The difficulty and ease of medical reform

Supply side reform is prone to failure In August 2003, the shadow of SARS has not completely disappeared In the context of the whole country's painstaking reflection on the loopholes in the public health system, the Ministry of health sent several officials to Suqian, Jiangsu Province, which was then known as "all public hospitals have been sold out" In the survey, it was confirmed that 134 of the 135 public hospitals in the city have been transformed into joint-stock, mixed ownership, sole proprietorship and other types of medical institutions through property right replacement, realizing the public ownership and private ownership A leader of the Ministry of health was in a hurry on the spot, turning to ask Ge Zhijian, director of Suqian Health Bureau: "are you still a health director?" This is a classic question that can be recorded in the history of China's medical reform It not only represents the intensity of the debate about "market leading" and "government leading" in the first stage of medical reform, but also brings out the relationship between the government departments and medical reform The latter is the most important rope that affects the difficult and easy changes of China's health reform The medical reform is divided into two parts with 2009 as the boundary There is just one part of the two parts which is relatively fast and easy In the first stage, the fastest and most effective reform is the "decentralization and invigoration" of hospitals In fact, this idea has been basically determined since 1979 On New Year's day of this year, Qian Xinzhong, then Minister of health, told Xinhua news agency that the health sector should also act according to economic laws This has brought unprecedented development to the medical and health system According to the report of Southern Weekend reviewing the history of China's medical reform, the number of medical institutions in China has increased rapidly from 180000 in 1980 to 320000 in 2000, but it has also planted seeds of chaos One of the background of the chaos is the shrinking of national financial investment in health after decentralization According to the statistics of the Research Center for health development of the health and Family Planning Commission, the proportion of government health expenditure to GDP was 1.2% in 1985, 1.0% in 1990, 0.6% in 1995 The proportion of government health investment to total health expenditure was over 38% in 1985, and it had dropped to less than 18% by 1995 Suqian, which mentioned at the beginning, sold all the public hospitals, is a poor place in itself Before selling the public hospitals, Suqian's per capita health assets and thousands of health technicians were the last in Jiangsu Province The asset liability ratio of township hospitals in the city was more than 48% The total value of equipment above 10000 yuan was only 18.686 million yuan, and only 3 of the township hospitals' on-the-job employees had bachelor's degree 4 people, accounting for 0.6% of the total number of employees Accompanied by chaos, there is also an increase in the medical burden of the people According to the statistics of the Research Center for health development of the health and Family Planning Commission, the proportion of personal health expenditure in the total health expenditure increased year by year from 21% in 1980 to nearly 59% in 2000 The health reform is vigorous, but the burden is more and more heavy Obviously, under the background of aging and the number of working population is about to decline, the insurance premium financing of medical insurance fund will become more and more difficult If it is not adjusted in time, it means that the security of medical insurance will be in trouble Similarly, as early as 2013, Caijing magazine made special reports on the reform of medical insurance for several consecutive issues within half a year In the article "medical insurance besieged city", a medical insurance agency official was quoted as saying that China's medical insurance system had been adjusted: "under the principle of" revenue and expenditure ", there is a great pressure to ensure the safety of medical insurance funds." At this time, the two municipalities directly under the central government, Beijing and Shanghai, have felt the huge pressure of medical insurance balance According to Caijing, before 2010, the balance of Beijing's medical insurance fund had been maintained at the scale of "6-9 months of operation" By 2011, the fund balance had fallen sharply to "only four months of operation" The measures Beijing is considering to take are very similar to the actions taken by the state health insurance bureau today to attack individual accounts According to the news report at that time, from the end of 2012, Beijing human resources and social security department began to study and adjust the background deposit proportion of individual accounts, so as to narrow individual accounts, support the unified account and relieve the payment pressure And Shanghai's approach is more direct: in 2010, the balance of medical insurance fund for urban employees in Shanghai was reduced to less than 3 billion, less than the 10% pointed out in that year, and the risk of wearing the bottom has roared Therefore, since 2011, Shanghai has officially combined the comprehensive medical insurance fund for migrant employees with the local urban employee medical insurance fund Due to the younger age structure of the migrant workers, there are still a large number of returning home after they are older The accumulated balance of the comprehensive medical insurance fund for the migrant workers is considerable After being transferred into a plate with the urban employees' medical insurance fund, the balance of the Shanghai Medical Insurance Fund was raised to nearly 30 billion yuan at the end of the year, which gives Shanghai a chance to breathe Obviously, mobilizing the "sleeping" fund in the medical insurance account is the most direct step to enrich the medical insurance co-ordination fund At present, canceling the individual medical insurance account is only the first step of the reform of "payment method" in the goal of medical reform, and there is the more difficult bone of the reform of medical service supply end.