公立医院规模持续恶性扩张机制——“一环、两流、三切点”理论模型的构建

The continuing scale-expansion mechanism of Chinese public hospitals:the theoretical model of "one circle-two flows-three entry points"

以"构成要素—要素间的作用关系—结果"为机制研究框架,运用规模经济理论和交易成本理论,结合医疗服务特征,确定了医疗生产技术、医院规模、专科细化程度、市场规模和成本转嫁能力作为医院规模持续扩张五要素,分析了五要素间的相互作用和制约关系,构建了"规模扩张均衡环,医院收益流和成本流,医疗生产技术、市场规模和成本转嫁能力三要素切入点"的医院规模持续恶性扩张机制的理论模型,简称"一环、二流、三切点"模型。运用该模型,可解释我国转型期公立医院规模持续恶性扩张的管理体制和运行机制的制度性因素,为规模持续扩张调控策略和政策制定提供思考路径。

Based on the ＂components-relations-result＂ framework, through applying the Economics of Scale Theory and Transaction-cost Theory, and considering the features of medical services, the paper proposes 5 components of the continuing scale-expansion mechanism of Chinese public hospitals ： medical technology, hospital scaling up, degree of specialization, market scale and cost-transfer capability, and explores the mutual interactions among these five components. At last, a theoretical model is set up ： ＂scale-expansion equilibrium circle, hospital＇ s profit flow and cost flow, medical technology and market scale and capability of cost-externalization entry points＂ which to call for short as ＂one circle-two flows-three cut points＂. This theoretical model can be applied to explain various embodiments of the continuing vicious scale-expansion of public hospitals during the Chinese economic transition and provides a path way for the regulations.