医改的逻辑与利益集团的阳光博弈——兼谈美国医疗保障制度演进中的博弈规则

医疗体制改革本质上是社会公共财富的再分配,伦理上涉及社会公正与正义,经济与管理上涉及各个阶层、利益集团的逐利博弈和理性之间的平衡张力。通过对美国20世纪60年代以来医疗保障立法过程中各个利益集团的交锋和妥协,尤其是代表美国医师利益的美国医学会在历次医疗保障立法程序中的诉求,揭示医疗制度改革的社会化流程,方案的精心设计是最重要的,当要取得社会共识,必须开放利益集团的"公堂博弈""舆论争锋"的空间,以便为后续实施提供良好的社会心理的土壤。

Logic of Healthcare Reform and Bright Game of Interests Groups:the Game Principles of Healthcare System Transition in US

The essence of healthcare reform is the redistributing of the public treasure of the society. This concerns the fairness and justice of society in ethics, as well as the game of pursuing interests by every class and interests group, and the balance of rationalities in economy and management. By reviewing the conflicts of interests groups during the healthcare legislation since 1960s, especially the appeals of American Medical Association, which presents the interests of medical staff, in the proceeding of healthcare legislation, it addressed that the socialized flow of healthcare reform and the delicate planning are the most important things. In order to get the common sense of the society, we have to wider the pace for the interests groups to "game in the law court" and "dispute in the public opinion" so that a good social psychology environment can be provided for the continuing implement.