改革管理体制：卫生服务供给系统的层次、问题和责任分析

卫生服务供给系统有3个层次4个方面，即卫生服务要素生产、流通、服务供给和卫生筹资。卫生服务供给的状况不仅决定于卫生服务供给层面，也决定于生产要素生产、流通和经费筹集等其它几个层次的运行状况。虽然每个层面都有可能产生问题，但所有问题往往显现和集中在卫生服务产出和供给这一个层面上。如果要解决卫生服务供给中存在的问题，首先应当发现所有层次上的问题，分析不同层次上问题的关联性，并找出这些问题存在的根源。在这几个层面上，涉及到10多个行政管理部门，任何一个部门不能尽其职责，都会产生不同的问题，并反映到卫生服务供给中。卫生服务供给中的某个问题的出现往往是多部门多层次综合作用的结果。不重视管理体制的改革，任何卫生改革策略或措施将很难取得预期效果。

Reforming Mechanism: Analysis of Stratification and Problems of Health Care System, and Accountability of Government Agencies

In general, health care system can be divided into three levels in terms of its production: market for producing in- puts, market for trading the inputs, and market for providing health services. Health financing is a special element in influencing health service production. The quantity and quality of health care would be determined not only by the structure and organization of services, but also by performances in other levels of the system. Though there may exist problems in all level we focus on the level of healthcare output and provision. To solve such problem, first of all is to find problems in all level, analyze their correlation and find out their origins. There are more than 10 government departments besides health sector that are associated with the causes of problems in health care in China. The appearance of some certain problem in health care provision is always as multiple effect of excessive de- partments and excessive levels. The success of health reforms will largely depend on the changes in managerial system in health care.