基于政府购买服务视角下的公立医院公益性的实现困境与对策分析

Analysis on the Dilemma and Countermeasure of Realization of the Public Welfares of Public Hospital Based on the Perspective of Government Purchasing Service

公益性是我国公立医院改革的一项重要目标,随着我国社会医疗保障制度的健全和卫生领域市场化机制的建立与完善,政府购买服务模式已逐渐成为公立医院公益性的重要实现路径。目前我国在政府购买医疗服务的过程中存在着诸多管理体制和运行机制等方面的问题,如政府职能"管办不分"、医院管理体制不完善、市场化程度偏低;政府和社保机构之间的职能错位、社保机构管理体制不健全;公立医院与社保机构间的目标缺乏统一、职责不明确等。因此,实现公立医院公益性的回归必须转变政府的职能,加快公立医院的市场化进程;明确政府与社保机构、社保机构与公立医院之间的关系及职能定位;积极探索、建立社保机构市场化机制、逐步分离监督与事务性服务职能;借鉴国外经验,建立医疗保险谈判机制、引入第三方监督,实现公立医院公益性的回归。

The public welfare is an important content and＇ goal of the reform of public hospital in our country. With the improvement of the social medical insurance policy and the establishment and improvement of marketization mechanism in health field, the government purchasing se/＇vice model has gradually become the main form of supplement of basic medical and health service, and the very important path for government to realize the public welfare of public hospitals. But there are many problems about management system and operating mechanism in the process of the government purchasing service. For example, the government function was not clear and the public hospital management system was not perfect, and the market degree of public hospitals was lower. There was function dislocation between the government and the social security institution and the management system of the social security institution was not perfect. The goal of public hospitals and social security institutions was lack of unity and the responsibility was unclear. So, we should transform the function of the government, and accelerate the marketization of public hospitals, to define the relationship and function between the government and the social medical insurance institutions, the social medical insurance institutions and the public hospitals. Actively explore and establish market mechanisms for social security insti- tutions, and separate the function of transactional service and supervision Of social medical insurance institutions step by step. To establish medical insurance negotiation mechanism and introduce the third party supervision organization from foreign experience to realize the return of public welfare in public hospitals.