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为什么中国医疗远比美国便宜,门急诊和住院预约时间很短,中国社会还普遍觉得看病难看病贵?

看上去这是个很老的话题了,我在沃顿的时候主要研究的是美国和世界医疗体系和医疗政策,就从结构性区别来谈谈。在这之前,我们首先要明确的,医疗体系没有对不对,只有博弈到达的局部稳定点,至于全局最优解,所有人都在研究,没有人有头绪。

    ​    ​医疗系统中最主要的是患者、医疗服务者、支付方,在美国支付方主要为商保,其次是社保,中国的支付方主要是社保和患者自费。美国的患者自费部分 (Co-pay) 原初的设计目的是限制患者过量使用医疗服务,浪费医疗资源。

    ​    ​理论上,抛去保险费的购买,美国的医疗的患者自费部分一定比中国便宜,但为什么事实又并非如此。

    ​    ​首先,因为中国离谱的便宜。

    ​    ​中国的国情决定中国的医疗机构公立机构为主力,早年中国的医疗资源都很落后,国有化统一调控比较合理,先解决资源可获得性问题,能让大部分人看得上病,随着改革开放,为了社会稳定,医疗也不敢随意市场化价格,哪怕最不值钱的那一部分尝试市场化的结果就是现在的莆田系,然后医保改革之后,医保由于人社局决策和拨付脱节,基本不控费裸奔, 资金穿底,更不敢提高支付给医疗的价格,同时也没有胆量提高患者自付部分给医疗涨价,毕竟患者人更多,还不是体制内的,无法管理,患者普遍不满会影响社会稳定和个人仕途,所以只能拿体制内的开刀。

    ​    ​同时,中国人普遍又不愿意为未知的需求买保险的,才有了理财型保险,疾病险要生了病才买,除了车险是强制的,否则也不会有多少人买车险,这种保险的观念的转化需要很长时间,所以短期内,缺乏商业保险支持的患者自费能力也是不足的。

    ​    ​这时候就不难理解为什么国内宣传的是医生护士的奉献精神,而不是像美国一样宣传的是有知识有地位高收入的精英群体,因为你们道德高,所以既要拼命工作满足门急诊需求,也不能对多要工资,不然就太俗气了。

    ​    ​同时,中国过往医生培训成本低,国内老一代医生大半是高中到大专学历,极少部分才是符合美国医生要求的博士级别的培训,学医入学和毕业门槛都不高, 平均收入不高也能接受。但是,随着医学教育的正规化,新一代医生就有了提高待遇的呼吁。

    ​    ​目前挂号费的上涨、北京医事服务费的引入、医生多点执业、医生集团被医生追捧等预示着中国当前的低价医疗体系也正在崩溃。

    ​    ​其次,美国价格体系在失控。

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