Recently，China Office、Several Opinions of the State Council reposted the "State Council's Leading Group for Deepening the Reform of the Medical and Health System on Further Promoting the experience of deepening the reform of the pharmaceutical and health system"，Summarize the typical experience of the new round of medical reform, especially since the 18th National Congress of the Communist Party of China,，Propose promotion from 8 aspects，Promoting the development of medical reforms in depth。I think，This is a major progress of a new round of medical reform。So，What valuable experiences have been left since the start of a new round of medical reform? What is the point of this "Opinions"、What key areas do you need to break through for medical reform?

 

  1. Reform methods have been explored from pilot exploration to pilot promotion

 

  Summary experience in practice，Drives the overall situation by promoting typical typical，It is China to seek construction realistic facts、Important experience of push reform。Especially when I touch the stone to cross the river，Pilot first and then promote，Is an important experience in reform and opening up。New medical reform also gradually advances according to this experience，Especially public hospital reform，Whether it is a county -level public hospital、Urban Public Hospital，Or comprehensive medical reform，All carry out the pilot work of reform。

 

  Pilot reform，The logic and laws that must be followed。One aspect，Pilot reform is staged。Pilot reform，Either bottom -up，Find successful experience in local spontaneous practice，Rich and improved to the whole country，Typical cases are the emergence and promotion of the rural cooperative medical system in the 1950s and 1960s;，Central top -level design reform mode，Pilot in several places，Promote to the whole country after the development is mature，Typical cases were the establishment of the basic medical insurance system of urban employees in the early 1990s。Both methods include exploring experience phase and experience promotion phase。On the other hand，Pilot reform，There must be relatively clear goals。Crossing the river by touching the stone，From here to the other side，The implicit meaning is that there is a clear bank of the river，Otherwise, you will not cross the river with the stones，Instead of touching it in the ocean ocean，Success can only rely on luck。

 

  This time the central government proposed to promote Sanming City, Fujian Province，and Jiangsu、Anhui、Fujian and Qinghai and other provinces with comprehensive medical reform pilot a total of 8 experiences in 8 aspects，Further promotion and deepen medical reform，It means the pilot work of reform，Has from the experience stage of exploration，Enter the experience promotion stage。At the same time，It also means that the implementation plan and specific goals of medical reform are more clear。Medical reform has a clear final goal & mdash; & stake sports betting appstake online sports bettingmdash; establish and improve the basic medical and health system、Realize everyone with basic medical and health services，Lay a solid foundation for promoting the construction of healthy China and building a well -off society in an all -round way。But how to achieve these goals，Need some specific implementation plans and work goals。Previous reform pilot，Mainly exploring each place，This is the needs and inevitable needs of pilot reform，But if it is scattered in various places for a long time，It is not conducive to the effective implementation of the pilots in various places，Because there may be a mentality of fear and observation，It is not conducive to promotion of typical experience in the future，Because there may be path dependence after decentralized exploration in various places。

 

  2. The reform content clearly meets the key content of the law of medical reform

 

  Eight aspects of the file proposed，Almost all reflect the purpose of controlling medical expenses，This is more in line with the rules of medical reform in terms of target。

 

  Saying truth from the truth，Reform typical Sanming City, Fujian，Promoting comprehensive medical reform was an important reason for the initial reason is to control medical expenses，Challenges brought by the medical insurance fund's unsuccessful support。This is one of the reasons why some views do not recognize Sanming's medical reform model。Actually control medical expenses，Solve the pressure of the medical insurance fund，It is an important law and trend of medical reform。

 

  Theoretically，Under the social insurance mechanism，Uncertainty of the effects of disease and therapeutic effect and the medical side、Moral risk caused by information asymmetry between Bao Fang and the affected prescription，It will inevitably lead to the rapid rise of medical expenses，This causes pressure on fiscal and economic development。and aging further exacerbate this trend，Because usually,，The medical expenses of a person's life mainly occur in the aging stage。Some studies have summarized the development trend of the third stage of social insurance based on the historical experience of the first national national insurance。In the first stage, social insurance is established from scratch，Although it is often necessary to establish different systems because of the crowd，Most people support; the second stage enhances fairness，Differences between different systems，Generally, it can only be high at low，Accelerate the level of guarantee of the low guarantee level system，Therefore, some people support someone to oppose; the third stage emphasizes macro efficiency，Condition crisis caused by solving moral risks and other problems，Due to the level of control protection，Most people oppose。Control medical expenses、The pressure of solving the medical insurance fund is a problem that the medical insurance must be solved by the whole people，The difficulty is also very large。For government departments，Realizing national medical insurance，It is both credit nor pressure，In the early stage, I enjoyed power and credit，Gradual is mainly responsible and stress。

 

  The characteristics of the development of medical insurance in my country are the three stages of social insurance development，While establishing a different level of medical insurance system from scratch，The difference between the differences between flattening different medical insurance systems and controlling medical and health costs。The country has also realized this problem，I was introduced in 2009.，Commonly known as a new medical reform plan，No control cost requirement，Just emphasizing reducing personal medical burden，But Guofa No. 11, which was introduced in 2012，Commonly known as the 12th Five -Year Plan for Medical Reform，It is clearly proposed & ldquo; reasonable stake online sports bettingStake Sports Bettingcontrol cost & rdquo;。Current，It must be faced with medical expenses pressure。The late reform，The more passive。The process of growth due to medical expenses，It is also a process of increasing interests in various interests。The greater the benefit，The greater the reform of the reform。

 

  3. The reform path focuses on highlighting the medical reform.

 

  Eight aspects of the file proposed，More in line with the rules of medical reform，Especially for the establishment of a strong leadership system and & ldquo; Three Medical & RDQUO; linkage work mechanism，Break the drug supplementation mechanism，Establish a personnel salary system that is in line with the characteristics of the industry。

 

   First，Coordinated integration can promote reform。Practical experience indicates，Excessive division of the medical and health system increases transaction costs，thus affecting the overall performance of the medical and health system。The Nobel Prize winner of Economics Crugman thinks，Excessive division of the American medical and health system，It is the highest in the world for medical and health expenses in the world，But the important reason why the overall performance is not excellent。Fujian Province and Sanming City coordinate and integrate multi -party forces，Not only does it create conditions for the promotion of reform，It also laid the foundation for the establishment of a high -performance medical and health system。The medical reform enters the deep water area，It will touch many interests。So，To ensure the smooth start and advancement of reform，First of all, the main leaders need to have reform consensus。Main leaders and leaders reached a consensus，All departments and government departments at all levels will cooperate，Only to coordinate various forces。Especially the establishment of power、Medical Reform Promotion Department of Power and Ability。One of the problems in the current medical reform promotion is excessive departmental games，Insufficient coordination。This is more of the discomfort of the department coordination mechanism。Sanming breaks the routine，Leading system for forming a unified management of the reform of the medical and health system of a deputy mayor，For a unified step、Give full play to，Effective promotion of medical reform has laid the foundation of the leadership，and establish a leadership group for medical reform，From finance、Development reform、Sanitary、Social Security、Supervisor and other departments responsible comrades who have been engaged in medical and health work for a long time attended。and Fujian Province on the basis of Sanming's reform experience，Implement similar mechanisms at the provincial level，Further expansion of the effect of the pilot of reform。

 

  2，Breaking & ldquo; Drug supplementation mechanism & rdquo;。Breaking & ldquo; supplement medicine & rdquo;，& ldquo; Cancel the drug bonus & rdquo;，But from the perspective of practical effects，or poor implementation，or implemented measures, but at the same time, the price of medical services has been improved，It did not reduce the overall medical cost。Therefore, there is a point of view that & ldquo; with medicine supplement medicine & rdquo; not the crux of the problem，Cancellation of drug bonuses will not be effective，I even thought it was a pseudo -proposition。Actually，Canceling the drug bonus is just the appearance，essentially is the incentive of eliminating doctors' excessive medical care，This is the fundamental problem faced by medical reforms in various countries。Due to serious uncertainty and information asymmetry in the medical field，Doctors and hospitals may use information advantages for pursuing economic benefits、Do more inspection、Provide more medical services，My stake betting appThis stake betting appover -medical incentive mechanism，It is often said & ldquo;，To be precise, it should be & ldquo;。Turn this mechanism，Inspired doctors to check reasonably、Reasonable medication、Reasonable treatment，It is one of the fundamental tasks of medical reforms in various countries。Due to excessive medical care, it will cause serious social hazards，1 is to stimulate the increase in medical expenses，Extra the burden of patients and social burdens，Resource occupying social development; the second is that ordinary people have taken injustice medicine、I did a wrong checkup，Cause health damage，Not conducive to the long -term healthy development of society，Typical examples are antibiotic abuse; the third is to damage the professional image of the doctor's team。DaviddeFerranti, former vice president of the World Bank, and Juliofrenk, Dean of the School of Public Health of Harvard University, summarized according to the experience of multi -national medical reform，If you can't reverse the doctor、The hospital provides more service incentives as possible，Medical insurance for the whole people is too expensive。So，Must understand the essential nature of & ldquo; to supplement the medical mechanism & rdquo;。This is not a unique problem with public hospitals，but the common problem of the medical service system。Break the public hospital & ldquo; use the medicine supplementation mechanism & rdquo; become the top priority of medical reform，Just because the current public hospital is the main body of the medical service provided by my country's medical services。

 

  third，Reform doctor income mechanism，Establishing a salary system that is in line with the characteristics of the industry is the requirements for improving the systemic medical reform。The doctor's income mechanism is the deep root of the medicine supplementation mechanism & rdquo;。& ldquo;、Hospital two objects，Therefore, there are also & ldquo; with the drug supplement doctor mechanism & rdquo; and & ldquo;，The mechanism and form of the two are not the same。For example, it is divided into & ldquo;。& ldquo; Ieya -supplementary hospital & rdquo;，Reflected in the book of the hospital。and & ldquo; Ierate the doctor & rdquo;，But the main part is not in the part of the bonus of the drug，but the rebate paid by the pharmaceutical factory and dealer，That is gray income。Cancellation of the drug bonus only solves & ldquo;，Not solved & ldquo;。Breaking & ldquo; Drug supplement doctor mechanism & rdquo;，The core is to solve the problem of doctors' income mechanism。From history,，The drug bonus policy is the reason for the problem that the problem of supplementing the medicine & rdquo;。Drug addition policy began in the 1950s，At that time, in order to supplement medical income，The government decides to sell the drug by 15%in the entry price，But the state's positioning of health work at that time was a welfare cause，Public hospitals are budget management units，Doctor's income is fiscal payment，Drug Bonus and Hospital、Doctor's income is not directly related，Therefore, the drug bonus policy at that time did not bring the problem now。Enter the 1980s，The hospital starts to make a negative profit and loss，Hospital and doctors' income and business directly linked。Drug bonuses and rebates have become an important source for hospitals and doctors to create revenue，Only caused a series of problems。From the perspective of reality，If the doctor's income and the learning cost they are invested、The occupational risk assumed is not consistent with the social status in which it is located，Doctors still have the motivation to create income through over -medical treatment。So，& ldquo; I made up a doctor's mechanism & rdquo;，Doctors may still stake online sports bettingbe Stake Sports Bettingthe key object of medical representative public relations and implementation rebates。

 

  The reform of the doctor's income mechanism is a prominent problem that hinders the systematic improvement of medical reform。The medical and health system is by the funding guarantee system、Public health service providing system and medical service provision system、Supervision and Management System、Supply system for drug equipment、Six parts of the doctor's talent system，Six parts must be systematically coordinated to be effective，The systemicity of the reform and development of the medical and health system is increasingly valued in the world，instead of focusing on some aspect。The systemicity of my country's medical reform gradually improves the policy。In 2009, the new medical reform plan proposed the reform framework of the four beams and eight pillars as the main structure，Key reform medical security、Public Health Service、Medical Service、Drug supply four aspects; the requirements of the 18th National Congress of the Communist Party of China & ldquo; focus on promoting medical insurance、Medical Service、Public Health、Drug Supply、Comprehensive reform of the regulatory system & rdquo; The Third Plenary Session of the 18th Central Committee decided to emphasize & ldquo;、Medical Service、Public Health、Drug Supply、Comprehensive reform of the regulatory system & rdquo;，Requirement to establish & ldquo; talent training that adapts to the characteristics of the industry、Personnel compensation system & rdquo;，Although the top -level design of the six -in -one is not proposed，But the system has basically complied with the systemicity required by the rules of medical reform。But the systemicity of my country's medical reform still has a gap in practice，The biggest problem is that the reform of the doctor system is not enough。The reform pilot represented by Sanming not only breaks through the regulatory system，The most critical in the current medical reform of the doctor system、It is also the most lacking breakthrough link.，Is a more comprehensive comprehensive reform，More in line with the requirements of the Third Plenary Session of the 18th Central Committee。

 

  early 2015，The author puts forward three wishes for medical reform in "China Health": I hope that the goal of medical reform is more clear，Hope that the path of medical reform is more clear，The accountability of hoping for medical reform is more clear。This file recently introduced if it can be implemented well，Then my country's medical reform will take a big step。

 

   (Text/Chen Qiulin，It is an associate researcher at the Institute of Population and Labor Economics of the Chinese Academy of Social Sciences、Academic Member of Pangu Think Tank)