The following contents are for reference only.
You open the political book. Find a new case. Just search on CCTV. There is a ready-made one today. Take a look.
What should the government do for medical reform?
Now, the medical system reform in China has reached a new crossroads. "Expensive medical treatment" and "difficult medical treatment" have become social problems of general concern to the public in China. How to diagnose and treat various problems in medical reform can be said to be different.
A popular diagnosis is to attribute the problem to "marketization". Since marketization is the root of the disease, the "prescription" is to abandon marketization, specifically to establish the main position of public medical institutions, strengthen the planned price control of medical services and drugs, and restore or even expand the public medical system.
Another diagnosis holds that "expensive medical treatment" and "difficult medical treatment" are not the inevitable result of marketization, but the power asymmetry between service providers and consumers in the process of marketization of medical services. If there are certain institutional arrangements to promote the strength of both sides to reach or approach a certain balance, the market-oriented medical service system can also safeguard social welfare. Based on this judgment, the "prescription" to cure the failure of medical reform in China is not to abandon marketization, but to move towards "managed marketization".
Facts have proved that it is not feasible to rely solely on market regulation in the process of medical reform. Under the background of market transformation, how to intervene in the market by "affinity" instead of "opposition" is the biggest challenge for corporate governance reform in China.
In other words, the idea of anti-marketization is simply to oppose the market and the government. In fact, in a normal market economy system, the government can participate in market activities in various capacities, such as insurers, buyers, employers, sponsors, regulators, lenders, planners and regulators.
Therefore, "managed marketization" is a new reform idea. Its focus is not blindly pointing out that the government should intervene in the medical market, but to discuss what role the government should play.
One of the roles of government: insurance companies promote the construction of universal medical security system.
The third national health service survey in 2003 showed that 44.8% of urban residents and 79.0% of rural residents had no medical security.
At present, the backbone of China's medical security system is compulsory insurance in cities, that is, social insurance system (basic medical insurance), while rural areas are voluntary insurance system (new cooperative medical care) organized and subsidized by the state. At the same time, other medical security models also exist, which only play a supplementary role. The problem is that universal coverage of medical insurance is far from being realized. From September to June 2003, the third national health service survey showed that 44.8% of urban residents and 79.0% of rural residents had no medical insurance.
The primary responsibility of the government is to promote the establishment of a universal medical security system. The importance of this work lies in that it can greatly promote the realization of medical and health equity.
More realistically, the establishment of universal health insurance can solve the problem of "expensive medical treatment" to a great extent. Universal health insurance means that medical expenses can be shared by the whole people, not just the patients themselves. After this "risk", it is naturally not expensive to see a doctor.
Another point that needs to be pointed out is that once the whole people get medical insurance, the organizer of this insurance, the government, becomes the purchaser of medical services, and people don't have to appear in medical service points as individual patients, so the problem of market power imbalance between buyers and sellers of medical services will be solved.
The second role of the government: buyers to curb the rising cost of medical services.
From August 9 to June 2005 1 1, this newspaper surveyed 733 people over 30 years old. The results show that 89.8% people spend more on medical care than before 10, and 810.2% people think that hospitals are for-profit rather than public welfare institutions.
Another important function of medical security system is to play the role of medical service purchaser.
Obviously, when people pay medical expenses in advance to medical insurance institutions, medical insurance institutions can become buyers with strong bargaining power in the medical service market with collective strength, and thus have the ability to control the behavior of medical service institutions through various means to ensure that the quality of medical services matches the price.
No matter who, as a single patient, is inevitably weak when facing the hospital, and has no ability to restrain the behavior of these medical service providers. This is the fundamental reason why some hospitals "sharpen their knives" when they see patients. Although medical litigation may have some effects, the most fundamental solution is to let a more powerful role restrain the hospital-professional health policy literature calls this powerful role "the third party buyer".
Since the government provides medical insurance, there is reason to act as a "buyer". However, a considerable number of insured persons in China's existing medical security system must pay all or most of the medical expenses before seeking reimbursement from medical insurance institutions. This practice has a very serious consequence, that is, a considerable number of medical insurance participants feel that they are equivalent to seeing a doctor at their own expense. The focus of the existing medical insurance managers is equal to managing insured patients, rather than performing the duties of restraining hospital behavior.
At first, people paid premiums to medical insurance managers, hoping that they would become their own agents and bargain with hospitals on their behalf. However, the current medical insurance managers have become the "mother-in-law" of the people. This is a major institutional dislocation of the current medical and health system in China.
Therefore, the fundamental reform measure is to change the institutional arrangement of individual paying first and then reimbursing, and replace it with a complete medical insurance prepayment system. After enrollment, people only need to pay their own expenses at the medical service point. The remaining medical expenses should be paid directly to the service provider by the medical security administrator. What the medical insurance management institution must do is to sign a contract with the medical service provider-the hospital and adopt a combination of various payment methods (such as fee contract system, charge by head, charge by disease type, charge by service content, etc.). ) to guide the latter to grasp the balance between cost control and quality assurance.
The third role of the government: planners or resource allocators to establish and improve the primary health care service system.
From August 9th, 2005 to11This newspaper conducted a survey on 733 people over the age of 30, showing that 90% of them were dissatisfied with the changes in the medical system since 10, and 78.9% of them felt that there were more hospitals now than before 10, 60.6438+.
Another major drawback of China's medical service system lies in the lack of institutionalized division of labor between outpatient and specialist medical services. Non-emergency patients flock to various hospitals regardless of their illness. The more advanced the hospital, the cheaper it is.
In many countries in the world, non-emergency patients must first see a general practitioner (family doctor) who practices medicine in the form of individuals or partnerships; If the family doctor can't see it, he will be referred to a specialist hospital. As for ordinary hospitals, there is no daily outpatient service at all. Therefore, most of the "Union Hospital" abroad are very quiet, and no one is waiting in line at all; Although the doctors inside are "experts", there is no such thing as an "expert clinic", and there will be no phenomenon that someone sells the "expert clinic number" specially.
China's medical service system is just the opposite. General practitioners are extremely scarce and are not trusted by the people. Even most people simply don't know what a general practitioner is.
1 9971June 19971The Decision of Central the State Council on Health Reform and Development clearly puts forward the strategic concept of developing the community health service system, which defines community health service as the backbone institution of primary medical and health services and the main workplace of general practitioners (general nurses), and its function is to provide the so-called "six-in-one" service, that is,
However, objective reality is not consistent with subjective desire. The development of community health service is slow, there are too few community medical service institutions, and the utilization rate and service level are also relatively low. Therefore, community health service institutions are at a disadvantage in the competition with hospitals at all levels, far from playing the role of "the backbone of urban primary health services".
Why is this happening?
The author believes that the resources invested by the government in medical services are very limited, and this limited resources are mainly used to subsidize hospitals that have occupied most of the market share, especially advanced hospitals. Whether it is township hospitals or urban community medical and health institutions, government subsidies are very small. The government's limited medical resources were not used to correct market failure, but led by market forces, which eventually formed the dual problems of market failure and government distortion.
Therefore, the government should become the "planner" or "resource allocator" of the medical system reform. To play this role well, the correct thinking is to move against the market trend-vigorously promote the development and growth of the community health service system.
On the other hand, the government should also let the market play its due role. In other words, where the market competition conditions are sufficient, the government should allow more competitors to enter and force the medical price to drop.
According to related reports, the central government will launch a new medical and health system reform policy in early 2006, and strengthening the construction of community health service system is once again listed as a "strategic focus". This is the first step in the right direction.
Dialectically treat the tide of migrant workers returning home
What attracts people's attention recently is the news that migrant workers return home.
According to the news of Anhui media165438+1October 30th, 400,000 migrant workers have returned home in advance, accounting for 3.6% of the total number of migrant workers. This is another province that can specifically report the exact number of migrant workers returning home after Jiangxi, a major labor export province. Earlier, Jiangxi Province reported that 300,000 migrant workers had returned home.
From the perspective of industrial layout. The employment situation of the labor force has always been the vane of the industrial situation. 30 years of reform and opening up, because of the rise of export-oriented and labor-intensive industries in the Pearl River Delta and Yangtze River Delta, a large number of rural laborers have moved to the southeast coast. Now, under the influence of RMB appreciation, exchange rate changes, financial crisis and other factors, labor-intensive industries are squeezed, and it is inevitable that some enterprises will shut down and turn. Under this premise, it is an option for migrant workers from closed enterprises to return to their hometowns. It can be said that the return of labor force this time may be to accumulate energy for the next industrial upgrading, provided, of course, that relevant localities and departments can actively guide and formulate training plans as soon as possible.
Starting from the actual situation of migrant workers. According to the analysis, there are several situations in which migrant workers return home early: First, they think that their income in the city is not high at present, and the cost of living in their hometown may be lower than that in the city, so they have no choice but to go home and wait for opportunities. Second, a series of national policies tilt towards the countryside, making them feel that there may be opportunities for development in their hometown. From a practical point of view, these two situations are not unreasonable. The transfer of migrant workers from rural areas to coastal areas is based on the premise that cities have enough employment space. If the employment space is reduced or the input-output ratio is uneconomical, migrant workers naturally have the right to make a decision to stay.
It is a simple truth that the use of labor fluctuates with the fluctuation of industry. It's just that such fluctuations come so suddenly that we can't adapt to them for a while. After a long period of large-scale migration of migrant workers from west to east, not long ago we encountered a "shortage of migrant workers". When this problem has not been solved, we can't wait to face the tide of a large number of migrant workers being laid off and returning home. The invisible hand of the market, although seemingly unfathomable and difficult to control, still has traces to follow. The early emergence of the tide of returning home is not only a signal of economic turn worthy of attention, but also a realistic economic phenomenon that needs to be directly faced and solved. In fact, we should pay attention to it long ago and take corresponding measures. Now, the global financial crisis provides us with an opportunity. ...
The return of a large number of migrant workers has made us rethink the adjustment of industrial structure and how to use surplus labor force, and made new explorations. All localities and departments have begun to act. Jiangxi, Anhui, Hubei and other places guide migrant workers to work in enterprises in the province and carry out training; The Ministry of Education also issued a notice to vocational schools to train migrant workers returning home. These measures are all positive. If effective, it will be a new opportunity to turn "crisis" into "opportunity"