Guiding the reform of medical and health system with Scientific Outlook on Development
The 17th National Congress of the Communist Party of China clearly expounded the strategic objectives, main tasks and major policies of health reform and development in the coming period, and regarded it as one of the important goals of building a well-off society in an all-round way. It is proposed to adhere to the public welfare nature of public health, establish a basic medical and health system covering urban and rural residents, and provide safe, effective, convenient and inexpensive public health and basic medical services for the people, marking that China will enter the ranks of countries in the world that implement universal medical care.
The report emphasizes that health is the foundation of people's all-round development, and it is the concrete embodiment of the latest achievements of Marxism in China on the health front. It points out the direction for China's upcoming comprehensive reform of the medical and health system and future health work, and fully reflects the great importance attached by the CPC Central Committee to health work that concerns the vital interests of the people. The report regards the development of medical and health undertakings as an important part of improving people's livelihood and emphasizes the close relationship between medical care and people's lives. It is clearly put forward to establish a basic medical and health security system, improve the health level of the whole people, and realize the general goal that everyone enjoys basic medical and health services. This is the general idea for the development of medical and health undertakings at present and in the future. We should study deeply, deeply understand, take Scientific Outlook on Development as the guide, and combine with the reality to promote the reform of the medical and health system.
The party and the state attach great importance to medical and health undertakings, which provides us with rare opportunities for development. Access to basic medical and health services for all is an important goal of building a well-off society in an all-round way and socialist modernization, and an important guarantee for sustainable economic and social development. To achieve this goal, there are still many problems to be solved, the most important of which is the reform of the medical system. At present, the government is brainstorming and soliciting reform plans for the medical and health system from all sides. Looking at the discussion on medical reform for many years, it is relatively easy to determine the part of the reform plan, and how to solve the difficult problems of medical reform is the key to determine whether the medical reform plan can be implemented smoothly. Therefore, this is worthy of our attention and correct handling and solution.
The first is the overall design of medical and health system reform. The reform of medical and health system is a gradual and continuous process, involving medical system, medical service, public health, medical insurance and other issues. So it can be divided into several stages. To design the reform of medical and health system, we must first determine the macro-reform framework, make clear the overall goal and phased goal of the reform, implement the reform in stages, and gradually approach the goal. In addition, the goal of design reform should be done according to one's ability, and the ability of governments at all levels to undertake citizens' medical and health protection is limited, especially in poor areas. It is obviously unrealistic for the government to invest more money in medical and health undertakings.
The second is the input and responsibility of the government. The government's responsibility for people's health is mainly reflected in two aspects, namely, establishing a health policy to protect residents' health; Improve residents' ability to use basic health services through various forms of funding. The second aspect is more critical. Therefore, the government should further increase its investment in health, and ensure the health needs of all residents through the combination of supply-side compensation, that is, the input of health institutions, and demand-side compensation, that is, the construction of security system. According to the actual situation in Guizhou Province, the government must subsidize both the demand side and the supply side when maintaining residents' health, so as to maintain good fairness and control costs easily.
The third is to establish a national security system. The report of the 17th National Congress of the Communist Party of China puts forward that everyone has access to basic medical and health services, which is very rich in content. One is to cover all urban and rural residents. If it covers1500 million people by 2020, it will be a very huge project and an arduous task. The second is "enjoyment", and the first is "enjoyment", that is, all residents are served; Second, "yes", basic medical and health services have become an important right of the people. Third, services include basic medical care and public health, which cannot be ignored or ignored.
At present, all walks of life are highly concerned about the problem of "difficult and expensive medical treatment". The report of the 17th National Congress of the Communist Party of China proposed to establish basic medical services covering urban and rural residents, that is, to ensure the basic health service needs of all residents and promote the fairness of health and health services. However, how to realize the basic medical care service for everyone, besides increasing government investment and establishing the basic medical care system, it also needs the medical insurance system as a guarantee. Through the medical insurance system, share the economic burden of residents' diseases and improve residents' ability to use health services. Under the current situation of economic and health development, medical insurance is one of the important means to solve the problem of "expensive medical treatment". The goal of establishing a basic medical and health care system covering urban and rural residents will also play an important role in promoting.
In real life, people have felt that with the establishment of the market economy system, the income gap between urban residents has widened. In order to promote social equity in the field of health care, the government can only establish a basic medical security system for residents in redistribution to ensure that all members of society enjoy basic medical services equally. Establishing a compulsory national health security system is the long-term goal of health reform. The medium-term goal is to establish a universal basic medical care system and solve the public health and basic medical problems of urban and rural residents fairly. The short-term goal is to improve the basic medical insurance for urban workers, implement the urban serious illness relief and the new rural cooperative medical system, and try out and popularize the medical insurance system for urban non-employed residents to achieve universal coverage. At the same time, the government can encourage the society to organize commercial medical insurance to meet the medical care needs of citizens at different levels and promote the service level of public medical insurance institutions.
The fourth is the reform of public hospitals. Health service is a social public service that the government implements certain welfare policies. As an important part of medical care, hospitals should undertake the responsibility and obligation of providing high-quality medical services for society and people. However, the key is how to scientifically locate public, private and joint-stock hospital systems under the condition of establishing a socialist market economy, and build a fair, reasonable and complementary development platform for them, so as to promote the healthy development of hospitals.
The reform of public hospitals is closely related to the reform of medical insurance system and drug circulation system, and there is no unified idea at present. The key issue is how to change the hospital financing mechanism, how much to change, and how the government manages it. At present, there are nearly 20 thousand hospitals in China, 95% of which are run by the government, but the government does not have enough capital investment, so it is inevitable to transfer some of them to the society. At present, according to the basic medical needs in regional health planning, the government should set up a certain number of hospitals and leave the rest to the society. The assets of public hospitals belong to the people and should not be for profit.
At present, because the government's financial investment can not fully meet the expenses of public hospitals, various business services carried out by hospitals for their own development have become the main source of hospital growth and medical staff's wages and benefits. It is the main purpose of the government to promote the reform of the medical and health system to avoid the unreasonable increase of medical expenses and the difficulty of people seeking medical treatment caused by the profit-seeking of public hospitals. The success of public hospital reform can not be separated from the support of economic, political and cultural environment. The government's health investment, budget compensation policy of medical institutions, drug policy and medical insurance policy, sound legal system and good market competition environment will all have great influence on the reform.
The fifth is the practice behavior of medical and health service institutions. The establishment of basic medical care system and basic medical insurance system is to provide basic health protection for urban and rural residents, but there is a problem worthy of attention. In recent years, the wage level of urban residents has been continuously improved, the per capita medical insurance fund for employees has increased substantially, and the new rural cooperative medical fund has also increased substantially. However, as a result of the implementation, the proportion of compensation for medical expenses of urban workers' medical insurance for insured personnel has basically not improved, and the medical insurance fund seems to be unable to make ends meet. The proportion of compensation for medical expenses of the new rural cooperative medical system has not been significantly improved.
It is understood that in 2005, the average actual hospitalization compensation ratio was around 30 yuan, which was the lowest per capita fund-raising in China. In 2006, the average actual hospitalization compensation ratio was around 50 yuan, which was 28%, far below the growth rate of fund-raising. The reason is that the rapid rise of medical expenses is the main factor. The increase in medical expenses largely offset the increase in financing level. There are many reasons for the increase of medical expenses, one of which is the irregular behavior of medical institutions, such as over-providing medical services and inducing demand. In this regard, the health administrative department must formulate effective measures to standardize the behavior of medical institutions, promote their reasonable services and standardize services, guide residents to make rational use of health services, effectively control the rise of medical expenses, and improve the efficiency of medical insurance funds. For example, encourage medical institutions to take the initiative to regulate their behavior by prepaying lump sum; By formulating compensation policies, we will guide residents to make more use of grassroots and community health services.
The reform of medical and health system involves the adjustment of interests in many aspects, so it is necessary to unify the understanding of the importance of health reform in building a harmonious society, and the government should vigorously coordinate all parties to solve various problems. At the same time, the government should grasp the initiative of the reform, correct the deviation in the reform in time, ensure the smooth progress of the reform, and realize the goal that everyone enjoys basic medical and health services as proposed in the report of the 17th National Congress.