中国城市公立医院民营化的政治经济学逻辑

The Political Economy of the Hospital Privatization in Urban China

过去十多年间,很多地方政府在中央政策缺位的背景下采取多种方式进行公立医院改革。其中最为激进也是饱受争议的就是民营化模式,或称"医院改制"。本文认为,这种改革有着其深刻的政治、经济、社会、行政原因,用单纯的卫生经济学很难全面解释。预算软约束与"甩包袱"是其基本财政动因;地方政府的强势推动带来了条块之间的利益冲撞,在既有的制度框架下,卫生系统和地方政府进行了微妙的互动,再加上利益集团的外在影响,这些因素型塑了公立医院民营化的全过程。

Over the past decade, several local governments embarked on various reform initiatives seeking a resolution of China＇ s heavily deteriorated heahheare system. Among others, hospital privafizafion has been the most radical and controversial. Given the complexities involved, solely relying on the traditional health economics would not arrive at a convincing explanation to these privatization reforms. In short, the load - shedding was the primary fiscal driver. Moreover, the overwhelming drive of the local governments triggered collisions between the local and sectoral interests. Under the given institutional structure, the health authorities and the local governments engaged in strategic interactions ; compounding this was the influence of various interest groups which have characterized the hospital privatization reforms in urban China.