医疗体制改革支点的比较和选择

我国医疗体制改革有3个支点，分别是医疗保险预付费方式、基本药物制度、医疗信息化。不同的改革支点可以撬动不同的医疗体制。医疗保险预付费方式可以推动医疗服务体系的“去垄断化”和医疗服务体制的“去行政化”，最终构建“有治理的市场化”医疗服务体制。基本药物制度可以强化医疗服务体系的“垄断化”和医疗服务体制的“再行政化”，最终构建“有管制的垄断性”医疗服务体制。医疗信息化既可以构建有治理的市场化医疗体制，也可以构建有管制的垄断性医疗体制。医疗信息化最终会构建何种医疗体制，关键看其掌握在谁的手中。建议以“预付费方式+医疗信息化”为支点推动有治理的市场化医疗体制构建。

The Comparison and Selection of Fulcrum of Medical System Reform

The medical system reform has three fulcrum,that is medical insurance prepaid method,the basic drug system and medical information.Different reform fulcrum can promote different medical system.Medical insurance prepaid mode can promote the de-centralization and de-administration of medical service system,finally construct the managed marketization of medical service system.The basic drug system can enhance the re-centralization and re-ad-ministration of medical service system,finally construct the controlled monopoly of medical service system.Medical information can construct managed marketization of medical service system,also can build the controlled monopoly of medical service system.This study proposed to build the medical system based on managed market with the help of the prepaid method and the medical information,providing a theoretical reference for the reform of the medical sys-tem.