中国私立医院及其卫生人力增长:与公立医院比较

The Growth of Private Hospitals and Their Health Workforce in China: A Comparison with Public Hospitals

背景：中国通过2000年左右实施的一系列政策,大力开放了医疗保健市场。本文旨在研究这些政策对私立医院数量增长带来的直接影响,并对中国私立医院与公立医院从事医疗保健工作人员的劳动力来源进行对比。方法：首先,我们对1990年至2009年间中国医院数量的系列纵向数据进行分段回归分析,检视私立医院市场开放政策实施前后的效果。然后,将2009年收集的省级调查数据与2002年收集的另一个数据库进行对比,了解私立和公立医院间劳动力的差异,检测医务人员到私立医院就职的流动性。结果：中国私立医院数量在2001年后急剧增长,从年均增长19家变为年均增长205家,其主要原因是专科医院增加。私立医院60岁以上的医生约占22.03%,而公立医院的这一比例仅为2.97%。2008年私立医院的工作人员中,至少有4.1%曾于2001年在当地公立医院工作。结论：私立医院自2001年以来大范围扩张,最可能的原因是无偏袒的公、私医院市场政策环境。此外,中国医院-医师关系的具体特征可能会导致医生的年龄分布不均衡以及私立医院医护人员的流动。

Background: China significantly opened its healthcare market through a series of market-opening policies in 2000-2001. This study aims to explore the direct consequences of these policies: the growth of private hospitals,their workforce characteristics compared with public hospitals in China,and the source of their healthcare workforce.Methods: First,we performed a segmented regression analysis of a longitudinal data series of the number of hospitals in China between 1990 and 2009 to examine the before and after effects of the market-opening policy on private hospitals.Then,to highlight the workforce differences between private and public hospitals,provincial survey data collected in 2009 was compared with data from a second database collected in 2002 to detect the mobility of medical staff from the public to the private hospitals.Results: The number of private hospitals rapidly increased after 2001,and the yearly growth rate increased from 19 to 205,represented primarily by an increase in specialty hospitals. Approximately 22. 03% of the physicians in private hospitals are over the age of 60,whereas this proportion in public hospitals is only 2. 97%.In 2008,at least 4. 1% of the staff working in private hospitals had previously worked in local public hospitals in 2001.Conclusion: The broad expansion of private hospitals since 2001 is most likely the result of an unbiased market policy environment for private hospitals. Moreover,specific features of the hospital-physician relationship in China may account for the unbalanced age distribution feature among doctors and the mobility of the healthcare workforce in private hospitals.