论医院的腐败与医院管理

Discussion on the Corruption of Hospital and Hospital Management

公共选择理论和委托-代理理论可以作为解析我国公立医院非伦理现象的理论基础,在此框架下从医院内部管理架构上系统分析医院管理不力导致或加剧医疗腐败的两个方面具体表现和行为成因,即对内部管理不够重视,管理体系不健全,现行宏观管理体制造成公立医院内部管理功能不完备或弱化。内部管理的基本构造不健全导致对腐败的制约监管乏力。一些医院价值取向偏差给腐败可乘之机。具体防控措施不力难以遏制腐败,如思想反腐不力,医德医风建设弱化;制度反腐软弱,内部控制不到位;正面防腐不到位,激励机制不合理。

The public choice theory and principal-agency theory are the theoretical basis to analyze the unethical phenomena in public hospitals in China. Under this framework, this article focuses on the structure of hospital internal management, systematically analyzing concrete manifestations and causes of medical corruption induced or aggravated by poor management of hospitals from two aspects. One can be summarized as the neglect of inner management and the imperfection of management system, including incomplete or weak inner management in public hospitals caused by current macro-management system, the poor supervision of corruption caused by imperfect basic structure of inner management and the chance for corruption caused by the deviation of value orientation in some hospitals. The other can be generalized as ineffective implements which fail to prevent or control corruption, including the failure of ideological anti-corruption, the loss of medical ethics, the weak system anti-corruption, inadequate internal control, inadequate positive anti-corruption policy and the inappropriate incentive mechanism.