补偿机制改革对公立医院角色行为改变的实证研究

An Empirical Study on the Impact of the Compensation Mechanism Reform on Public Hospitals' Social Role Behaviors

目的:探索不同阶段补偿机制改革措施对公立医院角色行为产生的影响,分析原因并提出针对性的解决策略。方法:对2003-2012年在不同公立医院补偿机制政策作用下江苏省无锡市某三甲医院的角色行为表现进行调查。结果:多种支付方式改革取得了一定成效,整体上服务数量、服务质量得到改善,而服务价格也呈现下降趋势;但改革过程中由于各项配套措施未协调跟进,导致供方采取非合作应对行为,最终形成了"补偿不足——浪费性行为增加——补偿更不足"的恶性循环,表现为管理成本效率从1.00持续走低到0.04,需方对改革效果不满。结论:在推进支付方式改革的同时,相关政策应与财政投入、医疗服务价格调整、医务人员监督与激励等改革措施相互配合,才能改变公立医院消极的角色行为,减轻患者的医药负担,达到政策的预期目的。

Objective：To examine whether the compensation mechanism reform is effective on changing the public hospitals＇social role behaviors and how this is achieved. Methods：Based on relevant literatur,we used the data from a teaching tertiary-level general public hospital, located in Wuxi China during the period of 2003-2012. Results：Various payment system reforn achieved some effect in a certain degreein wuxi, namely the service amount and quality improved intergrally and the service price presented a decrease tendency;however, without having suitable supporting measures, the providers took noncoperative behaviors, leading the vicious circle of ＂inadequate compensation - increase of wasteful behavior - further under-compensation＂ formed preaenting that the effectioeness of managemoat cost dropped from 1. 00 to 0. 04 continuouly and the demanders were non satisfied with the reform effect. Conclusion：On condition of prompting panyment system roform, better performance of these policies calls for support of such reforms as increasing government＇s financial investment,adjusting the medical service price,and enhancing the role of supervision and incentives mechanism for health care providers＇behavior. Only in this way can Chinese compensation mechanism reform policies reach their expected outcomes of improving public hospitals＇social value and alleviating the medical expense burden of the people.