公立医院制度性诱导下资金流转的系统结构分析

Analysis on the System Structure of Capital Flow under Institutional Inducement of Public Hospitals

目的从内部结构出发,构建医院内部费用的流转路径,为理解我国公立医院医疗费用流转结构提供参考。方法基于利益相关者理论,对公立医院医疗费用的利益主体、利益主体之间利益关联进行分析,梳理公立医院资金流转系统结构。结果公立医院资金来源主要是政府补贴和业务收入。政府补贴一部分为专项资金,用于医院发展;一部分作为医院可支配收入,补贴医院及医务人员薪酬。业务收入一部分属于物价收入,医院直接分配。业务收入中非物价收入,按照一定比例转化为可支配收入,用于医院自身发展或者补偿医生薪酬。结论医院和医生作为利益共同体,存在诱导业务的可能性和可行性。控制诱导核心在于改变对医生和医院的补偿渠道以及各渠道的资金补偿额度。理论上的可行途径包括:第一,加强财政投入,直接或间接弥补医院/医生收入需求。第二,提高物价收入比例,调整医疗收费物价政策。第三,切断业务收入中按比例转化为医院可支配收入的路径。

Objective To construct the transfer path of hospital internal cost from the perspective of internal structure,to provide a reference for understanding the transfer structure of medical cost in public hospitals in China. Methods Based on the stakeholder theory, the stakeholders of medical expenses and the relationship between the stakeholders was analyzed in public hospitals. The fund circulation system structure of public hospitals is combed.Results The main funding sources of public hospitals are government subsidies and business income. Part of the government subsidy is a special fund for the development of the hospital,and the other part is used as the disposable income of the hospital to subsidize the salary of the hospital and medical staff. Part of business income belongs to price income,which is directly distributed by hospitals. Business income is non-price income,which can be converted into disposable income in a certain proportion and used for the development of hospitals or compensation of doctors. Conclusion As a community of interests,hospitals and doctors have the possibility and feasibility of inducing business.The core of control induction is to change the channels of compensation for doctors and hospitals and the amount of compensation for each channel. Theoretically possible ways include: firstly,strengthening financial input,directly or indirectly making up for the hospital/doctor income needs. Secondly,increasing the ratio of prices to income.And adjusting the policy of medical fees and prices. Thirdly,cutting off the path that business income can be converted into hospital disposable income proportionally.