柳叶刀：三明模式正在引领中国卫生体系改革进程

Core Insights - The Sanming model serves as a successful example of healthcare reform in China, emphasizing transparency, restructuring the drug supply chain, and reforming the health insurance distribution mechanism, thus providing a "Chinese solution" for global healthcare reform [1][3][24] Healthcare System Background - China's healthcare system has evolved significantly since 1976, transitioning from rudimentary services to advanced healthcare, but rapid changes have led to increased costs and accessibility issues for ordinary citizens [4][6] - In 2011, Sanming faced a healthcare crisis with a local health fund deficit of $31.5 million, equivalent to 14.4% of the municipal government's revenue, prompting urgent reforms [10][21] Sanming Model Reforms - The Sanming reforms, initiated in 2012, aimed to address the healthcare fund deficit and underlying issues such as high medical costs and drug price inflation, leading to a systemic approach to healthcare delivery [10][11][22] - Key reforms included increasing doctors' salaries, implementing a new bonus system based on treated illnesses, and enhancing transparency through the "Healthy Sanming" website, which disclosed fund usage [11][24] Financial Outcomes - By 2015, the Sanming healthcare fund had turned from a deficit into a surplus of $19.5 million, demonstrating the effectiveness of the reforms [13][24] - The Chinese government has since recognized the Sanming model, encouraging other regions to adopt similar policies, particularly in health insurance innovation [13][24] Drug Supply Chain Transformation - The Sanming model introduced a two-invoice system for drug procurement, significantly reducing drug costs and eliminating excessive mark-ups in the supply chain, which has been replicated nationwide [15][25] - Between 2018 and 2022, the prices of 294 key drugs in China decreased by an average of 53% due to these reforms, while their quality improved [16][25] Broader Implications and Challenges - While the Sanming model has shown success in controlling costs and improving healthcare access, its applicability in larger cities like Shanghai and Beijing remains limited due to different healthcare dynamics [18][26] - Experts suggest that while some elements of the Sanming model can be adapted for densely populated areas, the overall model may not be easily transferable to all regions of China [19][20][26]