看病难看病贵的多视角透视.docx

看病难看病贵的多视角透视 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 【】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 managementof 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. Chinas 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。 现存“难”与“贵”的表现形式及其启示 从横向表现形式：不同的国家有不同的表现形式 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] 。 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， 但是与此同时由 于发展国家由于发展水平的限制卫生服务供给难以在短时间内