中国医疗机构分类管理的政策分析

【作者】 杨绍文；

【导师】 曹宪忠； 毛群安；

【作者基本信息】 山东大学 ， 行政管理， 2005， 硕士

【摘要】 医疗机构分类管理的治理结构作为一种制度安排,它所要解决的是如何在营利性医疗机构和非营利性医疗机构确定不同的治理模式,从而在医疗服务需求中,充分发挥政府与市场各自的优势。 本论文通过对医疗机构分类管理实施结果的实证分析,认为医疗机构分类管理政策实施四年来没有实现预期的政策目标,体现在两个方面:一是医疗服务领域没有形成营利性医疗机构和非营利医疗机构良性竞争的有效格局;二是医疗服务价格过快增长的势头没有得到有效遏制。政策没有实现预期目标,究竟是政策本身的科学性不够的问题,还是政策执行过程中出了问题,我们通过对这项政策的回溯性分析,提出以下观点: 在政策制定阶段存在的问题主要在于:一是制定医疗机构分类管理政策的理论依据尚不明确,政策制定之初就缺乏对医疗机构如何分类的理论指导;二是政策制定过程中的利益搏弈,导致分类管理的配套政策没有及时跟上;三是政策制定过程中的科学性问题,这包含四个方面:首先、我国医疗机构分类管理政策借鉴了欧美国家的分类模式,但是欧美国家与我国的整个医疗体制有着很大的不同,单纯地模仿不能解决实质性问题;其次,在缺乏法律地位的情况下就推出了非营利性机构,这就在实践操作上带来许多问题和困惑;再次,政策制定过程中缺乏深入地、多方面地、长期地调研基础上就实施了这项影响巨大的制度改革,导致政策执行中产生很多问题;最后,分类管理政策缺乏一个政策试点过程。 在政策执行阶段存在的问题主要在于:一是从执行主体看,存在着制度上的缺失,中国传统上的行政管理存在着一种天然的惰性,即热衷于政策制定,而对政策实施后的监管缺乏;二是从政策执行手段来看存在简单化的倾向,地方政府缺乏创新。 论文第四部分对分类管理进行了理论分析,认为医疗机构分类管理的理论依据在于对公共产品、私人产品在医疗领域的科学界定,由此来界定政府究竟应当在医疗领域所扮演的角色。论文第五部分是对医疗机构分类管理模式的国际经验比较,主要介绍了美国和日本的医疗服务体系,美国和日本的医疗服务体系各具特色,总结两国改革的经验或教训将会对我国医疗服务领域改革具有重要的启发意义。论文第六部分提出了分类管理的新框架并提出了相关政策建议。更多还原

【Abstract】 As a kind of system, what the administrative structure of categorized management of medical organization should solve is how to confirm different governances in the profit-generating medical organization and non-profit-generating one, thus within the demand of medical care, giving full play to the respective advantages of the government and market.In the past three years of carrying out the policy in categorized management of medical units, we have achieved some progress, but did not reach the original target set by policy makers at the beginning and there still exists many problems. If they remain unsolved, it will be difficult to develop regulated management in profitable and non-profit medical units and also not beneficial for the fair competition between them. As a fundamental policy in hospitals’ management, the categorized management policy of medical units belong to "original" policy concept, exerting overall impact on the management of medical staff, assessment of professional occupations, design of payment system, medical insurance, government’s financial subsidy and other regulations. The successful implementation of categorized management policy will help solve many critical issues like difficulty in seeing doctors, expensiveness in medical treatment, doctors expensiveness in medical treatment, doctors getting bribes. In addition, the tracking and assessment of policy is one important link in the whole process of policy implementation, which helps to discover problems in the making and execution of policies so as to make necessary amendment and improvement of policies. By reviewing this policy, the article wishes to identify the issues existing in the formulation and execution of policies, discussing these problems and find a good solution to them facilitating the highly effective implementation of optimization of categorized management policy of medical units.The new ideas that this thesis brings forth to lie in the scientific analysis to the policy-making and policy-executing processes of categorized management of medical organization, and also the analysis to the reasons of the policy-invalidating from this angle.which are rarely touched upon in the previous literature and studies. The significance of this thesis is to raise a new administrative structure of categorized management of medical organization and some relate policy suggestions through theoretical analysis.更多还原