改善卫生服务的公平性:任重而道远

提高卫生服务可及和公平,确保居民人人享有所需的基本医疗服务既是近年来国际热点问题,也是我国此次卫生改革的主要目标之一。当前的挑战主要体现为地区资源配置不公平、保险待遇差异引起的风险分担水平差异,以及服务供给中价格机制僵化。改善公平需要从加大偏远地区资源配置以提高其服务提供能力、缩小人群保险待遇差异、调整价格机制等方面入手,结合实际情况,科学决策,同时也需要多部门的协作。     

我国卫生服务系统绩效分析

以世界卫生组织(WHO)提出的卫生服务系统绩效评估框架为目标，以世界银行提出的卫生系统诊断工具为分析手段，对导致我国现阶段卫生绩效的结果、成因以及改善的办法与途径进行了系统分析，指出为改善我国现阶段卫生系统总体绩效不高的现状，必须要坚持公平优先、兼顾效率的原则，进一步改善基本卫生服务的可及性，提高卫生服务系统对人民群众普遍、合理期望的反应性。     

论居民医保个人筹资机制从定额制到定比制的改革

城乡居民基本医疗保险的资金来源由政府按人头补贴和个人定额缴费组成。目前,按人头定额缴费的筹资机制面临着筹资负担不公平、保费增长不稳定、筹资水平不充分、筹资责任不均衡等问题。本文论证了定额筹资制度向定比筹资制度转变,不但可以在筹资端实现负担公平,提升总筹资水平、内置筹资自动调整机制,破解城镇居民基本医疗保险保障不充分的问题,还可缩小与职工医保的差距;同时由于中高收入者个人缴费相对增加,还可以改善政府与个人负担不均衡的问题。本文计算了不同费率条件下,低收入人群减负、制度增收及个人与政府责任均衡的情景;建议在减轻低收入者缴费的相对负担时,财政补贴细化地区级差补贴,以保证低收入地区筹资总额相对水平不下降。     

我国全民医疗保障制度建立的依据与目标

在研究分析社会保障制度和医疗保障的发展与变迁及其特征的基础上，提出我国全民医疗保障制度不同的发展阶段目标，第一阶段为保障基本卫生保健的公平可及性；第二阶段为逐步向筹资公平性目标迈进；第三阶段为促进健康公平性目标的实现。对全民医疗保障制度的内涵与外延、全民医疗保障制度设计基本依据与原则进行了阐述。     

成都市基本医疗保险筹资纵向公平性评价

成都市作为国家统筹城乡综合配套改革试验区,一直致力于解决原有医疗保险制度存在的不公平现象。2009年,成都市正式实行新的基本医疗保险制度,围绕人人享有医疗保险的目标,通过城乡居民医保,实现了新农合和城镇居民医保管理的一体化。     

国民基本卫生服务筹资国际经验研究

通过对国际基本卫生服务筹资经验的总结,发现更多的国家采用了公共筹资机制和以税收为主的筹资模式,在此基础上对部分发展中国家的资金筹集、分配和使用进行分析,总结各国基本卫生服务筹资的经验和教训,为在我国建立充足、公平、高效和可持续的基本卫生服务筹资制度提供参考和依据     

全民医保制度的内涵与设计原则

全民医疗保障制度是指我国政府为保障国民基本健康权益，保障城乡全体居民能够公平获得基本卫生保健所做出的制度安排，是为了在基本卫生保健方面为国民提供筹资保护与风险分担、改善卫生筹资公平性的政策选择。依据WHO对全民覆盖医疗保障的定义，我们将全民医疗保障制度覆盖范围界定为，“是全体国民在需要保健服务时，能够以可支付的费用获得适当的健康促进、预防，     

加拿大卫生改革现状、发展趋势及其对我国的启示

全民医疗保健制度是加拿大卫生体系乃至社会政策的核心,经济起伏下的筹资增减深刻影响到加拿大近二十年卫生发展历程,以公平、公正为基本价值观,构建低成本高效益卫生服务体系,为全民及时提供高质量卫生服务是加拿大卫生改革发展的基本趋势。本文介绍了上世纪后十年和本世纪初十年两阶段的加拿大卫生改革的背景、现状、特征、主题、内容、影响、经验和教训,并从公平、效率和长期性三方面阐述了对我国卫生改革发展的启示。     

国际医疗保险模式和改革发展比较分析

医疗保险的覆盖度、管理体制、保险内容及运营效率直接关系到卫生服务的公平程度、医疗费用的控制、卫生资源分配和利用效率、医疗服务质量、研究、选择合理的医疗保障制度地于合理组织卫生服务，公平分配卫生资源，提高卫生体制的运行效率具有十分重要的意义。     

卫生筹资的垂直公平和累进性研究

探讨测算与分析卫生筹资垂直公平性的方法，以及如何量化某种卫生筹资渠道累进或累退的程度，并模拟测算和分析不同经济发展水平的两个地区卫生筹资的垂直公平和累进程度。     

我国卫生筹资系统的历史沿革与分析

文章结合卫生费核算数据描述了我国卫生筹资系统的演化过程,并对其原因和存在的问题进行了讨论,在此基础上结合医药卫生体制改革政策,对未来一段时期我国卫生筹资系统的发展进行了展望。     

新医改以来我国卫生筹资的进展、问题与面临的挑战

新医改四年来,我国各级政府大规模增加卫生事业的财政投入,卫生公共筹资体系建设成效显著,然而亦存在一些突出问题,卫生筹资的可持续性面临挑战。当前我国新医改进入“提质增效”的第二季,需要以转变政府管医办医职能为统领,协同配套推进体制机制改革,多渠道增加卫生资源,提高卫生投入绩效,实现卫生筹资的可持续发展。     

浙江省卫生总费用筹集与医疗保障机制

卫生总费用的筹集直接关系到医疗保障机制的改革与完善,近年来随着国民经济的发展和人民生活水平的提高,浙江省卫生总费用筹资机制不断完善,提升了公民医疗保障水平,但也存在一些问题。本文通过浙江省卫生总费用筹集现状和问题分析,提出解决对策,以促进浙江省医疗保障机制的进一步完善。     

Equity, governance and financing after health care reform: lessons from Mexico

To determine, from the perspective of providers, community leaders and users of health services, equity, governance and health financing outcomes of the Mexican health system reform.Cross-sectional study oriented towards the qualitative analysis of financing, governance and equity indicators for the uninsured population. Taking into account feasibility, as well as political and technical criteria, six Mexican states were selected as study populations and a qualitative research was conducted during 2004-2006. Two hundred and forty in-depth interviews were applied, in all selected states, to 60 decision-makers, including medical and administrative personnel; 60 service providers at health centres; 60 representatives of civil organizations, including municipal representatives and, finally, 60 members of health committees and users of services at second and first levels of care units. The analysis of interviews was performed using ATLAS-Ti software. An outcome mapping of health reform was developed. For political actors, Mexican health system reform has not modified dependence on the central level; ignorance about reform strategies and lack of participation in the search for financial resources to finance health systems were evidenced. Also, in all states under study, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Health strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. There are relevant positive and negative effects of the reform on equity, governance and financing in health. Special emphasis is placed on the analysis of lessons learned in Mexico and the usefulness of the main strengths and weaknesses, as relevant evidences for other middle-income countries which are designing, implementing and evaluating reform strategies in order to achieve equity in resource allocation, good levels of governance and a greater financial protection in health.     

实施卫生投融资改革的初步构想

章提出了通过塑造公立医院的投资主体和产权代表，以明晰产权归属，界定投资权益为抓手，来实施卫生投融资改革的构想，化指出，改革的核心是依托市场机制来提高政府投资效率，推动公立医院的机制转换和快速发展，章最后提出应正确理解这一改革与政府职能转变，医院管理体制改革，多元化办医，医院建立法人治理结构，医院产权制度改革，组建医院集团等的关系。     

Recent issues of the Romanian health financing system

The aim of the paper is to examine the health financing reform in Romania in order to find out to what extent the expected results were achieved, what were the main factors that influenced the reform process and in what way the main unsolved problems are to be sorted out. The paper describes the main features of the health financing reform outlining the factors that determined or influenced it, presents some of the reform outcomes and discusses the current health policy agenda. The main findings of this examination are the following: the expected results of the health care reform were not fully achieved (one of the main causes was the too high expectations that did not take into account the country’s low starting point at the beginning of the transition); the reform process was slowed down mainly by political instability, the funds for health increased over time, but this was not enough to increase health system performance and patient satisfaction, the health system reform finally became one of the main priorities on the government agenda. The paper concludes that it took quite a long time until the Romanian government took over its stewardship role of the health system, with the understanding that health reform cannot be a separate process but rather is in need of intersectorial action, clear and coherent legislative support and strong political backing.     

黑龙江省医药费用增长研究

本文对黑龙江省90年代以来的医药费用增长变化情况进行了详细的研究,指出黑龙江省卫生总费用增长速度落后于GDP的增长速度。文章同时从卫生筹资、支付方式、组织和规范管理4个方面剖析了导致这一结果的原因,以及为配合城镇职工医疗保险制度改革,卫生系统所应进行的改革。     

The recent health reform in Croatia: True reforms or just a fundraising exercise?

Croatia's most recent reform of the healthcare system was implemented in 2008. The aim of the reform was to enhance financial stability of the system by introducing additional sources of financing, as well as increase the efficiency of the system by reducing sick pay transfers to households, rationalising spending on pharmaceuticals, restructuring hospitals etc. This paper attempts to assess the success of the 2008 healthcare system reform in reaching financial stability and sustainability, and to evaluate the effects of the reform on equity in funding the system. It takes into account the fact that the reform coincided with a severe economic crisis and decline in the overall living standard of Croatian citizens. The paper shows that the reform ended up being expansionary and thus impaired the necessary fiscal adjustment. Finally, it is argued that in circumstances of declining disposable incomes, increased co-payments aimed at the financial stabilisation of the health system made health services less affordable and could have had detrimental effects on equity in the utilisation of health care.     

Moving towards universal health insurance in China: performance, issues and lessons from Thailand

China is now in the course of implementing a new round of health system reforms. Universal health insurance coverage through the basic social medical insurance system is high on the reform agenda. This paper examines the performance of China's current social medical insurance system in terms of revenue collection, risk pooling, the benefit package, and provider payment mechanisms based on a literature review and publicly available data. On the basis of critical assessment, the paper attempts to address the issues challenging China as it moves towards universal coverage. Focusing in particular on the reform experience in Thailand as it implemented universal coverage, the following policy implications for further reform in China are articulated, taking into account China's particular circumstances: firstly, the gaps in the benefit package across different schemes should be further reduced; secondly, the prevailing fee-for-service payment system needs to be transformed; thirdly, the primary health care delivery and referral system needs to be strengthened in coordination with the reform of the health insurance system; and fourthly, raising the risk pooling level and integrating fragmented insurance schemes should be long-run objectives of reform.