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近年来,老百姓普遍感觉到“看病难、看病贵”。据卫生部门统计,2008年门诊病人平均医药费用为146.5元/人次,住院病人平均医药费用为5463.8元/人次。同时,由于缺乏风险分担机制,大量的医疗费用需要个人直接支付。在卫生总费用中,个人支出由1980年的21.2%上升到2000年的59%。此后由于政府加大了预算投入以及医疗保障体系的完善,个人支出的比例虽有所降低,但这一比例仍然高达45.2%。自费医疗不但缺乏公平性,而且抗风险能力弱,使得许多人生病时面临费用障碍,也使得人们收入的不平等转化为获得医疗服务的不平等。正是在这样的背景下,国家加快了医药卫生体制改革的步伐,并最终公布了《中共中央国务院关于深化医药卫生体制改革的意见》(以下简称《意见》)以及《医药卫生体制改革近期重点实施方案(2009～2011年)》(以下简称《实施方案》),全面启动了新一轮的改革。
In recent years, people have generally felt that “it is difficult to see a doctor and expensive to see a doctor.” According to the statistics of the health department, the average medical expenses for outpatients in 2008 was 146.5 yuan per person, and the average medical expenses for inpatients was 5463.8 yuan per person. At the same time, due to the lack of risk-sharing mechanisms, large amounts of medical expenses need to be paid directly by individuals. In the total health expenditure, personal expenditure rose from 21.2% in 1980 to 59% in 2000. Since then, the government has increased the budget input and the improvement of the medical security system. Although the proportion of personal expenditure has been reduced, this proportion is still as high as 45.2%. Self-financed medical care not only lacks fairness, but also has weak anti-risk capability, which makes many people face cost barriers when they are ill, and it also makes people’s income inequalities translate into unequal access to medical services. It is against this background that the country has accelerated the pace of reforms in the medical and health system and finally announced the “Opinions of the Central Committee of the Communist Party of China on Deepening the Reform of the Medical and Health Care System” (hereinafter referred to as “Opinions”) and the recent focus of the reform of the medical and health system. The Implementation Plan (2009-2011) (hereinafter referred to as the “Implementation Plan”) fully initiated a new round of reforms.