医改经济学人课件

Health-careReform

Heroesdaretocross（excerpt）医疗改革英雄敢渡津20091978年，市场体制改革，看病费用也水涨船高了。病人的自付费用占医疗总开支费用的比例从78年的20%攀升至2001年的60%。而原先承担大部分开支的国有企业，经济实力每况愈下。2000的时候，世界卫生组织列举了191个国家医疗支出公平性的排名，中国位列倒数第四。医疗成为了中国最为严峻的问题。政府的介入使得医患自费的比重逐渐下降，但此次政府会采取更多的措施加速医疗体制的大规模变革。Medicaluserfee看病费用Theshareoftotalhealthspendingbornebypatients病人的自付费用rosefrom20%in1978tonearly60%in2001.Crumble衰落崩溃每况日下WorldHealthOrganization世界卫生组织fairnessoffinancialcontributionstoitshealthsystemRankChinafourthfromthelast中国位列倒数第四改革真正开始于2009，政府承诺在未来的三年内拨款1200亿用于医改。这些钱已被投入社区医疗中心的建设和相关医生的工作培训上，同时还让超过1.72亿的居民参加了医保补贴计划。截止2011年底，95%的公民都已参保，而在2003年只有不足1/3人参。Inearnest真正地Withapledgeto承诺120billionPourinto投入Newcommunity-healthcenters社区医疗中心的建设trainingfordoctorstostaffthem相关医生的工作培训Tojoinsubsidizedinsurancescheme医保补贴计划改革的措施对解决了民众对医疗服务不满的根本原因没有太大作用，即医院“以药养医”这一不争的事实。来自北京大学的刘国恩教授谈到，通常医院40%的收入来自药品销售，40~50%来自院内服务，例如诊断测试和治疗，仅有10%是直接来源于政府补助的。hospitalspayfortheirstaffbysellingmedicine.

医院以药养医Diagnostictestsandtreatments

诊断测试和治疗6月25日，卫生部下达指令，要求全国超过2000个县级城市的311家医院试行改革，旨在杜绝医院销售药品。7月，北京友谊医院（前苏联建造并赠予中国，象征友好）就在其列。Told下达指令toexperimentwithreforms试行改革aimedatweaninghospitalsaway逐渐杜绝医院frommedicinesales.Beijing’sFriendshipHospital(builtbytheSovietUnionasacomradelygift)

这样一来，医生们就不会再想给病人开一大堆药，做一大堆测试了，而这些往往都是医疗支出的大头，无论患者有无参保。losetheirincentiveto不再想over-prescribemedicinesandtests过度开药体检cripplingcosts巨大开支Thankyou!!!Reformbeganinearnestin2009withapledgetospendmorethan$120billionoverthreeyears.Fundinghasbeenpouredintonewcommunity-healthcentresandtrainingfordoctorstostaffthem,andhasenabled172mmoreChinesepeopletojoinsubsidisedinsuranceschemes.Bytheendof2011,95%ofcitizenshadsomeformofinsurance,upfromlessthanone-thirdin2003(thougharecentstudyinthe

Lancet,aBritishjournal,foundthatthepercentageofhouseholdssuffering“catastrophic”healthexpensesbarelychangedbetween2003and2011).WhenChina’smarketreformsbeganin1978medicaluserfeessoared.Theshareoftotalhealthspendingbornebypatientsrosefrom20%in1978tonearly60%in2001.State-ownedenterprises,whichhadonceshoulderedmuchoftheburden,crumbled,andin2000theWorldHealthOrganisationrankedChinafourthfromlastamong191countriesintermsofthefairnessoffinancialcontributionstoitshealthsystem.Healthcarebecameoneofthecountry’smostexplosivesocialissues(see

article).Theshareofpatientspendinghassincefallenasthegovernmentbegantoaddresstheproblem(seechart)butthelatestreformmeasuresarepartofanaccelerateddrivetooverhaulthesystem.Thesemeasureshavedonelittletosolveafundamentalcauseofpublicdissatisfactionwiththehealthservice:thefactthathospitalspayfortheirstaffbysellingmedicine.GordonLiuofPekingUniversitysaysabout40%ofhospitalrevenuestypicallycomefromsuchsales,withanother40-50%fromservicessuchasdiagnostictestsandtreatments.Lessthan10%comesdirectlyfromthegovernment.OnJune25ththeMinistryofHealthtold311ofthemorethan2,000countiesinChinatoexperimentwithreformsaimedatweaninghospitalsawayfrommedicinesales.Thismonththeywerejoinedbyasprinklingoflargercityhospitals,includingBeijing’sFriendshipHospital(builtbytheSovietUnionasacomradelygift)andallthepublichospitalsinthesoutherncityofShenzhen.Xinhua,astate-runnewsagency,saidthesehospitalshadembarkedon“theboldestandhardestpart”ofChina’smedicaloverhaul.BannersandnoticesintheFriendshipHospital’sfoyerproclaimthechanges:nomoremark-upsonmedicineprices(hospitalsarenormallyallowedtoaddupto15%)orchargesfordiagnosis,andnomoreregistrationfees.Instead,anewfeehasbeenintroducedfor“medicalservice”.Thisisastrikinginnovation.China’sdoctorsareusuallypaidjustafewhundreddollarsamonth,apittanceincomparisonwiththeirWesterncounterpartsandwithprivate-sectorprofessionalsinChina.InmostChinesehospitals,theirshareofprofitsfromthesaleofmedicinesissupposedtomakeupforthis.AttheFriendshipHospital,thenewfeeismeanttoplugthisgap.Patientscanchoosebetweendifferenttypesofdoctor,fromavisittoan“ordinary”oneat42yuan($6.60)toaconsultationwitha“famousspecialist”,costing100yuan.Theideaisthatdoctorswilllosetheirincentivetoover-prescribemedicinesandtests,whichhasledtocripplingcostsforChinesepatients,whetherornottheyhaveinsurance.(In2010thoseinsuredstillhadtobear60-70%oftheiroutpatientcostsandmorethanhalfoftheirexpenditureforinpatienttreatment,accordingtoanotherrecentstudyinthe

Lancet.)TheFriendshipHospital’spricelistnotesthatinsurancewillcoverupto40yuanofthenewmedicalservicefee,meaninganout-of-pocketpaymentofjust2yuanforaconsultationwithan“ordinary”doctor.Atthehospitalpharmacy,alistoftheoldandnewpricesofmedicinesscrollsendlesslyonahugedigitaldisplay,likeastockmarketupdate:ceftriaxone(anantibiotic)at57.13yuan,downfrom65.69;Hirudoidcream(forbruising),downto27.41from31.52.Butsomepatientsaresceptical.A65-year-oldwomansaysthatlastyearshehadtopay10,000yuan($1,570)ofherownmoneyfortreatmentofhervariousailments,eventhoughsheisinsured.Thatamountedtofivemonths’pensionpayments.Sheworriesthatthenewsystemwillbenocheaper.Hercomplicatedconditionswillrequiremorethanjustordinarydoctorsandshewillneedtoseeseveraldifferentspecialists.Shesaysthepharmacydoesnotalwayshavethemedicinessheneeds,forcinghertouseothersthatarenotonthelistofdrugsforwhichthegovernmentoffersreimbursement.Officialmediasaythecutinthepriceofmedicineswillcostthehospitalabout2myuaninlostrevenuethisyear.Thegovernment,theyadd,haspromisedtohelpcoverthis.Butmanyexpertsbelievethatdoctorsandhospitaladministratorswillhavemisgivingsaboutthereforms.Doctorsrisklosingnotonlythedirectbenefitstheyreceivefrommedicinesales,butalsothekickbackstheyreceivefrommedicinecompanieswhentheystocktheirproductsandprescribethem.MrLiuofPekingUniversityreckonsthis“greyincome”canamounttomuchmorethandoctors’officialsalariesorwhattheyreceivefromthemark-uponmedicinesales.Becauseitisunderthetable,officialsstruggletofactoritintotheirreforms.Yettheyarereluctanttoboostdoctors’salaries,notleastbecausetheyworrythatmanyothersonthegovernmentpayrollwouldimmediatelydemandpayrisestoo.CrossingtheriverbyfeelingthestonesVariousexperimentswith

yiyaofenkai,or“hospitalandmedicineseparation”,atlower-levelhospitalshaveprovidedlittleencouragement.AstudylastyearbygovernmentresearchersinHebei,theprovincesurroundingBeijing,foundthathospitalmanagerswereafraidthatlocalgovernmentswouldnotmakeupforthelossofrevenuefrommedicinesandthathospitalswouldfinditincreasinglyhardtocovertheiroperatingcosts.“Expressionsofsupportforreforminpublichospitalsarecoldandcheerless,”thereportsaid.Withoutclearerguaranteesoffinancialsupportfromthegovernm