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1、 医改Healthcare reformAbstract: This article focuses on the role of health care reform, pointing out that the concept of attention is the empirical research based on extensive. This paper aims to: 1) construction and target of the concept of health theory; 2) abroad is mainly USA health status of 3) p
2、ointed out that the urgency of the problem of Chinas reform face; 4) the main contents of Chinas reform of the influence and the. The conclusions are as follows: 1) through empirical research, proved that the health in building a well-off society in the role of health care; 2) the feasibility; 3) th
3、e reform of the form and the content for further study, briefly explore the direction of the medical reform. Keywords: health care; content; feasibility; direction摘要：人生在世，生老病死，谁也免不了。一个国家的医疗卫生事业，关系到每一个人的切身利益，也关系到国家的人口素质，国民健康，民族兴旺。本文着重研究了医改的作用，指出这一概念受到广泛重视是基于广泛的实证研究.本文旨在:1)探讨“医改”这一概念的理论构建及其目标；2）国外主要是美
4、国医改状况3）指出我国“医改”面临的紧迫性的问题；4）我国医改的主要内容及其带来的影响。本文得出结论如下：1)通过实证研究，证明了“医改”在全面建成小康社会中的作用；2）医改的可行性；3）通过对医改的形式和内容作进一步研究，简要探究出医改的方向。（五号）关键词：医改；内容；可行性；方向（五号） Healthcare reform 1. Introduction （一级标题，四号加粗顶格；所有标题后均不加逗点或句点）The significance of the role of conscious and unconscious processes and the notion of inter
5、face in second language (L2) development has been the focus of much debate in the general field of cognitive psychology. One proposal is that put forward by Burka (1996), who offers a hypothesis related to conscious learning that focuses on what Skehan argues is “the crucial concept of noticing” (De
6、leuze, 1986，p.48) （这是参考文献出处文中注的格式，p用小写）. The purpose of this paper is to a) consider the theoretical constructs that underlie the role of noticing, and b) assess the validity of the assumption that noticing enhances language acquisition. Life, death, who is also unavoidable. A national health servic
7、e, related to the vital interests of each individual, but also related to the countrys population quality,national health, national prosperity. The contradiction is not adapt to the current development of Chinas medical and health level of coordinated economic and social development and peoples heal
8、th needs are still quite prominent. Urban and rural and regional health development is not balanced, irrational allocation of resources, public health and rural, community medical and health work is relatively weak, the medical security system is not perfect, the order of the medicine production and
9、 circulation is not standard, the hospital management system and operation mechanism is not perfect, lack of government investment in health care, medical costs rose too fast, the masses are compared strong. With the development of economy and the improvement of peoples living standard, people have
10、higher requirements to improve medical and health services will. Industrialization, urbanization, aging population, the change of the disease spectrum and ecological environment changes, brought a series of new challenges to the medical and health work.Deepening the reform of the medical and health
11、system, is the strategic choice to speed up the development of medical and health care, is an important way for the people to share the fruits of reform and development, is the urgent desire of the broad masses of people. Gradually realizes everybody to enjoy the lofty goal of basic medical and heal
12、th services. 当前我国医药卫生事业发展水平与经济社会协调发展要求和人民群众健康需求不适应的矛盾还比较突出。城乡和区域医疗卫生事业发展不平衡，资源配置不合理，公共卫生和农村、社区医疗卫生工作比较薄弱，医疗保障制度不健全，药品生产流通秩序不规范，医院管理体制和运行机制不完善，政府卫生投入不足，医药费用上涨过快，人民群众反映比较强烈。 随着经济的发展和人民生活水平的提高，群众对改善医药卫生服务将会有更高的要求。工业化、城镇化、人口老龄化、疾病谱变化和生态环境变化等，都给医药卫生工作带来一系列新的严峻挑战。深化医药卫生体制改革，是加快医药卫生事业发展的战略选择，是实现人民共享改革发展成果的
13、重要途径，是广大人民群众的迫切愿望。 逐步实现人人享有基本医疗卫生服务远大目标。 一级标题与一级标题之间空一行，一级标题和二、三级标题之间都不空行。 所有标题均顶格、并只有第一个单词首字母大写（除专有名词外）。2. The theoretical constructs and targets that underlie the role of reform “医改”这一概念的理论构建及其目标（一级标题）2.1 Consciousness raising and noticing （二级标题，小四加粗） The theoretical constructs that underlie the r
14、ole of reform医改”这一概念的理论构建 The medical and health system reform must be based on national conditions,proceed from reality in everything, adhere to reform and the correct principle. Adhere to the national conditions, the establishment of medical and health system Chinese characteristics. Insist on sta
15、rting from the basic national conditions, adhere to suit ones measures to local conditions, classification guidance, give full play to local enthusiasm, explore the establishment of basic medical and health system according with the situation of our country. Adhere to the unity of fairness and effic
16、iency, combine the government leadership and the role of market mechanism. Strengthen the government inbasic medical and health system of responsibility, strengthen the government responsibility in the system, planning, financing, service, supervision and so on,maintaining the public health, promoti
17、ng fair. At the same time, pay attention toplay the role of market mechanism, mobilize social forces to participate in,contribute to the formation of orderly competition mechanism, improve the level of medical and health efficiency, service and quality, meet peoples multi-level,diversified health ne
18、eds. Adhere to and improve the system, combining the current outstanding problems.From the overall situation, urban and rural, regional development, taking into account the interests of all parties to the supply side and demand side, with theemphasis on prevention, treatment, rehabilitation of the t
19、hree, correctly handle the relationship between the government, health agencies, pharmaceutical enterprises, medical personnel and the masses of the people. 医药卫生体制改革必须立足国情，一切从实际出发，坚持正确的改革原则。 坚持立足国情，建立中国特色医药卫生体制。坚持从基本国情出发，坚持因地制宜、分类指导，发挥地方积极性，探索建立符合国情的基本医疗卫生制度。坚持公平与效率统一，政府主导与发挥市场机制作用相结合。强化政府在基本医疗卫生制度中
20、的责任，加强政府在制度、规划、筹资、服务、监管等方面的职责，维护公共医疗卫生的公益性，促进公平公正。同时，注重发挥市场机制作用，动员社会力量参与，促进有序竞争机制的形成，提高医疗卫生运行效率、服务水平和质量，满足人民群众多层次、多样化的医疗卫生需求。坚持统筹兼顾，把解决当前突出问题与完善制度体系结合起来。从全局出发，统筹城乡、区域发展，兼顾供给方和需求方等各方利益，注重预防、治疗、康复三者的结合，正确处理政府、卫生机构、医药企业、医务人员和人民群众之间的关系。The term “consciousness raising” refers to the drawing of learners a
21、ttention to the formal properties of language (Fee and Fox., 1988). However, a key difference between noticing and consciousness raising is that noticing has supposed implications for language processing and the actual acquisition of linguistic features.（每段第一行退进4个空格）2.2 Noticing and language acquisi
22、tion 医改的目标 Establish a basic medical and health system covering urban and rural residents,in order to provide a safe, effective, convenient, affordable medical and health services. To 2011, the basic medical insurance system covering urban and rural residents, preliminary establishment of the essent
23、ial drug system, urban and rural medical and health service system to further improve the basic publichealth service, obtains the popularization, the pilot reform of public hospitals to achieve a breakthrough, improve the basic medical health service accessibility,effectively reduce the burden of me
24、dical expenses of residents, to alleviate theproblem of difficult to see a doctor, expensive. To 2020, the basic medical and health system covering urban and rural residents basic establishment. Generally a comparatively perfect public healthservice system and the medical service system, perfect the
25、 medical security system, drug supply security system more standardized, scientific and medical and health institutions management system and operational mechanism, the formation of multiple medical office pattern, universal access to basic medical and health services, basically meet peoples multi-l
26、evel health needs the health of the masses, to further improve the level of.建立健全覆盖城乡居民的基本医疗卫生制度，为群众提供安全、有效、方便、价廉的医疗卫生服务。到2011年，基本医疗保障制度全面覆盖城乡居民，基本药物制度初步建立，城乡基层医疗卫生服务体系进一步健全，基本公共卫生服务得到普及，公立医院改革试点取得突破，明显提高基本医疗卫生服务可及性，有效减轻居民就医费用负担，切实缓解“看病难、看病贵”问题。到2020年，覆盖城乡居民的基本医疗卫生制度基本建立。普遍建立比较完善的公共卫生服务体系和医疗服务体系，比较健全
27、的医疗保障体系，比较规范的药品供应保障体系，比较科学的医疗卫生机构管理体制和运行机制，形成多元办医格局，人人享有基本医疗卫生服务，基本适应人民群众多层次的医疗卫生需求，人民群众健康水平进一步提高。Geertz (1973) identifies three aspects of consciousness involved in language learning: awareness, intention and knowledge. Johnstone (1993) states that a) whether a learner deliberately attends to a lin
28、guistic form in the input or it is noticed purely unintentionally, if it is noticed it becomes intake. To help clarify Schmidts hypothesis and the place of noticing in L2 acquisition the following model, proposed by Ellis, is useful.(一级标题与一级标题之间空一行，一级标题和二、三级标题之间都不空行)3. Influences on noticing Abroad
29、is mainly USA health status 国外主要是美国医改状况3.1 Vigorous and resolute use of public pressure On June 9 , Obama announced the Senate Democratic health care reform proposal, the next day in national grassroots mobilization of the nations two million supporters in 50 states to have a publicity, which set of
30、f a big national discussion. This is actually using the power of public opinion forced the bow of vested interests.3.2 Withstand the pressure of its convictions Obama has the full support of high-profile medical reform program,and then he faced the problems from the interference of Congress and inte
31、rest groups, and even many voters began to waver on his support. But Obama has not manipulated by them, instead of taking a more active engagement situation to face it , even if such contact is not happy.3.3 The easier one by one to break Obama have a active lobby with the American Medical Associati
32、on ,which is referred to as restricted medical reform . Then reach a consensus with the nations hospital system and has been supported by the National Nurses Association.3.4 Lessons provided only program Clinton has pressed for medical reform with hundreds of pages of reports but it failed to get an
33、y votes from the Congress. With this lesson, Obama did not release hundreds of pages of the program which will make the Members lose patience before understand, but to introduce programs and policies which is drafted by Congress. To avoide the reforms will be limited by political demand Obama made a
34、 concession that the relevant idea of setting up public insurance institutions was die out in the final Medical reform. This not only put down a huge controversy, but also will greatly reduce government expenditure.(一级标题与一级标题之间空一行，一级标题和二、三级标题之间都不空行)4. The urgency of the problem facing Chinas reform
35、我国“医改”面临的紧迫性的问题 4.1 Doctors accept drug rebate is the most important, the most pressing problems facing the current health care reform医生收受药品回扣是当前医改面临的最重要、最紧迫的问题 Needless to say, the most important, the most pressing problems facing the current health care reform is: in the drug rebate temptation, st
36、imulation and kidnapping, the doctor is more and more biased towards the use of expensive drugs, prescription is more and more big, the irrational drug use is also more and more serious. The prescription drug rebates, under the stimulation of excessive drug use not only money, but also to, the docto
37、r-patient contradiction sharpened, and the patients to kill innocent doctor, that 60% of the netizens applaud.毋庸讳言，当前医改所面临的最重要、最紧迫的问题是：在药品回扣的诱惑、刺激乃至绑架下，医生越来越偏向于使用高价药，处方金额越来越大，不合理用药也越来越严重。药品回扣刺激下的大处方、过度用药不但“谋财”，而且“害命”，使得医患矛盾日益激化，以至于患者杀死无辜的医生后，竟有60%的网友拍手叫好。4.2 Anti market drug income rate regulation i
38、s the root cause of a series of medical reform serious problems“反市场”的药品收益率管制是导致一系列医改严重问题的根源The drug income rate regulation of this reform policy anti market performance for public price competition mechanism failure, commercial bribery forcing pharmaceutical production business enterprise can only b
39、e recessive competition. In the drug production and circulation has the market of today,pharmaceutical production and management behavior will be around the medical needs of the organization and operation. While the rate control the medical reform policy in the drug income, medical institutions drug
40、 procurement orientation and results of drug purchase price is higher, the more profit, both in Ming Dynasty, and the dark, dark more. The public medical institutions in this distorted demand led directly to the enterprise competition behavior and drug production and operation twist, enterprises wer
41、e forced to abandon the public legitimate price competition, the choice of illegal implicit transaction competition,competition is not the one who drug prices lower but who drug rebate more,otherwise you will exit the public medical institutions drug market. In addition,government officials, such as
42、 a large number of medical representatives had nodirect relationship with the medicine purchase and sale of the various people for drug income rate regulation and tender pricing, sales of drugs involved, and secretly participating, which is an important factor of hospital drug price is much higher t
43、han that of pharmacy. 药品收益率管制这一医改政策的“反市场”性表现为让公开的价格竞争机制失灵，迫使药品生产经营企业只能进行隐性的商业贿赂的竞争。在药品的生产流通已经市场化的今天，药品的生产和经营行为必然会围绕着医疗机构的需求而运转。而在药品收益率管制这一医改政策下，医疗机构的药品采购导向与结果是药品的采购价格越高，获利越多，既有明的，又有暗的，暗的更多。公立医疗机构这一扭曲的需求直接导致了药品生产经营企业竞争行为的扭曲，企业被迫放弃公开合法的价格竞争，选择非法隐性交易的竞争，彼此比拼的不是“谁的药品价格的更低”而是“谁的药品回扣更多”，否则就要退出公立医疗机构的药品市场。
44、另外，政府官员、医药代表等一大批原本与药品购销没有直接关系的各路人马也因药品收益率管制而与药品的招标定价、销售扯上了关系，并暗中参与分利，这也是医院药品的价格远远高于药店的重要原因之一。 4.3 A pressing matter of the moment is to cancel the reform of drug income rate regulation, but the maximum retail price of medical reform policy implementation医改的当务之急是取消药品收益率管制，实施只管最高零售价医改政策In the governme
45、nt despite the highest retail price of health care policy, reduce drug purchase price, against individual doctors receiving drugs rebate are beneficial to increasing the income of public medical institutions, the public medical institutions will be like a private hospital, drugstore, private clinics
46、 as the price for purchasing drugs, there is no need to also do not allow drug rebates,price buy it no doctors drug rebate, no drug rebate doctors can not excessive use, legal to fill medicine hospital naturally curb illegal to fill medicine doctor.In despite of the maximum retail price policy of me
47、dical, pharmaceutical production enterprises will choose to disclose price competition, there is no need to hire a lot of pharmaceutical representatives to the doctor a drug rebate, there is no need to amateur performance of money laundering, drug production and operation order will naturally specif
48、ication, concentration degree will naturally improve.在政府只管最高零售价的医改政策下，降低药品采购价、打击医生个人收受药品回扣都有利于增加公立医疗机构的收益，这样公立医疗机构就会像民营医院、零售药店、私人诊所一样以底价购进药品，没有必要也不允许有药品回扣，底价购进就不会有医生的药品回扣，没有药品回扣医生就不会过度用药，合法的“以药补医院”自然就遏制了非法的“以药补医生”。在只管最高零售价的医改政策下，药品生产经营企业自然就会选择公开的价格竞争，没有必要高薪雇用大量的医药代表给医生送药品回扣，没有必要“走票洗钱”，药品生产经营秩序自然就会规范
49、，集中度就会自然提高。5.The main content of Chinas reform and the Effect 我国医改的主要内容及其带来的影响 5.1 The main content of Chinas reform 我国医改的主要内容 5.1.1 Accelerate the construction of the basic medical security system 加快推进基本医疗保障制度建设 3 years of basic medical insurance for urban workers and residents and a newrural cooperative me
