自主治理视角下茂名市某公立医院公益性与逐利性的相容与失衡成因研究

Research on the Causes of Compatibility and Imbalance Between Public Welfare and Profit-seeking in a Public Hospital in Maoming City from the Perspective of Self-governance Theory

从自主治理理论出发,分析我国公立医院公益性与逐利性的相容和失衡成因。本研究以茂名市某公立医院30年发展历程为案例,于2018年2月对时任院长和护士长进行访谈,获得2005-2018年的医院年度管理与分配方案,并于2019年6月进行回访。研究结果发现,在政府支持、集体内部制定规则、可信分配承诺以及有效内部监督惩罚的条件下,该医院建立了自主治理制度,实现了公益性与逐利性的相容;政府支持的中止,导致其自主治理制度的消解,公益性与逐利性走向失衡。自主治理是“政府-市场”二元选择之外的可选制度路径,我国公立医院改革亟待引入自主治理的制度逻辑。

To analyze the causes of the compatibility and imbalance between public welfare and profit-seeking of public hospitals in China.A public hospital in Maoming city was used as a case,and its data were collected from the interviews of president and chief nurse in February 2018,as well as its annual management and distribution plan from 2005 to 2018.Return visit and interviews were made in June 2019.With support from local government,internal rule-making,credible profit distribution commitment and effective internal supervision and punishment,this hospital had successfully established a self-governance system,achieving the compatibility between public welfare and profit-seeking.The suspension of support from local government led to the failure of the self-governance system,causing the imbalance between public welfare and profit-seeking.Self-governance is an alternative institutional path outside the dual choice of"government or market"and the institutional logic of self-governance is believed to be important in the reform of public hospitals in China.