我国大型医院床位增长成因分析

Factors of Bed Size Increase in the Large General Hospitals in China

近年,我国大型医院床位规模呈持续增长趋势,引发诸如国家医疗服务体系"正三角"结构遭到破坏、医疗费用上涨、优质资源稀释、骨干作用发挥不充分等一系列问题。本研究应用几何模型,将床位规模设为三角形面积,内外因素分别设为三角形的内切外接圆,供方、需方、举办方,分别设为床位规模扩张的作用方,制度因素、市场因素、需求因素和内部管理因素分别设为床位规模扩张模式的影响面,提出医院床位规模扩张的"一角、两圆、三方、四面"综合作用模型;并从医疗保障制度、支付与补偿机制、转诊制度、价格体系、区域卫生规划和内部绩效考核与激励机制等政策方面,需求价格弹性、患者趋高价格、供给诱导需求、行业垄断性等市场方面和老龄化、疾病谱的变化、医学模式转变等需求方面,对大型医院床位规模增长的成因进行分析。

In recent which leads to problems like years the bed size in the large general hospitals in China increases continuously, damaged triangle structure of health care delivery system, increase in medical expenses, destroyed high - quality resources, and insufficient functions of large hospitals. In this paper the author intro- duced a geometric model in which bed size is set as triangle, internal and external factors as the incircle and the excircle of the triangle respectively, supplier, demander and the owner as three impact sides ; institution, market, demand and internal managerial factors as four impact bands. Based on this model, the factors of bed size increase are analyzed from several perspectives like policies of medical security system, payment system and reimbursement mechanism, patient transfer mechanism, price system, local health care planning, internal performance evaluation and incentive mechanism; marketing aspects of price elasticity of demand, seeking higher price by patient, supply induced demand and monopoly; demanding factors of population aging, change in spectrum of diseases and .transition of medical model.