对深化上海医改的几点思考

国家医改方案已经公布，上海医改设计时必须注意处理好组建医疗联合体、管办分离、医保改革、医院补偿机制、全科医师培养、发展高端医疗服务业这六方面的问题。分析了组建医疗联合体必须克服的四个障碍；管办分离的精髓是政府卫生行政部门与医院院长间真正意义上的职责边界合理与清晰；医保改革应由医疗保险向健康保障模式转变，处理好“一卡通”与“个人帐户”问题；医院补偿机制应着重处理好政府财政、医疗服务收费与药品收入三者的关系，在核定支出前提下，医院收支结余部分上交是实现公益性回归的途径之一；社区卫生服务中心医师不必全部是全科医师；关闭公立医院开展的特需医疗服务是吸引社会资金举办高端医疗服务业的最佳途径。最后提出“三包一线”，即建立上海市公共卫生服务包、基本医疗服务包、基本药品包及个人自负封顶线的上海市医改基本思路。

Some considerations on Shanghai health care reform

Design health care reform need deal with six issues： establish medical united groups; ownership- ers separated with management; health insurance reform; general physicians training; and develop high level techni- cal medical service. This paper analyzed four obstructive factors, that are： clarify the responsibility between govern- ment with director of the hospital ; the health insurance need transfer from curative model to health promotion; hospi- tal reimbursement mechanism need deals with relationship among government financing, hospital income and drug; the hospital need return to their public welfare characters. Finally the author suggested three packages need set up in Shanghai health care reform, that is： public health package, essential medical package, and basic drug package.