行政、市场与职业:城市分级诊疗的三种治理模式及其实践

Administration,Market and Profession:Three Governance Patterns of Tiered Medical Services and Their Practice in Urban China

实现分级诊疗是新医改工作的一项重点和难点。分级诊疗的实现依赖行政、市场和职业三种治理模式。这三种治理模式各有相应的实现分级诊疗的机制,分别为指令、价格与专业权威。改革前的分级诊疗体系由行政治理模式占主导地位,而改革后则是行政为主、市场为辅,但两个阶段中职业治理模式均未发挥应有的作用。因此,有必要给予医生充分的职业自主性,以专业权威为基础,结合另外两种治理模式,协同促进分级诊疗的实现。

Successfully providing tiered medical services is a key point of the new reform of healthcare system. Based upon the experience of urban China, this paper summarizes three patterns of governance of the system of tiered medical services： administration, market, and profession. The three patterns have their own mechanism to providing tiered medical services： command, price, and professional authority. Before the Reform, the system was dominated by administration governance. After the Reform, this pattern still dominates the system, and market governance also plays a minor role. However, profession governance has not functioned in the system as supposed. Therefore, this paper suggests that medical doctors should be given professional autonomy. Only three patterns of governance function well, the system can operate well.