医疗体制“管办分开”与服务供给——基于公立医院改革试点的实证研究

Regulation Separating from Management and Health Care Supply: An Empirical Investigation from three Cities' Reform

本文从服务供给的角度,将"管办分开"政策放到整个医疗卫生体制改革的背景下,讨论了"管办不分"对市场供给可能产生的制约,以及"管办分开"改革在概念和理论上的不同认识,最后根据潍坊、无锡和苏州市公立医院"管办分开"的改革试点,应用一阶差分方程对改革的影响进行估计。研究发现,"适当"分开的潍坊市和"彻底"分开的苏州市改革均显著增加了卫生资源的供给,并且影响逐年递增,但是"彻底"分开的无锡市改革没有显著影响供给。因此,我们建议各地在实施卫生体制"管办分开"改革时不应强调统一的模式,应该积极探索适合当地实际情况的改革措施。

This paper evaluates the separation reform between operation and regulation of public hospitals in China. Using city-level data and the difference-indifference(DD) model method, this paper estimates the changes in health care supply in response to the policy reform. Based on the DD model estimates, the pure reform effect led to a significant increase of 9.238 for hospital beds and 7.743 for doctors per 10000 people in Weifang city from 2006 to 2008. And for Suzhou city with data from 2005 to 2008, the reform-led increase is 35.38 for hospital beds and 8.369 for doctors per 10000 people, respectively. Moreover, the magnitude of impact increases over time based on the dynamic trend. Furthermore, the study finds a consistent increase in supply capacity in response to the separation policy regardless of whether it takes place inside or outside the government. This leads us to conclude that it is crucial for the government to focus on regulatory roles while leaving market forces to determine the operational functions for better and greater healthcare supply in China.