看病难\看病贵的多视角透视(1)
http://www.100md.com
2011年2月1日
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【摘要】看病难看病贵因国家形态、历史时期、社会阶层的不同而呈现不同的表现形式。看病难源于医疗服务供给总量不足与结构失衡；看病贵源于医疗服务价格的扭曲与医疗保险体系的残缺，看病难看病贵的感受差异根源于社会阶层的高低。解决看病难与看病贵的治本之策是通过公共卫生与健康管理控制医疗服务的需求；治标之策是扩大供给总量、调整供给结构与提高医疗保险的保障水平与保障范围。中国未来的看病难、贵主要体现为特需医疗服务的看病难、贵，必须从特需医疗服务供给与商业医疗保险建设两个方面加以解决。
【关键词】看病难 看病贵 控制需求 增大供给 社会分化 特需医疗服务
中图分类号：R197文献标识码：B文章编号：1005-0515(2011)2-307-03
In the situation of the new medical reform, the difficult and expension
of medical care mus tbe treated and diagnosed classificly
PAN Xiaoyan，ZHAO Yun
【Abstract】The patterns of medical care difficult and expension show different manifestations.from different country, historical period, social classes. Medical care difficult is due to the insufficient supply of medical services, and structural imbalances; medical services expension is due to the price distortions and medical insurance system incompleted; medical care difficult and expension is rooted in the feeling of social class differences in the level . Fundamental strategy to solve Medical care difficult and expensive is management of public health and health and control of medical services; a temporary solution is to expand the supply of a policy, adjust the supply structure and increase the level of protection and medical insurance coverage. China's future medical care difficult and expension, mainly reflected the difficult and expension of special needs of your medical services, must both to be addressed, supply of specially required medical services and construction of commercial medical insurance.
【Keyword】Medical care difficult；medical care expension；control requirements；increase supply；social differentiation；special medical service Authors address：Zhongnan university school of public health,Changsha,Hunan,China,410000.
看病难与看病贵是一个看似简单实则复杂的社会问题，多次医改都未能根治足以证明看病难、贵根源的复杂性与根治的艰巨性。为什么多次医改均未解决，我们以为并非病根误诊，药方误治，根本原因在于不能分类诊断与分类治疗。看病难、贵有不同的表现形式、诱发根源，必须用不同的对策解决，才能对症下药。
1 现存“难”与“贵”的表现形式及其启示
1.1 从横向表现形式：不同的国家有不同的表现形式
1.1.1 发达国家：或难或贵。目前西方发达国家，典型的医疗卫生模型有三个：英国政府主导模型；美国的市场主导模型；德国社会主导模型。从结果看，政府主导的英国卫生体制，由于政府的大量投入与严格监管看病不“贵”，但是由于官僚垄断缺少效率依然存在着看病“难”问题。市场主导的美国由于高度的市场竞争与有效的卫生服务供给没有看病“难”的问题，但是由于医疗保险的商业化导致看病“贵”的问题。社会主导的德国，由于市场程度高，看病不“难”，由于保险缴费个人负担较重，也同样产生另类的看病“贵”问题[1]。
1.1.2 发展中国家：又难又贵。发展中国在过渡发展时期，在卫生事业发展领域同时并存看病难与看病贵的问题。发展中国家在发展中由于人口扩大、环境恶化、生活方式转变以及疾病谱的变化导致了对卫生服务需求的快速大量增长 ......
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