法国公立医院改革的主要做法与启示

The main practices and implications of public hospital reform in France

为了应对经济危机和人口老龄化,法国公立医院开始了以成本控制为主要目标的改革。改革的重点在于服务体系、管理体制和补偿机制,具体措施包括成立区域卫生管理局,制定区域卫生规划,为公立医院发展设定目标和明确功能定位;通过构建权责明晰的治理结构和签订绩效管理合同,公立医院院长在政府宏观管理下拥有较大的经营自主权;通过加强预算管理和支付方式改革等多种方式控制医疗服务成本;加强对公立医院的认证和评价。改革主要特点是加强医疗资源规划与整合,促进公立医院与区域卫生管理局的契约化,明确公立医院治理的各方权责,通过控制医疗费用提高资源利用效率,对我国公立医院改革具有一定借鉴。

In response to economic crisis and population aging, French public hospitals lunched a reform tar- geted mainly on cost control. The reform focuses on service system, management system and compensation mechanism for public hospitals. Specific measures include： i） establishing regional health administration bureaus; formulating regional health plans; setting objectives and clarifying functional orientation of development of public hospitals; ii） through building governance structure with clear authorities and responsibilities as well as signing performance man- agement contracts, presidents of public hospitals own greater independent rights of management and operation under governmental macro-administration; iii） the government controls medical service costs through multiple approaches such as strengthening budget management and reform of payment method ; and iv） enhancing certification and evalua- tion of public hospitals. The reform is characterized mainly by ： strengthening the planning and integration of medical resources; promoting contract system between public hospitals and regional health administration bureaus; clarifying the authorities and responsibilities of all parties involved in governance of public hospitals ; and improving resource u- tilization efficiency through controlling medical expenses. It also provides a sound reference for the reform of public hospitals in China.