【作者】 罗丹；

【导师】 夏志强；

【作者基本信息】 四川大学 ， 行政管理， 2007， 硕士

【摘要】 随着我国政治、经济和社会的发展与进步，医疗卫生事业的改革与发展同国家宏观经济体制改革和社会发展的关系更加密切，它已成为完善社会主义市场经济体制和全面建设小康社会的重要组成部分。在近30年的医疗体制改革中，我们取得了一定的成绩，同时也突显出一些问题和矛盾，政府在医疗体制中究竟应担任何种角色承担何种责任，这是本文要探讨的重点。本文通过对我国医疗体制改革的演进状况、现状及价值取向的分析，对比国内外不同的医疗体制改革的模式，期望对医疗体制改革中的政府职责进行探讨，最终得出在医疗体制改革中，政府的职责主要有以下几个方面：1、政府充当保险者，建立普遍覆盖的医疗保障体制。无论政府是选择公费医疗模式还是选择继续扮演保险者的角色，都应在现有社会医疗保险的制度框架下进行渐进式的改革，在满足全体国民现有医疗服务需求的水平上实现医疗保障的普遍覆盖。2、政府充当购买者，约束医疗服务的费用上涨。当人们把医疗费用预付给医疗保障机构之后，医疗保障机构就可以以集体的力量，成为医疗服务市场上具有强大谈判能力的购买者，从而可以确保医疗服务的质量与价格相匹配。3、政府充当规划者，建立健全医疗卫生服务体系。在我国医疗服务递送体系的改革上，政府应该充分规划好有限的卫生资源，通过制度建设和政策安排引导医疗体制改革朝向良好正确的方向发展。4、政府充当监管者，抑制医疗服务中的市场失灵。政府的监管范围一般包括：对医疗服务市场进入和退出的控制、对竞争行为的控制、对市场组织的控制、对从业人员待遇的控制、对医疗服务数量的控制、对医疗服务标准和质量的控制，以及对医疗服务安全性的控制。缓解医疗领域中社会矛盾尖锐的根本出路在于深化改革，尤其是政府改革，坚持政府主导与引入市场机制相结合的改革路径，在强化政府公共卫生服务和基本医疗服务责任的同时，逐步开放医疗服务领域，提供市场机会与市场竞争机制，实现垄断性医疗市场向竞争性医疗市场转变，形成医疗服务的买方市场，促使医疗服务的供给者节约成本、改善质量和提高效率：同时使政府从“管”、“办”不分中摆脱出来，强化服务质量监管职能，从而建立起有序的医疗市场规制，以创造一个有效率、有管理的医疗服务市场。更多还原

【Abstract】 Along with the political, economic and social development and advancement in China, the reform and development of medical and health undertakings has stepped into a closer relationship with the reform of national macroeconomic system and the social development, and therefore has become an important role in improving the socialist market economy and building a well-off society in an all-round way. While we have made certain achievements in the thirty-year long medical system reform, some problems and discrepancies have occurred. What kind of role the government should take in the medical system becomes the focus of this thesis.Through the analysis of the evolutionary progression, present status and value orientation of medical system reform, the contrast of the different modes of medical system reform home and abroad, and the discussion on the governmental responsibilities in medical system reform, this thesis comes to the conclusion that governmental responsibilities shall include the followings:1. The government should act as an insurer and establish a medical insurance system with universal coverage. Whether the government intends to adopt the free medical service mode or act as an insurer, it should carry out a gradual reform within the framework of current social medical insurance system, realizing the universal coverage of medical insurance while meeting the current need of all the citizens for medical care. 2. The government should act as a purchaser who should curb the increase of medical service fees. Taking the advantage of the collective use of medical insurance premium, the medical insurance institutions become powerful purchasers with strong negotiating capability in the medical service market and are able to ensure the match between the quality and price of medical service3. The government should serve as the planner, to establish and improve medical and health service system. In the reform of medical service delivering system, the government should make a cautious plan over the use of limited hygiene resources, and guide the medical system reform to move towards a correct and promising direction.4. The government should act as the supervisor to make up the malfunction of the market in medical service. Generally, the supervising scope of the government includes the control on: market access and withdraw, competing behavior, market organizing, the treatment to employees, and the quantity of medical service, the standard and quality of medical service, and the safeness of medical service.The ultimate solution to the problems in medical care lies in deepening the reform, especially the reform of the government. Sticking to reform way of combining the government’s leading role and the introduction of market mechanism, we shall strengthen the government’s responsibilities in public hygiene service and basic medical service while gradually open medical service sector by providing market opportunity, establishing market competing mechanism and realizing the transition from a monopolized medical treatment market to a competing medical treatment market. Thus, the buyer’s market in medical service shall take shape, which will urge suppliers of medical service to reduce cost, improve quality and efficiency. In the meanwhile, the reform will help to free the government of mixing role of "supervising" and "running" at the same time to the effect that its supervising function in service quality is intensified and ultimately an ordered medical service system shall be established and an efficient and well-managed medical service market shall be created.更多还原