2) assessing whether the region’s health care reaches a high level and benign operating standards; (3) enhancing the local health care services, so that they offer a wider range of services; (4) monitoring whether health care institutions put priority plans such as cancer treatment into reality.
China Community-oriented: To better balance between fairness and efficiency, we advocate the use of community-led model, which is, emphasizing on public and fairness in health financing while giving prominence to competition and efficiency in the mode of production.
Reform experimental units:
1.The basic medical insurance of employees
2. Basic medical insurance of urban residents 3.The new type of rural cooperative medical system
Reform experimental units:
1.Rural : county (district hospital), the township (Health Center), Village (the health service stations) three referral.
2. City : community service stations, community service centers, teaching hospital (General Hospital) three referral
Although the health sector is the direct manager, but its medical institutions’ ineffective supervision and constraints causes soft constraints of medical institutions.
【14】Zhang Lishan<>.
3. Comparison on China's health care system with models from the United States and Britain
The ultimate goal of China's reform, opening up and economic reform is to improve the living standards of the people, to let the people live a healthier, more permanent and happier life. Good health care system can improve people's health effectively, the health workforce can promote economic development, and economic development can further improve the health and the health of the people. However, since reform and opening up, the government had less importance and inputs of health, and proportion of health expenditure in the state financial expenditure continued falling. At present, China's health expenditure is mainly from finance of local government, rather than central government. This pattern determines that the health expenditure per capita depends on the level of its provinces financial strength and the attention on health. However, in the United States, it is a very market-oriented health care system. The health expenditure proportion in the total cost of government increases yearly, while private spending accounted for the total health costs falls in proportion. In the United States, with the market-oriented health care system, the government does provide a high-quality service. The British’s government-oriented health care system is not as good efficiency and service as the United States, but the effective and fair use of resources is far better than the United States; the people's satisfaction is also much higher than the United States. Britain's community health service system makes that every citizen has the specialized community of family doctors who are responsible for their basic medical services. Family physicians play the roles of community hospitals as doctors in domestic hospitals, township hospitals and health units’ clinics.
Chapter 4 Reform proposals and the effectiveness of China's and health system
1. Proposals to health system reform
(1) The realization of effective combination of the government and the market mechanism. At this stage, China must fulfill effective combination of government regulation and market mechanisms. Through the introduction of market competition mechanism, upgrade the operation efficiency of existing health system and increase the supply in medical service. Moreover, the government should devote more energy to the macro-regulation and control to ensure the fairness of medical service providers.
(2) Continue to deepen medical institutions categorized management. Referring to the important role of the international typical medical and health system of private (non-profit and for-profit) in medical services institutions, combining the actual situation of China, operating from a policy and specific operation to fairly treat private medical institutions (such as allowing access to medical sentinel bodies)to let private medical institutions grow healthily, to ultimately allow all medical institutions to compete with each other and to improve microcosmic efficiency of medical institutions through competition.
(3) Clarify the property rights of public hospitals. Allow the flow of property rights. To clarify property rights in public hospitals, to establish an independent legal status of the Hospital, The ownership of Government-funded hospitals should be separated from property rights of Hospital Corporation. Government agencies who work as investors, only own the access to property ownership. The function turns from “operating” hospitals to "managing" hospitals. Medical institutions operate in accordance with the law on their own, self-restraint and self-development as independent legal entities. In this way, the responsibilities of hospitals can be clear. The hospitals will not abuse their powers to do damage to their own patients and pursuit the excessive interests. While property rights should be allowed to the movement of the market mechanism to play a better role in the future.
(4)Reliance on market mechanisms, explore and implement Hospital Group channels. Collectivize of hospital management, socialization is popular channels to reduce operating costs and improve operational efficiency of hospitals abroad. In China, some regions have begun to implement the Group of operations (such as Shanghai Ruijin Hospital Group, etc.). But now more acts of our group are of the government, not the market, so the group is not yet satisfactory result. In the deepening of reforms, we must rely more on market mechanisms than hospitals or combination of complementary advantages, then, we can really play the power of hospital groups and improve efficiency of health care delivery.
(5) Establish an authoritative independent assessment body to the medical institutions for appraisal and supervision. Lack of restraint and supervision of our medical institutions is the important reason that China’s medical institutions can not have a healthy development. China's medical institutions have been under the umbrella of government for a long-term. The health sector is the direct manager, but its ineffective supervision and constraints on medical institutions results in the soft constraints of medical institutions. Therefore, in the deepening of reform, it is necessary to establish an authoritative independent assessment body to the medical institutions to conduct an independent assessment, so really form an effective monitoring, evaluation and constraints on the medical institutions.
2. The main effectiveness in the changes of medical health system
The condition of two health systems has improved for nearly 20 years with the development of economy. The main results of commercial and market-oriented toward institutional change are as follows: supply capacity of medical services has increased across the board through the competitive strength of the economy and civil extensive intervention. The number of medical services institutions, doctors and the number of beds has significant growth than the planned economy period. Technology and equipment is improving, the quality of medical staff is rapidly increasing, and the clinic project which can be developed is increasing. Moreover, the changes of ownership structure, changes in the management of institutional and competition of multiple levels have improved the enthusiasm of medical services agencies and the staff markedly. The efficiency of internal operations has been generally raised.
Medical reform is a worldwide problem. China's large population, special conditions, solving the problem of medical protection must not be dependent on foreign "prescription." British model or the American model, what we can learn is from their experience and lessons that lump sum to make up for their weaknesses. Because medical reform is a major policy decision of the national economy, the key issues of the new design system should be researched and discussed, with the scientific development concept as a guide, with the spirit of seeking truth and pragmatism. This will ensure that medical reform is in a scientific and democratic basis and ultimately serve the health and happiness of public effectively.
Relevant literature
【1】www.zhongxin.comcn19/9<> Section two the first paragraph
【2】Li Shenglong. "Universal health care and patient rights" (counsel section 194), p. 28.
【3】Qiu Qinghua ¡ The high-quality, high-efficiency requirements of medical patients -- to protect the interests of balance (a medical jurisprudence Volume III 6,7, eight combined issue), p. 20 : Five consumer rights, applied to medical services.
【4】Wang Shaogang Book "more" Seventh (2003) <>
【5】Wang Wei? Suzhou University Business School,<< inequality studies of medical health in Jiangsu Province urban and rural areas>>
【6】http : / / finance.sina.com.cn August 22, 2004, <>section2
【7】<>in 2002 the first four p13
【8】Wang Shaoguang book <>Seventh (2003) "China's public health crisis and turnaround" p78
【9】Zhou Yan Ling the disparity between difference : China's health cause faces severe challenges the third line of the fourth paragraph
【10】[library -- Bo and Crafts-China articles pooling system ( www.blogtree.net)the fourth model of the health care system reform
【11】Zhang Lishan<> III
【12】Bo and Crafts library-article Department of the Chinese reform Set (www.blogtree.net), the four models of the medical system reform
【13】Li Ling<>magazine in 2004 the first 21?p77
System, the hospital established a corporate governance structure.
【14】Zhang Lishan<>.
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旅游陪同
曾于两年暑假兼职做英文导游，带领法国等外国游客。 |
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