走向高度行政化还是有管理的市场化

COMMAND-AND-CONTROLVERSUSREGULATEDMARKETIZATION--AREVIEWOFEIGHTPROPOSALSFORCHINA'SNEWHEALTHCAREREFORMSTOWARDSAUNIVERSALCOVERAGEOFHEALTHCARESECURITY.............................23PUBLICFINANCEANDHEALTHCAREFINANCING......................................................25REFORMSOFPAYMENTMODES.................................................................................28REFORMSINHEALTHCAREDELIVERYSYSTEM........................................................29STRENGTHENINGHEALTHCAREADMINISTRATIONORRESHAPINGHEALTHCAREREGULATORYREGIME?.............................................................................................31PHARMACEUTICALPOLICY:COMMANDECONOMYVERSUSMARKETECONOMY......32CONCLUDINGREMARKS............................................................................................33
1
2
34567
8910111213141516171819202122Command-and-controlversusRegulatedMarketization--AReviewofEightProposalsforChina’sNewHealthCareReformsChina’shealthcarereformsareatacrossroads.Ashealthcarecostsaresoaring,manypeoplecannotaffordbasichealthcareservices.Abouttwentypercentofpeoplewhofeelsickdonotseekforoutpatientservicesoutoffinancialconsiderations.TheproblemoflackofaccesstobasichealthcarehasbecomeoneofthetopsocialissuesinChina,andhastriggeredtremendousdiscontentamongthepublic.Fromthemid-2005onwards,theproblemwithinaccessibilityofhealthcareserviceshasarousedmuchattentionfromthemassmedia.Aconclusionarisenfromthemassmedia’sreportageisthathealthcarereformsoverthepastthreedecadeswerebasicallynotsuccessful.Inresponsetothissituation,theChinesegovernmentisplanningtolaunchanewroundofhealthcarereformsin2008.ApprovedbytheStateCouncil,aNationalHealthCareReformCoordinatingGroupwasestablishedinSeptember2006,workingondraftinganofficialproposalfornewhealthcarereforms.ThegroupischairedjointlybyMaKai,theChairmanoftheNationalDevelopmentandReformCommission,andGaoQiang,thethenMinisterofHealth.1Inearly2007,sevenorganizations,namelyPekingUniversity(Beida),FudanUniversity,BeijingNormalUniversity(BNU),theDevelopmentResearchCentre(DRC)undertheStateCouncil,theWorldBank,theWorldHealthOrganization(WHO),andMcKinseyCompany,wereinvitedbyNationalHealthCareReformCoordinatingGrouptosubmittheirproposalsforChina’snewhealthreforms.2OnMay30,2007,allproposalswerepresentedatatwo-dayinternationalconferencejointlychairedbytheNationalDevelopmentandReformCommissionandtheMinistryofHealth.RenminUniversityofChina(Renda)alsodeliveredaproposaltotheconferenceatthelastminute.Eightproposalsarecommoninthattheyareallconcernedwithhowtoachievetheuniversalaccesstobasichealthcareservices.Theydeliberateanumberofprinciples,guide-lines,andstrategiesforcarryingoutacomprehensivereformcoveringhealthcaresecurity,healthcarefinancing,healthcareservices,healthcareadministrationandregulation,andpharmaceuticalpolicy.Basically,twoapproachesemergefromtheeightproposals.Onefavoursagovernment-dominatedsolutionbyestablishingaMini-NHSsystemtodeliverfreeprimarycaretoallChinesecitizens.Theothersuggestsamarket-orientedsolution,inwhichbasichealthcareservicescanbepurchasedbyamulti-tierpublichealthcareinsurancesystem.Basically,theformer1Theofficialnewsannouncementisavailableat’s,sevenproposalsalsopresentsomepolicysuggestionsforreformingpublichealthservices.However,whattheysuggestarelargelywhathavebeendoneinreality.Inotherwords,sevenproposalsfailtopresentanygenuineproposalsforreformingthetroublesomepublichealthsectorinChina.Therefore,thispartwillnotbeexaminedinthisreview.23approachreliesonacommand-and-controlmechanismforachievingequityinprimaryhealthcare,aswellasinpublichospitalswhichdeliversecondaryandtertiaryhealthcare,whileleavingsmallspaceformarketmechanismintheso-called“non-basic”healthcaresector.Thelatterembracesamodelofregulatedmarketizationwhiletakingthegovernmentasoneoftheactiveplayersinthehealthcaremarket.Alongwiththemarket-orientedapproach,themajorrolesthegovernmentshouldplayinthehealthcaremarketincludeaninsurer,apurchaser,andaregulator.Thefollowingsectionswillexaminetheconsensusesanddisagreementsontheseissuesamongeightproposals.TowardsaUniversalCoverageofHealthCareSecurityOneofconsensusesthateightproposalshavereachedisthatthegovernmentshouldplayanactiveroleinprovisionofhealthcaresecurity.AsthecoverageratesofexistingpublichealthsecurityprogrammesarealltoolowandcommercialhealthcareinsuranceistoounderdevelopedinChina,themajorityofChinesepeoplehavetopaytheirhealthcarebillsentirelyorpartiallyoutoftheirownpocketsatthepointsofservice.Asaconsequence,financialrisksofordinarypeopleforpayinghealthcarebillscannotbeproperlypooled.Meanwhile,whenout-of-pocketpaymentisdominant,provider-inducedover-consumptionisallegedtobewidespread,andthisphenomenonhasbecomeatargetforharshpubliccriticism.Themechanismofthethird-partypurchaseislargelylacking,andtherebysoaringofhealthcareexpensescannotbeeffectivelycontained.Hence