公立医院的体制改革与治理

The Restructuring and Management of Public Hospitals

本文通过回顾中国公立医院改革历程,分析其改革政策,认为政府财政补助不足、不规范的市场、扭曲的医院服务定价政策,以及政府管制和公共治理能力不足是造成目前医疗费用上涨、资源缺乏配置效率的深层次原因,而现行的治理结构又是导致公立医院费用上涨、效率低下的重要原因。正如公立医院所有者职能不统一,缺乏评估公立医院组织绩效的手段,对公立医院院长缺少有效的激励约束机制等导致公立医院内部治理失效;社会医疗保险覆盖面小,社区卫生服务发展缓慢无法形成资源有效配置的市场结构等导致外部治理失效等等,为此我们提出,应该全面规范公立医院自主化改革。

Reviewing the reform course of Chinese public hospitals in retrospect and analyze the reform policies, the paper argues that the deep reasons for the rising costs medical care and inefficiency in resource distribution are insufficient government subsidies, the non- standard market, distorted price policy as well as the incapability of government administration. Moreover, the present governing structure is the main reason for rising costs and inefficiency in public hospitals. The varied functions of owners of public hospitals, the lack of means of evaluating performance of public hospitals, and the lack of effective encouraging and binding mechanisms for hospital directors result in the ineffective internal management of public hospitals; on the other hand, the small- scale social health insurance and the inefficient market caused by the slow development of community health service lead to ineffective external management. Hence, the author claims that the reform on autonomy of public hospitals must be standardized in all aspects.