“收支两条线”:公立医疗机构的行政化之路

Restoring Budgetary Control:Towards an Integrated Hierarchy of Public Health Care Providers

新一轮的医疗体系改革已经起步。医疗保障体系改革的方向已经明确,但是公立医疗机构的改革却混沌不清。其中,"收支两条线"管理成为最引人关注的一种"改革"思路。依照这一思路,卫生行政部门对公立医疗机构行使充分的预算管理,同时,还要掌控其人事权、医疗器械与药品的采购权。无论是历史经验还是理论分析均表明,公立医疗机构行政化之路是走不通的。公立医疗机构正确的改革方向只能是"管办分离",促使其走向法人化,同其他类型的医疗机构展开公平的竞争。

A new round of health care reforms has kicked off, While it has been sure that health security moves towards universal coverage, it is unclear where public health care providers move towards. Among a number of alternative approaches, restoring budgetary control over all public providers has become prevalent. According to this approach, all providers restore their previous status as the budgetary, units of health bureaus, and their financial, personnel, and operational decisions are made by the government. Historical experience and analytical analysis indicate tbat it would not work. Through separation between public providers and their administrative superiors, public providers can move towards corporatization, competing with other types of providers on a leveled playground.