我国城市社区卫生服务机构的公益性研究:基于财政投入与工作动机的比较

Fiscal Subsides, Work Motivation, and the Non-for-profit Operation among China's Urban Community Health Centers

医疗卫生系统被认为是当前我国公益性最不足的公共服务领域之一,而基层医疗卫生机构又是各国医疗卫生体制改革的突破口。文章分别以财政投入和工作动机为视角对我国城市社区卫生服务机构的运行进行了比较分析。研究表明:单纯通过增加财政投入不可能实现其公益性运行,以及逐利性工作动机是导致社区卫生机构公益性未能实现的主要原因。基于此,文章提出了科学界定财政投入的数量和方式、大力发展私立社区卫生机构和建立以公益性工作动机为核心的监管机制等政策建议,以保障城市社区卫生服务机构的公益性运行。

China's health care system is recognized as one of the most lacking in pubic interests and the most discontented public services. Further, the primary care has been taken as a breakthrough in the national health care system reform. This paper analyzes the operation of community health centers in China with the fiscal subsidy indicatorand the work motivation, respectively. The results show that it is impossible to realize its nonprofit operation simply by increasing financial input, and the for-profit motivation is the main reason for the unprofitable operation. Based on this, this paper puts forward the suggestions, such as defining the quantity and mode of financial input, developing private community health centers, and setting up supervisory mechanism focusing on non-for-profit work motivation, so as to ensure the public interest operation of community health centers.