我国医疗费用总体构成情况分析及医改建议

目的:解读当前我国医疗卫生体系中的"以药养医"问题,为我国医疗卫生体制改革提供参考。方法:依据我国卫生事业发展统计公报等文件数据,分析我国医疗费用构成、医保费用构成、药品价格构成情况及医保基金的使用现状;同时对我国的医疗卫生体制改革提出建议。结果:2012年全国卫生总费用达24 345.9亿元,其中药费占45.9%,检查费用占32.8%;医保费用中自费部分占个人卫生支出的比例,城镇人口为31.0%,农村人口为68.3%,呈现医疗待遇不公平现象;个人卫生支出占医疗总费用的34.8%,药品价格中约59.6%的费用耗费在物流、公关层面;目前医保基金浪费和流失的比例不低于50%;"看病难、看病贵"依旧是民生痼疾,我国医疗卫生体制改革的核心应在于着力加强公立医院的公益性。结论:需要重新全面审视当前的医疗卫生体制,适时调整医疗政策,如建立免费的基本药物生产、供应制度,细化医保项目的免费、自费报销比例和品种等;公民免费基本医疗保障和医疗保障阶梯化应适时得到关注。

Analysis of Medical Expenditure Structure in China and Recommendations on Medical Reform

OBJECTIVE： To explain the real problems of ＂drug-maintaining-medicine＂ in the current medical system and put forward several suggestions on the medical system reform. METHODS： The medical cost structure, the structure of health care cost, the structure of drug prices and the situation of health care funds were analyzed according to statistical bulletin of health care development in China and other documents. RESULTS： The total health expenditure was 2 434.59 billion yuan in 2012, and drug cost accounted for 45.9% and inspection fee was 32.8% of them; the ratio of self-supporting expense from health care costs in per- sonal health expense was 31.0% for urban population and 68.3% tbr the rural population, showing the unfairmedical treatment. Per- sonal health expense accounted for 34.8% of the total medical cost; logistics and public relations expense accounted for 59.6% of drug prices. The health insurance fund waste and loss occupied no less than 50% ; ＂difficulty and high cost of medical care＂ was still livelihood problem, and the core of medical system reform should focus on public welfare of public hospitals. CONCLU- SIONS： We need to readjust the medical policy through a comprehensive look on medical system in the appropriated time, such as establishing free production and supply system of essential medicine, refining the proportion and types of reimbursement for free and self-supporting treatment in medical insurance. Great importance should be attached to free basic medical insurance and step- wise medical insurance.