财政养医体制下基层医疗卫生机构绩效管理制度的转型

Studying on the transformation of performance management system of grass-roots medical institutions in finance system

信息难以充分和绩效难以归因将引发绩效考核的失真和绩效奖惩的失公,从而导致基层医疗卫生机构绩效管理的失灵。文章借助信息理论和归因理论探索解决信息不对称和绩效难归因的路径。在信息不对称方面:认为隐性信息的存在是考核主体与对象信息不对称的主要原因,从而提出收支结余分配权的思路根治考核主体与对象的信息不对称难题。在绩效难归因方面:认为行政管制下基层医疗卫生服务垄断供给是导致绩效难归因的体制原因,从而倡导以取消行政管制、破除垄断格局为途径解决绩效难归因问题。

The problems of insufficient information and difficult performance attribution will cause the distortion of performance appraisal and injustice of performance rewards and punishment,which can result in the failure of performance management in grass-roots medical institutions.The pathway to solve the problems of information asymmetry and difficulty in performance attribution was explored based on information theory and attribution theory.For the asymmetric information,it was believed that implicit information was the main reason of subject-object information asymmetry,which can be solved by the power of distributing the balance of revenue and expenditure.For the difficulty in performance attribution,monopoly-supply pattern of the basic medical services in the administrative control system was the reason,which can be solved by abolishing administrative management and breaking the monopoly pattern.