医疗保障体系与服务供给体系的摩擦与整合.pdf

□□医疗保障·MEDICALINSURANCE 《中国卫生经济》第36卷第1期 （总第407期）2017年1月 医疗保障体系与服务供给体系的摩擦与整合* ①② ①② 张 研 ，张 亮 摘 要 2003年以来，我国基本医疗保障体系与医疗服务供给体系取得了长足发展，但当前居民的疾病经济负担并未减 轻，居民健康改善有限。卫生服务体系是一个复杂的动态系统，各要素及子系统间存在结构性摩擦。我国医疗服务供给系统 与医疗保障系统间存在负向摩擦，主要在于 “医”“保”分离，管理与目标不一致；保障体系重视个体机构的支付，轻视对服 务体系的引导设计。建议在未来的保障制度设计重视对服务供给改革的引导，侧重对体系、对健康的考虑。 关键词 卫生服务体系；医疗保障体系；复杂系统；结构性摩擦；改革 中图分类号 R1-9；F840.613 文献标志码 C 文章编号 1003-0743(2017)01-0021-03 DOI 10.7664/CH StructuralFrictionandIntegrationofMedicalInsuranceSystemHealthCareDelivery/ZHANGYan,ZHANGLiang// ChineseHealthEconomics,2017,36(1):21-23 Abstract Since 2003,thebasicmedicalinsuranceandmedicalservicesupplysystemhaddevelopedwell,however,thecurrent diseaseeconomicburdenofresidentswasnotreducedandthehealthimprovementofresidentswaslimited.Healthservicesystemwas acomplicateddynamicsystemwithstructuralfrictionsamongdifferentfactorsandsubsystem.Therewasnegativefrictionsbetween medicalservicesupplysystemandmedicalinsurancesysteminChina,whichmainlydeparted “medicine”and “insurance”while themanagementandgoalwasnotequal;theinsurancesystemfocusedonthepaymentofindividualinstitutions,ignoredtheleading designofservicesystem.Itsuggestedthatthefuturesecuritysystemdesignpayattentiontotheleadofservicesupplyreformandthe considerationonsystemandhealth. Keywordshealthservicesystem;medicalinsurancesystem;complexsystem;structuralfriction;reform First-author’saddress SchoolofMedicineandHealthManagement,TongjiMedicalCollege,HuazhongUniversityofScience andTechnology,Wuhan,430030,China CorrespondingauthorZHANGLiang,E-mail:zhangliang@ 1 我国医疗保障体系与服务供给体系的发展与及存在 数、执业医生数以及乡村医生数的年增长率分别为 的问题 4.63%、8.53%、9.34%、4.81%和2.02%；全国平均住