本篇论文目录导航：
【题目】新医疗改革中的问题与对策探析
【引言】新医疗深化改革的困境研究引言
【第一章】新医改取得的成效
【第二章】新医改进入深水区后遇到的问题
【第三章】国外医药卫生体制模式及对我国新医改的借鉴
【第四章】深化新医改的路径选择
【结论/参考文献】深水区新医改优化探究结论与参考文献
摘 要
卫生医疗发展关系民族健康，影响意义深远。但多年来我国经济建设取得巨大成就，而与每个人都息息相关的卫生医疗事业没有同步提高，不能满足国民需要。2009 年 4月国家出台深化医药卫生体制改革的意见，提出目标，到本世纪 20 年代初建立起涵盖所有居民的基本医疗卫生制度，并且建立相对完善的公共卫生、医疗服务体系，促进办医格局形成，普遍享有基本医疗服务。这标志着新医改正式启动实施。新医改实施几年来，取得了很大成效，然而现在医改已步入深水区，体制机制方面长期积累的深层次矛盾也浮出水面，推进改革的难度越来越大，应对措施也在进行积极探索。在此背景下，本文主要提出了新医改遇到的三个问题：一是公立医院改革问题；二是城镇职工居民医保和新农合统筹问题。三是基本药物实施问题。并有针对性的探讨进一步医改的可能途径。
本文共分为五部分：
第一部分，引言部分，主要介绍的是新医改实施的背景。本部分从医药卫生事业本身的专业性和复杂性着手，分别介绍此前进行过过的三次医改推出时的国家的宏观政治社会环境，并将三次医改的方向、采取的措施以及不尽人意之处一一列举，从而推导出新医改出台的必要性。
第二部分，新医改取得的成效。通过列举一些具体数据，得出新医改实施几年来的成果，即初步建立了覆盖全民的医保体系，提高了城乡居民基本医疗水平，减轻了群众因病返贫的问题。在基层医疗卫生机构实施了基本药物零差率销售，减轻了患者的就医用药负担。实施的公共卫生服务信息化建设，建立起个人就医的电子病例档案。在农村筑牢县、乡、村三级就医服务网络，在城市加强了社区卫生服务中心建设，提高了就医看病的便利性，最大程度的满足了患者的就医需求。
第三部分，新医改遇到的问题，这是本文的重点内容。通过列举调研走访中遇到的医改难题，查找问题的普遍性，并进一步分析原因，找出问题背后的实质困难，归纳出几个方面的问题脉络。即涉及到以前医改过分市场化造成的部分问题，而这些都是有惯性的，当今部分改革举步维艰一定程度上有这个方面原因，比如公立医院改革遇到的逐利性明显，而公益性不足问题；也有需要更多更深层次改革支撑的问题，比如国家财税体事权不对等，财权集中于中央政府，而具体工作的执行依靠基层政府，造成基层医疗卫生资源配置不合理问题等等。
第四部分，国外医疗保障的基本情况以及可借鉴性分析。主要介绍了以英国为代表的国家健康保险模式、以德国为代表的社会健康保险模式、美国为代表的商业健康保险模式和以新加坡为代表的储蓄保险模式，通过重点介绍几种模式的运营理念、管理结构以及支付方式等，提出对我国当前医改难题的可借鉴性分析。
第五部分，继续深入推进医改工作的可能途径分析。主要对应的是公立医院改革问题，城镇职工、城镇居民和新农合三种保险形式的不统一问题，以及基本药物制度的完善问题。这三个问题是下一步深入推进医改的重点问题，探讨三个问题的解决方式具有非常重要的现实意义，希望借此对继续深化医改工作有所借鉴。
关键词：新医改 路径 探讨
Abstract
The development of medical and health influence the national health. However it can'tkeep pace with the growth of the economic development in recent years. The care developcan't meet the needs' of national. In 2009 April years, the state promulgated the opinions ondeepening the medical and health system reform, the goal is to establish a basic medical andhealth system covering all peoples in the 2020s, and to establish a relatively perfect publichealth, medical service system, the universal have access to medical services. This marks theofficial launch of the implementation of the new care reform. The new care reform has madegreat achievements in recent years, but the reform has entered into the deep water area as thedeep-seated contradictions in system and mechanism of long-term accumulation appeared. thereform become more difficult, the relevant departments actively explore possible ways. Underthis background, this paper mainly presents three problems in the new care reform, first, thereform of public hospitals. two, urban people and the new rural cooperative medical insuranceplanning. Three, implementing the basic drug. And some measures are given to resolve theproblem accordingly. This paper is divided into five parts.
The introduction part mainly introduced a new medical reform background, from thepoint of the specialization and complexity of the medical and health itself to introduce thethree reforms had been launched, due to the national macro political and social environment,the directions and measures and unsatisfactory, so it is necessary in the introduction of thenew care reform.
The second part, the new medical reform achievements. By listing some specific data,initially established a universal health care system, improve the basic medical level of urbanand rural residents, alleviate the problem of poverty due to illness of the masses. Theimplementation of essential drugs zero rate sales in basic medical and health institutions,reduce the patient's medication burden. The public health service information, establishpersonal medical electronic case files, building a strong service network in the rural areas,strengthen the construction of community health service center in the urban, improvingconvenience for medical treatment, the greatest degree of meet the medical needs of patients.
The third part, the new health care problems, this is the main content. Through thereform, the problem encountered in the cited research visits, find the universal problems andanalyzes the reasons behind the problem furtherly. Summarize a few aspects of context. Itpresents part of the problem before the reform involves excessive caused by market, and theseare inertia, this is the part reason part difficult reform to a certain extent, such as reform ofpublic hospitals faced significant profit-driven, and lack of public welfare issues; also a needfor more support deeper reform issues, such as the national body powers unequal taxation,financial power concentrated in the central government, and the implementation of specificwork relies grassroots government, resulting in primary health care resource allocationproblems, and so on.
The fourth part, the basic situation of overseas medical insurance and analysis we canlearn. It is mainly introduced in the United Kingdom on behalf of the national healthinsurance model, Germany's social health insurance model, represented by commercial healthinsurance model of the United States, and Singapore as the representative of the savingsinsurance model in this article. By focusing on several modes of operation concept,management structure and payment methods, the paper propose to the problem our currenthealth care reform which we can learn from these modes.
The fifth part is the analysis of possible ways to continue and promote the health reform,including public hospitals reform, urban workers, urban residents and the new ruralcooperative medical insurance in the form of three questions are not uniform, and improvebasic problem drug system. These three issues are the focus of the next step to furtherpromote health care reform. To explore ways to solve three problems have a very importantpractical significance. I hope that my thesis will have a reference for deepen the health carereform.
Keywords: NewHealthcarereform Path Discussion
目 录
中文摘要
引 言
（一）研究背景
（二）国内外研究现状
1.医疗保险方面
2.药物制度方面
3.医疗卫生方面
（三）研究内容
（四）研究方法
一 新医改取得的成效
（一）全民医保体系实现全覆盖
（二）基本药物体系初步建立
（三）医疗服务和公共卫生服务体系更加完善
（四）医药卫生监管体系日益健全
二 新医改进入深水区后遇到的问题
（一）公立医院综合改革步履维艰
1.高质量医疗资源供应不足，分布不平衡
2.保障公益性投入不足，政府职责缺位
3.医院管理方式有待优化，水平亟须提高
（二）医疗保险双轨运行问题重重
1.居民重复参保、重复补贴严重
2.经办机构和信息系统建设重叠
3.制度公平性无法体现
4.人口流动受到限制
5.医保体系可持续性受制约
（三）基本药物制度尚需完善
1.基本药物在一定程度上不能满足群众需求
2.药品配送零散送达不够及时
3.“网底”抗风险能力有待加强
三 国外医药卫生体制模式及对我国新医改的借鉴
（一）医保管理体系的国际经验借鉴
1.社会健康保险模式
2.国家卫生服务模式
3.商业健康保险模式
4.储蓄医疗保险模式
（二）“医药分开”的国际经验借鉴
1.部分西方国家主要做法
2.部分亚洲国家主要做法
（三）新医改借鉴国外经验的可行性
1.社会办医为患者提供了多样性选择
2.明确经办机构有利于医保体系完善
3.基本药物实行市场化运作
4.改革医保支付方式
5.加速完善医疗保障法律体系
四 深化新医改的路径选择
（一）依托行政改革不断深化促动新医改深入开展
1.推动大部制改革促进全民医保一体化进程
2.建立财政投入长效机制确保医改措施平稳实施
3.构建服务型政府强化政府公共服务职能
（二）调动公立医院参与改革积极性
（三）加速城镇化降低医改综合成本
1.用城镇化带动卫生资源配置优化
2.用城镇化带动公共卫生服务均等化
3.用城镇化降低基本药物使用成本
（四）在公立医疗机构试行“医药分开”
1.出台支持医药零售行业发展政策
2.提高执业药师整体水平
3.为执业药师制度立法
结 论
参考文献
后 记
