控费机制与我国公立医院的运行逻辑

Cost-Control Mechanisms and Operational Logic in Chinese Public Hospitals

医疗卫生服务领域中的控费机制不仅是医疗保险领域的核心问题,更是解决公立医院"看病难看病贵"的关键所在。控费机制植根于整个医疗服务供给体系的运行逻辑之中。对我国公立医院运行流程和控费状况进行逻辑的和经验的分析,尝试构建并借助基于激励机制的公立医院运行逻辑的分析框架,考察形成"看病难看病贵"现象的原因,可见公立医院的改革政策不应仅针对医院本身进行设计,而应基于公立医院的运行逻辑,从外、内部同时建构有效的控费机制,以大幅度缓解当前的"看病难看病贵"问题,而卫生主管部门只需委托医院向社会提供医疗服务。

Cost-control mechanisms in the field of healthcare services are not only a core issue for medical insurance,but,even more,a key point in the solution of 'inaccessible and costly healthcare'in public hospitals.Such mechanisms are rooted in the operational logic of the whole medical service supply system.Through a logical and empirical analysis of operational procedures and the cost control situation in Chinese public hospitals,we have attempted to construct an incentive-based analytical framework for the operational logic of public hospitals that will enable us to investigate the cause of the phenomenon of 'inaccessible and costly healthcare.'It can be seen that the formulation of public hospital reform policies should not be targeted only on the hospitals themselves but rather should be based on their operational logic,with a view to simultaneously creating an efficient internal and external cost-control mechanism that will largely alleviate the problem of 'inaccessible and costly healthcare,'and allow health authorities to confine themselves to commissioning hospitals to provide medical services to society.