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.