上海卫生改革的经验和问题

上海是一个国际性的大都市，近20年来医疗服务的设施和能力已有很大的提高，医疗服务总需求量的不断增加与上海市具有健全的城市基本医疗保险制度和农村的合作医疗制度是分不开的，此外，还与发展了“以病人为中心”的服务理念和渐进性，分步实施卫生系统改革的政策有关。然而，上海也面临着国际上其他大都市同样的困难，医院的“总量控制，结构调整”政策和按项目付费的方式，并不能从根本上控制医疗费用的不合理增长，该详细讨论了上海市卫生改革的主要的经验和存在的问题，作建议应加强当前医疗市场的竞争和规制。政府要处理好增加卫生投资和保证人民群众健康目标的关系。

The experiences and issues of health reform in Shanghai

Shanghai is a metropolitan in China. The capacity of medical services was improved significantly over the last two decades. The most important factors on raising the aggregate health demand are due to establishing a competent medical security system in both urban and rural areas, developing a patint oriented service model and applying a phased approach in health system reform. However, Shanghai is faced with similar difficulties like other metropolitans in the world. The hospital capping revenue policy plus fee for service payment system does not get the root of the cost escalation. The experiences and issues of health reform in Shanghai are discussed in details, The author recommends that current market competiton and regulation should be enforced. The government should be aware of the combination of investing health services and reaching health target of population.