公立医院经济性目标与公益性目标监管分析——基于共同代理理论的研究

Analysis of regulation of economic and public welfare objectives of public hospitals based on common agency theory

目的分析我国公立医院监管中经济性监管与公益性监管失衡的原因,提出解决公立医院多委托人共同代理难题、平衡经济性监管与公益性监管的可行措施。方法利用多委托人共同代理理论对公立医院监管体系及监管者目标进行分析,比较公立医院经济性目标与公益性目标下监管者们不合作但同时行动、各自先后序贯行动、相互合作等4类行为的收益及福利。结果不同行为模式对公立医院实现监管者各自目标及社会总福利产生不同的影响。两类监管者合作能够实现社会福利最大化;两类监管者不合作但是同时行动时,代理人利用监管者的不合作获取最高的利润;两类监管者不合作且先后序贯行动时,先行动的监管者利用自己的先动优势,获取高的收益。结论通过多个规制者之间的合作可以实现社会福利最大化。医疗改革中,政府应该采取措施促使多个监管者合作,促进不同规制机构的沟通与协调,措施包括自我协调、第三方协调及统一的大部制等。

Objective To analyze reasons of the imbalance between economic supervision and public welfare supervision of public hospitals and to propose applicable measures for solving the problem of common agency of multi-clients and balancing the economic supervision and public welfare supervision. Methods The theory of common agency of multi-clients was adopted to analyze the supervision system and objectives of supervisors. The benefit and welfare of 4 activities, i.e. supervisors act with cooperation, supervisors act simultaneously without cooperation, supervisors of economic supervision act first, and supervisors of public welfare supervision act first, were compared. Results Different action modes had different effects on achieving objectives of supervisors and total social welfare. Cooperation of both supervisors could maximize the social welfare. Simultaneous actions of supervisors without cooperation caused agents obtaining maximum benefits by taking advantage of the in-cooperation of supervisors. Sequential actions of supervisors without cooperation caused supervisors who acted first obtaining maximum benefits. Conclusion Cooperation of multi-supervisors can maximize the social welfare. The government should take measures to promote the cooperation of supervisors and improve the communication and coordination among different regulatory institutions during the course of health care reform, including self coordination, third-part coordination, and super-ministry system.