公立医院财政补助制度失灵的原因及改进建议

Failure of the financial subsidy policy for public hospitals: Reasons and suggestions

本文剖析了公立医院财政补助制度失灵的原因,通过理论和案例分析提出了从根本上改变财政补助机制的思路和方法。首先回顾了政策的历史变迁,分析了财政补助前期研究的问题,提出了对当前财政补助的目标、内容和方式的可操作方案。然后通过某市13家三甲医院的财务数据,剖析了目前公立医院的基本运营状况和财政补助存在的问题,发现在没有界定合理诊疗规范和运营效率的前提下,政策性亏损是无法界定的。如果按照目前公立医院的诊疗方式和运营效率,财政补助不足以弥补公立医院由于政策原因造成的亏损,因为财政补助没有与价格政策变化和人力成本上升配套。要改善财政补助失灵的状况,配套的管理成本也随之增加,因此,政府应考虑改变目前通过价格控制和财政补助的方式提供经济性医疗服务的思路,由医疗保险与医院决定价格,卫生部门负责服务质量,政府预算部门根据公共服务任务制定工资总额,医院根据预算决定聘任各种医务人员,从根本上改变公立医院的运营机制。

In this study, this paper analyzes the failure of subsidizing public hospitals, and proposes a reform plan that can solve this problem at its root. We review the history of subsidy changes since 1949 and review the asso- ciated literature. We discuss the case studies of 13 tertiary public hospitals in a city, and examined financial state- ments of those hospitals, identified problems with current subsidization policies. We concluded that without specifying appropriate diagnostic and treatment procedures and reforming efficiency measurements for medical care, current sub- sidization policies cannot achieve their expected objectives. Hence, policymakers should reconsider the strategy of u- sing price controls and government subsidies to restrain medical care cost. Instead, government should allow social health insurance agencies to negotiate payment with hospitals, allow health bureaus to be responsible for quality of medical care, allow finance bureaus to budget government spending according to the public workload of a hospital, and allow hospital managers to run hospitals with a budget.