直接举办还是购买卫生服务:相关理论与政策问题探讨

Theory and policy issues:the purchase of healthcare services by government contracting or the direct provision by public health facilities

政府购买卫生服务还是政府举办医疗机构直接提供卫生服务,这是学术界和政策制定者关注和争论的焦点问题之一。本文从这两项政策的具体内涵入手,比较两种干预方式的具体形式、理论基础和实践经验,分析购买卫生服务中必须解决的为谁购买、购买什么、从何处购买、如何购买、以何种价格购买以及谁是购买者等基本问题,并根据现阶段我国医疗卫生市场的发展状况进行政策取舍,得出了基本结论:二者都是政府实现卫生责任的方式,具有不同的适用范围和条件;当前应以政府直接举办医疗机构为主要形式,当务之急是完善卫生经费的拨款方式,加强绩效考核,提高资金的使用效率。

The trade-off between the purchasing healthcare service by contracting and the operation of the public healthcare facilities directly by the government agencies is one of the hot debates on healthcare delivery options among the health policy researchers and policy-makers.The authors of this paper intend to clarify the definitions of both the purchasing by contract and the provision by the public health facilities,to compare the theoretical and practical basis,the specific ways of these two policy interventions,and to analyze key issues on the purchasing by contact such as for whom,what and how to buy,where and at what price to purchase,and who is the purchaser.Through integrating the current situation of medical market in China,the study finds the following conclusion: both the purchasing by contract and the operation of the public health facilities are the solutions of realization of the government's commitment to healthcare services for the citizens.It is feasible and applicable for the government to own and operate the public health facilities to provide healthcare services in the context of China today.The top priority of funding is to promote the efficiency of public health funds through the reform of fiscal transferring,evaluation and appraisal system of the health system performance.