2007年下半年,中国开始了新一轮的医疗体制改革,其标志是城镇居民基本医疗保险的试点在全国范围内展开。由此,一个由城镇职工医疗保险、城镇居民医疗保险和农村新型合作医疗组成的三层次公立医疗保障体系开始形成,并且走向普遍覆盖。在全民医保起步的同时,医疗服务体系却在回归计划体制。通过对公立医疗机构实施“收支两条线”管理,医疗器械的政府集中采购和基本药品的统购统销,以及维持原来对管理人员的任命权,各地卫生行政部门试图全面恢复对下属机构人财物的行政控制。中国的新医改,究竟是回到计划体制时代的行政化体制,还是走向有管理的市场化,依然是未知数。
<<During the second half of 2007,the pilot programs of urban residents’ basic health care insurance have been carried out throughout the country,indicating that China’s new health care reform has taken off. A three-tier public health care insurance system will take shape,and the universal coverage of health care insurance will be achieved over the near future. While China’s health security system moves towards universal coverage,the health care delivery system seems to be back to the planned system. Through intensifying the budgetary control,centralized government procurement of equipments,and planned system of producing and delivering essential drugs,as well as maintaining the power of appointing managerial personnel,health bureaus are attempting to retain comprehensive administrative control over all public health care providers. It is uncertain if China’s new round of health care reform will move towards a planned system or a managed marketization.
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