【摘要】 补偿机制是公立医院公益性的重要影响因素。文章在明确公立医院的定位和职能的基础上,利用系统动力学因果关系图分析在取消药品加成政策前后,患者、政府与公立医院之间的利益关系。政府可通过提高医疗服务价格或单位补助标准弥补公立医院的收入缺口;提高医疗服务价格,存在两个方向相反的力的作用,能否增加医疗服务收入取决于两个力的相对大小,以及低收入人群的承受能力和医疗服务的可及性;如果提高单位补助标准,在弥补收入缺口的同时也会降低医疗服务收入。建议加大政府对公立医院的财政补助;为了确保公立医院公益性需加强监管;在合理测算医疗服务成本的基础上确定财政补助标准和医疗服务价格。更多还原

【Abstract】 Compensation mechanism is an important factor affecting the behavior of public hospitals. On the basis of defining the orientation and functions of public hospitals, this paper uses the causality diagram of system dynamics to analyze the interest relationship between patients, government and public hospitals before and after the abolition of the "pharmaceutical markup" policy. The government can make up for the income gap of public hospitals by raising the price of medical services or the standard of unit subsidy. There are two opposite forces in raising the price of medical services. Whether it can increase the income of medical services depends on the relative power of both forces, as well as the affordability of low-income people and the accessibility of medical services. If improving the standard of unit subsidy, it will make up for the income gap but reduce the income of medical services. It is suggested that the government should increase financial subsidies to public hospitals, strengthen supervision to ensure public hospitals’ behavior consistent with the public interests, and determine the standard of financial subsidies and the price of medical services on the basis of reasonable calculation of medical service costs.更多还原