Cracking the Structural Contradictions in China's Health Care Sector

　　Author: Yang
Zheng, Institute of Sociology, Tianjin Academy of Social Sciences, is one of the most important livelihood problems in China at present, and the structural contradictions in the field of medical
and health care in China are concentrated in the problem of difficult y The problem of difficult yelling involves the supply of medical and health resources, while the problem of expensive medical care is closely related to the price of medical and health products and services.　　The imbalance of medical and health resources and service allocation aggravates the difficulty of seeing a doctor In fact, the problem of difficult to see a doctor is manifested not only as absolute, but also as a relative difficulty of seeing a doctor Absolute medical difficulties are caused by absolute shortage of medical resources, which is characterized by "lack of medical care and medicine" With the continuous development of China's medical and health services, the problem of absolute medical difficulties has been basically solved, but the problem of relative difficulty in seeing a doctor still exists, especially in cities People in the city's large hospitals often appear "three long one short" phenomenon, that is, the queue registration, payment and take medicine for a long time, doctor consultation and examination time is short "Registering five more, queuing one dragon", this is the current Chinese people difficult to see a real picture.　　It is difficult for medical and health resources and service supply to meet the growing demand of the people for medical and health care, which is the basic contradiction facing the development of medical and health services in our country The shortage of absolute supply of medical and health resources is the basic reason why people are difficult to see a doctor Our country, with 20 per cent of the world's population, accounts for only 3 per cent of the world's total cost of health At the same time, imbalances in the allocation of health resources and services at the regional and inter-agency levels have also contributed to the problem of difficultaccess to medical care to some extent From the regional and spatial structure, the medical and health resources are mainly concentrated in the eastern region, the western region is relatively scarce, the urban medical and health resources are relatively concentrated, and the medical and health resources in rural areas are relatively scarce Judging from the allocation of resources among health institutions, the allocation of health resources at all levels of health institutions is also uneven The imbalance of medical and health resources in inter-agency allocation, resulting in a situation, that is, the more medical and health resources concentrated medical institutions, the more the people are flocking to, so that medical and health resources become more scarce;　　"Drug-based medicine" leads to expensive medical care problem sq This problem is more important than the difficulty of seeing a doctor Although the state has repeatedly lowered drug prices, but some enterprises to change the name, change packaging, change to the proportion, re-approval and other measures to avoid price reduction constraints, so that the people in fact did not fully enjoy the country's reduction of the price of essential drugs brought about by the benefits At the same time, due to the public welfare of public hospitals gradually fade, formed a "drug-based medicine" model, driven by economic interests, some hospitals ignore the application of basic drugs and appropriate technology, through large prescriptions, repeated examinations, over-examination and other increased fees These improper medical behavior directly lead to the medical costs increased significantly, personal health care costs are overburdened In addition, the high cost of medical care is also related to the low proportion of basic medical insurance for urban residents and the reimbursement of new farmers' association, and the still high proportion of individual out-of-pocket expenses.　　It can be seen that the problem of expensive medical care is mainly caused by the supply price of medical products and services exceeds the ability of ordinary people to pay This problem is related to the price of supply of health products and services, but also to the ability of ordinary people to pay Accordingly, the problem of expensive medical treatment is also manifested in absolute cost of seeing a doctor and a relatively expensive doctor Absolute medical expensive and medical supply price related, relative lying expensive and medical expenses sharing structure Among them, the price of drugs depends on the drug pricing standard, circulation link cost and hospital fee policy, and the cost of medical services depends on the medical treatment behavior, charging standard and charging mode adopted by the hospital.　　The unreasonable structure of medical and health expense burden is the main reason for the high cost of medical care In our country, the proportion of individual burden in the structure of medical expenses is too high, which is the key to the cost of relative care Therefore, the medical security system is of great significance to reduce the burden of individual medical expenses Although the total amount of china's health expenditure has increased in recent years, compared with the speed, level and scale of China's economic development, the increase is not considerable The author believes that to solve the problem of expensive medical care for ordinary people, we should not only completely eliminate the situation of inflated drug prices, excessive medical treatment and medical treatment from the medical production, circulation and use links, and reduce the absolute supply price of medical products and services, but also by changing the burden and payment structure of medical and health expenses, increase the government's medical and health input and social health expenditure, reduce the proportion of personal health care burden, and then reduce the relative supply price of medical and health products and services.　　To promote the transfer of high-quality medical resources to primary medical institutions As mentioned above, the structural contradictions in China's medical and health care fields include both static structural contradictions caused by the imbalance of medical and health resources and factor allocation, but also the dynamic structural contradictions formed by the interaction and integration between medical supply and demand side Therefore, in order to solve the problem of difficult and expensive medical treatment, we must resolve the structural contradictions in the field of medical and health care.　　First, the structural adjustment of medical and health resources In particular, the stock of medical and health resources should be restructured to change its allocation imbalance status quo We will make full use of market forces and policy tools to encourage, guide and promote the transfer of some quality medical resources from large public hospitals to primary and medium-sized hospitals and primary health care institutions In this way, it can not only solve the problem of overcrowding and overload operation of large public hospitals, but also solve the problem of shortage of funds and talents in primary medical institutions, and solve the contradiction that the resources of large public hospitals are more concentrated and more scarce, and also solve the paradox that the more scarce the resources of primary medical institutions are more and more wasted In addition, selective investment spending should be made on incremental health resources In terms of the amount of China's existing economy, the government's economic support for health care has room for further improvement both in size and volume, but the investment in incremental health resources must be selective, such as focusing on incremental medical and health resources into small and medium-sized hospitals and primary health care institutions.　　Second, actively explore a more reasonable mode of medical treatment In view of the uneven allocation of medical and health resources between regions in China, the existing mode of medical treatment can be maintained in areas with concentrated population, convenient transportation and facilities In rural areas where people are sparsely populated, transportation is inconvenient, facilities and equipment are scarce, the cost of asking for medical treatment is relatively high, and it is necessary to change the existing medical treatment model It may be more reasonable to find patients through doctors and adopt a home-based approach to medical care As far as the city is concerned, large hospitals can be implemented to see major diseases and small hospitals to see minor diseases Large public hospitals can maintain the existing model of medical treatment, while community health institutions should actively explore new models of medical treatment, such as the community general practitioner system and the family doctor system in primary care institutions.　　Finally, build a better health care system Health is the basic needs of people, and medical and health needs are the basic needs of the people The medical security system should not only strive to achieve full coverage, basic and multi-level, but also enhance the fairness and sustainability of the medical security system At present, China's medical and health financing channels are mainly government, society and individuals Under the condition that the total fund-raising scale is relatively stable, the increase of the proportion of government input will bring about a fundamental change in the structure of health financing In other words, the government's budget for health expenditure as a proportion of total health expenditure has increased, health-based social health expenditure will also increase, and the proportion of individual cash health expenditure will be significantly reduced (Responsible Editor: Wang Jinbao)