市场化取向的中国的医疗卫生体制改革基本上是不成功的,既不公平又效率低下,医院、患者、政府三方都不满意。造成目前这种尴尬局面的原因主要有两点:其一,政府对经济增长和市场过于迷信,“发展是硬道理”被理解成经济增长是硬道理,似乎只要“把蛋糕做大,”其他的一切问题包括医疗卫生体制改革就迎刃而解了。市场被看成是包医百病的灵药,市场可以提高资源配置的效率,包括医疗卫生资源。因此,选择了一条市场化的改革路径;其二,政府在医疗卫生领域的职能定位发生了偏差,没有负起该负的提供医疗卫生公共物品的责任。事实上,医疗卫生作为一种混合公共物品,是政府与市场双“失灵”的领域。要想从根本上扭转医改“夹生饭”的状况,就必须充分发挥医学协会的作用,政府、市场、行业协会三者共同“治理”医疗卫生改革,才可能达到“善治”的结果。 Market-oriented medical and health care system reform in China is basically unsuccessful. It is neither fair nor inefficient, and hospitals, patients and governments are not satisfied with it. There are two main reasons for this embarrassing situation. First, the government is overly superstitious about economic growth and the market. “Development is the last word.” It is understood that economic growth is the last word. It seems that as long as “the cake is bigger,” the other All the problems, including the reform of the medical and health system, have been solved. The market is seen as a cure for the ill, and the market can improve the efficiency of resource allocation, including health care resources. Therefore, a market-oriented reform path has been chosen. Second, the government has deviated its functional orientation in the medical and health field and has failed to shoulder its responsibility to provide public health and medical public goods. In fact, as a mixture of public goods, health care is a double “failure” area between the government and the market. If we want to fundamentally reverse the state of medical reform, we must give full play to the role of the Medical Association. Only when the government, the market and the trade associations collectively “govern” medical and health care reform can we achieve the result of “good governance.”