行政型市场化与中国公立医院的改革

Bureaucratic Marketization and Reforms of Public Hospitals in China

在中国的医疗领域,供方改革相对于需方改革来说正遭遇更多的障碍,尤其是公立医院的改革非常迟滞。所有的公立医院正处于行政型市场化的制度格局之中:一方面,其运营主要依赖于通过提供医疗服务和出售药品所换取的收费;另一方面,其运营受制于众多政府行政部门的干预,但也享有政府保护。医疗服务体系改革的关键就在于公立医院如何走出行政型市场化的泥沼。有两种可能的选择:其一再行政化,即卫生行政部门将分散在众多政府部门的资源配置权力集中起来,从而以自上而下的方式,对公立医院的运营进行全方位的行政管理;其二是去行政化,即公立医院走向法人化,而政府则以监管者的角色,致力于维持医疗服务市场竞争的公平性。如果公立医院改革是在这两种选择之间摇摆,自然就会裹足不前。

The supply-side reforms are encountering more obstacles than the demand-side ones in China's healthcare sector, and in particular the institutional restructuring in public hospitals is sluggish. All publish hospitals are embedded in an institutional configuration of bureaucratic marketization. One the one hand, they are marketized as their operation rely heavily on revenue generating from service provision and drug sale; on the other, their operation is subject to government interventions, as well as enjoys government protection. The key for reforming healthcare delivery is to move public hospitals out of bureaucratic marketization. One option is to adopt a command-and-control approach, by which health bureaus impose comprehensive management over all public hospitals. Another option is debureaucratization, in which public hospitals are corporatized while the government assumes a role of regulator so as to maintain the fairness of competition in the healthcare sector. If vacillating between the two options, the reforms of public hospitals would hang a leg.