衛生保健體制改革: 理性與現實的選擇

Health Care Reform: Practical and Reasonable Choices

Abstract

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

衛生保健制度改革之艱難，主要在於要在諸多因素發展勢頭的相互硑撞中維持衛生保健工作的良性發展。衛生保健改革目標的設定，應當着眼於現實，但又必須顧及長遠。為此，它應當是首先有利於為更多的人群提供最基本的保健服務，同時又 能有力地控制保健費用的增長，有利於控制疾病的發生。只着眼於開源或節流，或者只強調衛生服務組織自身的營運，都可能使衛生保健產生更多的麻煩。多方位的雙層或多層的體制是使衞生保健工作適應各方需要的理想構思，它包含多種雙層或多種多層的內涵。在衛生資源有限的情況下，配給是保證為更多的人群提供保健的有效措施，救援則是其重要的補充。現行的醫療服務體系與為最廣大的人群提供基本的醫療保健服務不適應，也與抑制醫療費用上漲的要求不適應，必需有較大力度的改革。衛生保健改革的選擇，必須是道德的，同時又是理性而現實的。

Health care costs soar and become unbearable everywhere in the world. This is not only a problem faced by developed Western countries. It is also a difficult issue for the third world countries such as China. China's health care system needs reform. On the one hand, a great number of people have not been covered by any basic health insurance. On the other hand, however, critical care medicine in high-technology hospitals in urban areas consumes tremendous public health care resources for a very small group of patients. This essay argues that China should appropriately establish multiple goals for its health care reform, based on ethical and reasonable deliberations on China's actual health care situation.

First, rationing is crucial in containing health care costs. Public health care resources are limited. It is impossible to satisfy all medical needs for all people at all times. This is especially the case for mainland China, where public resources that can be invested in medical care are scarce. An appropriate goal of China's health care reform should be to provide basic, not luxury, health care for the people. Some luxury medical procedures must be left to individuals for purchase through their own resources.

Second, a basic level of health care must be ensured to most people, even if it is impossible to ensure to everyone. It is important for everyone to understand that providing the best care for everyone is practically impossible. The best a government can do is to provide some level of basic care. However, the goal here must be the basic health of all or most people, rather than total care for a small group of people.

Third, an appropriate pattern of China's health care should be prevention-oriented and ordinary-treatment-oriented, rather than high-technology-medicine-oriented. Since the early 1980s, many hospitals have relied on high-technology medicine to deal with diseases and to earn more income for themselves at the same time. But high-technology medicine is not panacea, though it is extremely costly. Inexpensive medical prevention is often more effective than high-technology medical procedures.

Finally, a rule of rescue should be established in society. Society ought to provide some help for those who need special expensive medical care (such as organ transplantation) and are not able to afford it. The rule of rescue guides our efforts in this direction. Society should organize and establish special foundations to help people in this regard.

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