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美国、瑞典健康保障制度在公平与效率的目标选择、政府在制度中的功能以及健康保障资金来源等方面存在较大差异,并由此导致了两国健康保障绩效的不同。以政府为责任主体、强调制度公平性的瑞典比以效率为导向、强调个人责任的美国在健康保障领域取得了更大的成就:在总投入较少的条件下,瑞典人口预期寿命、婴儿死亡率、劳动年龄人口早亡率等方面均取得了比美国更好的产出。中国健康保障制度改革应改变市场化导向,确立公平性原则,强化政府职能,同时在医疗服务领域引入竞争机制,提高服务效率、降低医疗服务价格,实现健康保障领域中政府与市场的良性互动。
The health insurance system in the United States and Sweden has great differences in the choice of the objectives of fairness and efficiency, the functions of the government in the system, and the source of funds for health protection. As a result, the performance of health insurance in the two countries is different. Sweden, with the government as its main responsibility and emphasizing system equity, has made even greater achievements in health protection than its efficiency-oriented and personal responsibility: With a small total investment, Sweden’s life expectancy, infant deaths Rate, premature death rate of working-age population and other aspects have achieved better output than the United States. The reform of China’s health security system should change the orientation of marketization, establish the principle of fairness, strengthen government functions, and at the same time introduce competition mechanism in the field of medical services to improve service efficiency, reduce the price of medical services and achieve benign interaction between the government and the market in the field of health protection.