中國醫療制度改革–從市場化轉向準市場化？

Abstract

中國於1978年經濟改革開放後將市場化機制引入醫療服務體系，使醫療制度從計畫經濟中央管控轉向市場經濟的過程中衍生出許多醫療弊病，隨著人口老齡化、快速城市化、疾病複雜化和醫療保險普及發展，加劇醫療服務城鄉差距促使醫療政策不斷修正。現階段關於中國醫療制度改革的探討，大多研究從市場失靈和政府過度干預的角度出發，認為市場化不完善是造成醫療改革成效不彰的主因。然而在社會主義體制的影響下，中國醫療制度結合市場激勵機制和政府計畫干預，發展出截然不同的醫療市場改革模式。 .本研究採用市場化理論、準市場化理論、公私協力理論的理念觀點，比較1998年和2009年兩次醫療制度改革過程和市場化機制運作方式差異。探討醫療服務中政府主導角色的轉變，以及政府、醫療服務提供者和醫療服務消費者三方之間的關係。本研究發現中國醫療制度市場化轉型過程中，政府都將公立醫院作為主要的改革對象並關注於醫療服務品質和基層醫療機構能力，同時結合社會資本提供多元醫療服務，建立公部門與私部門合作關係。整體而言，中國政府積極強化基礎公共服務和建立社會保險制度，避免因政府角色轉變而產生市場失靈問題，面對各種醫療弊病不斷推出改革政策，醫療改革市場化發展也影響社會政策制定。作者認為中國社會福利政策已有明顯的市場化現象，展現出社會福利中醫療服務結構的轉型，準市場化的醫療改革模式也為現今世界各國的發展趨勢之一。

After the economic reforms in 1978 China introduced the market mechanism into healthcare system. The transition from a centrally planned economy to a market‐oriented economy has caused problems in the public health arena. China has a large health care demand gap due to aging population, rapidly growing urbanization, proliferating diseases and the advancement of universal health care insurance. According to the most existing studies, they thought that medical problems were caused by market failure and government failure, especially the market mechanism has not been fully in place. Under the socialist system, the healthcare reform was combined with government regulation and market mechanism to form a different pattern. However, in this study, it adopted the perspective of the marketization, quasi-marketization and public-private partnership, comparing the changes and the operations of market-oriented mechanism between healthcare reforms that was announced in 1998 and 2009. To discuss the role on government adjustment in health service domain and the tripartite relationship of government, medical service providers and medical service consumers. Through the reform of public hospitals the State Council focused on the need to improve the service’s quality and the competence of grassroots healthcare institutions. Together with the reform of public hospitals schemes, China’s government has formed partnerships with social capitals to provide diverse medical services. As a whole, the government is facing strengthen basic public services, establish a social security system in order to overcome market failure issues facing forward in the process of transforming government functions. Faced with different problems, the government has launched a number of reforms. I use the example of China’s healthcare reform policy experiments to illustrate changes set in motion by these market-oriented healthcare policies in terms of their influence on social policy making. The ongoing marketization of social protection is transforming the medical service structure of social welfare. Quasi-marketization is one of the development trends of healthcare reform in the world.