【作者】 吴敏；

【导师】 李安明；

【作者基本信息】 武汉大学 ， 社会医学与卫生事业管理， 2005， 硕士

【摘要】 我国医疗机构管理体制是在计划经济体制下建立并发展起来的,所有制形式单一,公立医院支撑着医疗服务供给“大一统”的局面,且部门所有,条块分割,效率低下。80年代以来,虽然对公立医院进行了放权让利及调整和完善内部运行机制的改革,但是随着改革的深入,一些深层次矛盾逐渐暴露出来,医院内部改革效应出现递减趋势,微观层面的医院改革总是试图突破现有宏观管理体制的束缚,然而收效并不明显。其关键问题一是补偿机制、运行机制问题并没有解决,医院不满意;二是“看病难、看病贵”问题非但未解决,而且呈加重之势,群众不满意。说明如果宏观管理体制不改革,微观管理体制就会保持原有体制的惯性,从而使社会总体成本增加,最终受损的还是需方(患者)。因此,在宏观层面上从产权制度重构和国有资产重组角度关注我国公立医疗机构改革是本文探讨的主要议题。 具体研究中,笔者将理论与实践相结合,在浏览、学习与借鉴前人研究成果的基础上,明确地提出了有一定创新意义的观点:其一,公立医疗机构治理模式的最大特点是政事不分,治理行为过度行政化,其直接后果是医院内的非效率,并指出其致命的缺陷是由产权制度不明晰所决定的。笔者认为,作为公立医院改革与重构管理体制的前提和关键环节,产权制度改革只是一个时间问题。其二,竞争机制的缺乏既是当前医院改革面临的主要问题形成的外部原因,也是制约体制改革成效的重要因素,推进体制改革要将建设外部竞争机制作为先导,完善医院分类管理与产权制度改革同步推进。其三,基于对传统体制下政府“既办医院又管医院”的体制缺陷的认识以及对相关国际经验的借鉴,从理论分析的角度构建了医院管理体制的目标模式。其四,以当前改革中出现的四种代表模式为案例进行分析评价,认为上海国有资产管理体制架构是一种较佳的体制选择;苏州模式是我国公立医院体制改革的有效选择;而无锡模式还要作一些产权制度改革的探索;金华模式操作中出现问题较多,需要结合目前的基本医疗保障水平、医疗服务市场的竞争均衡状态作进一步的分析和研究。其五,当前一些公立医院在改革方面进行的探索,大多是一种微观的自发性行为,公立医院在微观改制方面所需的宏观政策往往还缺乏清晰的方向和明确边界。综合上述观点及其研究基础上,提出了加速我国公立医疗机构改革的对策建议。更多还原

【Abstract】 The system of healthcare management in our country was established under the planned economics. Since 1980s, public hospitals had successively gone through the reforms, such as "more self-determination and more yield" and the adjustment of interior mechanism. But as the reform developed, the positive effects of reform appeared decreasing progressively. The hospital innovations always attempted to elude the macroscopic healthcare system, but few effects were attained. Today both public hospitals which supplied medical service and patients who needed medical service seemed to get into predicaments. So if the macroscopic healthcare system wouldn’t change, those individual hospitals could still maintain the original state. Based on these analyses, this paper focused on the reform of the public healthcare facilities in our country from the view of property rights and reconstruction of public hospitals as state-owned assets.In this paper, the author proposed the following several viewpoints. Firstly, the governance pattern of public hospitals in our country was a government-dominating pattern, with the disadvantage of politics instead of administration, which leaded to inefficiency. And it was caused to a great extent by inappropriate property rights system. The property rights system innovations were imperative and it was the precursor of public hospital reforms. Secondly, the indispensable inter-hospitals competitions were so exiguous for public hospitals that they wouldn’t effort to reform. To advance the reform, inter-hospitals competitions system should be constructed as soon as possible. The hospital classification system should keep pace with the property rights system innovation. Thirdly, based on the disadvantages of traditional healthcare system and the learnings from other countries, the author proposed a theoretical pattern of public hospitals management system. Fourthly, after analyzing the four reform modes currently being carried out in several cities, the author thought that the Shanghai mode of special organization in charge of public hospitals was a better choice. The Suzhou pattern was an effective choice for the public hospitals. The Wuxi pattern needed to make some more explorations on property rights system. During the operation of Jinhua pattern, many defects were exposed out, and should be taken into further analysis, whileconcerning the basic level of medical service and the situation of market competition. Finally, the author thought some public hospitals’ reform which had been taken was mostly some kind of spontaneous exploration, and the macroscopic policy lacked of continuity, stability and definitude. Encountering many challenges, public hospitals’ inspiring themselves is urgent, but macroscopic healthcare reforms are more urgent.更多还原