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1、背景知识�当2005年7月，国务院发EconomicsofthePublicSector展研究中心社会发展研究lectureNo.9部副部长葛延风在接受《中国青年报》记者采访时ChongjinWang公开表示“目前中国的医疗Email:wangchjin@126.com卫生体制改革基本上是不成功的”引起了轩然大波。背景知识Theanalysisofexpenditurepolicy�一种观点：“问题的根源在于商业化、市场�Thischapterprovidesaframeworkforthinking化的走向违背了
2、医疗卫生事业发展的基本规systematicallyaboutexpenditurespolicies,律。”suchashealthcare,educationsystems,social�另一种观点：“看病难”、“看病贵”归罪于“市security,andsoon.场化”。�我们应该如何分析？(1)theneedforaprogramSocialsecurityprogramintheU.S.�ItisoftenusefultobegintheanalysisofFewemployersprovidedadeq
3、uatepensionsforapublicprogrambyinvestigatingthetheiremployees,andtheprivatemarketforannuitieswasundeveloped.program’shistoryandthecircumstancesunderwhichitarose.Manyindividualshadfailedtosaveadequatelyfortheirretirement,andmanywhohadsaved�Whoweretheindividuals
4、orgroupswhoBackgroundhadfoundtheirsavingswipedout[摧毁]bypressedforitspassage,andwhatwerethestockmarketcrashin1929.theperceivedneedsthatitsupposedlyThefailuretohaveadequatesavingswasnotaddressed?asirrationalandimprovidentasitappearstoustoday;inthosedays,manyindi
5、vidualscontinuedtoworkuntiltheydied.CaseinChina：我国医疗卫生体制改SocialsecurityprogramintheU.S.革的必要性Theyneededlifeinsurancetolookaftertheir�医疗卫生领域现状：不是某一部分人不满意familyaftertheirdemise[死亡],butnot�从1990年到2004年，全国综合医院的门诊费用pensionsforthemselves.上涨了大约11倍、住院费用上涨了约9倍，而Butinthe
6、GreatDepression,manyofthose同期城乡民众的收入仅仅上涨了大约6倍和4倍individualslosttheirjobsandhadno多。unemploymentinsurance.�造成医疗费用快速上涨的一个主要原因，或者说为人们所诟病的主要因素，在于医疗服务提Itwaswidelyfeltthatsocietyhadtomake供者常常对患者进行重复检查、不必要的检查、provisionforthemandthatitwaspreferableto开大处方等，也就是医疗政策或卫生经济学
7、文dosoonasystematicbasisratherthanjustto献中概称的“供方诱导的过度消费”。solvetheimmediateproblemsofthetime.Step2:Marketfailureswhydoesgovernmentintervene?�Thesecondstepintheanalysisofpublic�Marketfailures:imperfectcompetition,publicprogramsistoattempttorelatetheneed,thegoods,
8、externalities,incompletemarkets,andsourceofdemand,tooneormoreoftheimperfectinformation.marketfailures.�Inaddition,eveniftheeconomyisParetoefficient,therearetwofurtherargumentsforgo
