公立医院经济行为分析及资源整合研究

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3.0 陈辉 2024-11-19 4 4 1.75MB 121 页 15积分

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摘要

本文对国内医疗卫生改革、医院产业化倾向、医院经济行为和公立医院资源

整合文献进行了回顾，深入研究了我国公立医院所处的制度环境和其主体特性，

重点分析了医院产业化倾向问题和医院资源整合参与主体的行为，重新认识医疗

卫生系统的特殊性以及公立医院在我国所处的特殊位置和特殊作用。本文认为，

前一时期医疗卫生体制改革中之所以出现了医院产业化倾向，是由于改革管理层

和理论界有意或无意地将公立医院视为了社会性企业，而且过分强调了其“企业

性”所致。为此，本文从社会性企业的角度对公立医院在该阶段经济行为及资源

整合进行分析。

本文认为对公立医院的研究及其行为分析，既不能把它当成只追求利润而不

考虑社会公益性的企业来看待，也不能把它当作一个只注重社会公益性而完全不

考虑收益和成本核算的纯福利性事业单位来研究。因而，如何平衡社会公益性及

其收益的关系是一个重点，也是一个难点问题。本文研究结果显示，在未来相当

长一段时间内，我国政策制定者应当改变前一时期过分强调公立医院的“企业性”

及弱化其“公益性”的观点，应确立公立医院以“公益性”为第一要务的观点。

同时，政府应当加大对公立医院的财政支持力度，使公立医院的资金来源逐步过

渡到以财政补贴为主的轨道上来。

通过研究分析前一时期我国公立医院资源整合过程中参与主体的行为特点，

发现公立医院的资源整合可以提高资源利用的有效性。为了进一步利用公立医院

医疗资源，本文认为应该把我国公立医院的资源整合放在医疗卫生改革的大背景

下来进行，放在宏观医疗卫生制度的约束下来进行，放在政府主导的公立医院区

域布局和功能服务对象特定的背景下进行。同时，由于公立医院的特殊性，既要

以社会公益性为其核心宗旨，又要在相同制度约束的医疗市场上与其他企业性医

院进行竞争，既要做到满足广大人民基本的医疗保健需求，又要收取一定的费用

以补充其营运成本。这决定了该类主流公立医院的资源整合，不能照搬照抄一般

国有企业的资源整合的方式和方法，需要走出有中国特色的，既符合我国目前的

实际情况，又适应医院行业特殊性的公立医院资源整合之路。

本文也对前一时期公立医院的资源整合进行了实证研究，得出结论：该类医

院的社会效益、财务状况、运营效率和患者满意度均有较大的改善。至于医院的

员工满意度，从统计结果上来看，其改善并不显著。

总之，公立医院应当以“公益性”为其第一要务。在适当的医疗制度、医药

制度、社会保障制度的配合与支持下，可对公立医院进行资源整合。整合完成后

还要加大财政投入，在政府财政投入为主的前提下，使得公立医院的成本在国家、

企业和个人之间得以分摊。这样将更易实现公立医院的“社会性”和“公益性”，

使广大人民公平地享有基本医疗卫生保健的权利，保证我国医疗体制改革与社会

进步的和谐发展。

关键词：社会性企业公立医院经济行为资源整合

ABSTRACT

The thesis reviewed reformation literatures of medical treatment system, hospital

industrialization tendency, hospital economic behaviors and resource conformity of

public-owned hospital, analyzed deeply the system environment and main

characteristics of public-owned hospital, emphatically analyzed the industrialization

trend of hospitals and the behavior of those participating in resource conformity of

hospitals and understood renewedly the characteristic of medical treatment system and

public-owned hospitals’ special position and function. The thesis pointed out that the

industrialization tendency in the reformation of medical treatment system was due to

that public-owned hospitals had been consciously or not considered as social

enterprises by reformers or scholars and been overemphasized the “enterprise”

character. Thus, the thesis analyzed the public-owned hospitals’ economic behaviors

and resource conformitation in pre-period from the point of view of social enterprise.

In studying public-owned hospital and analyzing its behavior, it could not be

treated as an enterprise that only seeking profit without considering any “public

welfare”, at the same time, it could not be treated as social well-being units without

considering any porfit and cost too. Whereas how to counterpoise interrelation of

“public welfare” and “enterprise” is key problem, yet is very difficult. From the result

of study, it was suggested that in the future reformation, policymakers should change

the standpoints before that overemphasizing “enterprise” and weakening “public

welfare” of public-owned hospitals, should establish the viewpoints in which “public

welfare” is the most basic function of public-owned hospitals. And meanwhile,

government should increase investment to public-owned hospitals, the public finance

should become the main funds source of public-owned hospital.

Through studying the behavior traits of main participators in the course of

resource conformity of public-owned hospitals, the thesis found that resource

conformity of public-owned hospitals of our country could improve efficiency of

utilization of medical treatment resources. For making farther use of the resources of

public-owned hospitals, the thesis suggested that the resource conformity should be put

in the big background of country’s medical treatment reformation, should be put in

restriction of medical treatment institutional system, and should be put in the region

and function distribution of public-owned hospitals by government. Because of

particularity of public-owned hospitals that not only hold “public welfare” as their first

tenet, but also need to compete with other business-hospital in the same medical

market, they not only should satisfy the basic need of medical treatment of citizens, but

also need to make some charges to balance their cost. Therefore, the resource

conformity of public-owned hospitals, could not simply copy the methods or modes of

state-owned enterprises, should explore a new way according with the reality of the

country and special characteristic of medical treatment system.

The thesis also made an empirical study to resource conformity of public-owned

hospitals that consistuting an similar group, it was discovered that after the resource

conformity, hospitals’social benefit, financial states, operation efficiency and the

degree of satisfaction of patients were improved. However, the improvement of

satisfying degree of personnel in those hospitals was not evidently.

In conclusion, “public welfare” is the first responsibility for public-owned

hospitals. Resource conformity can be made in appropriate medical institution and

social security system. After reformation, the government should increase financial

investment in public-owned hospitals ，and under that presupposition, hospitals’ cost

should be shared by state, enterprises and patients. In this way, the “public welfare”

of public-owned hospitals could come true easily, making more people share the right

of elementary medical and health care, assuring the reformation of medical treatment

system harmoniously with the social progress.

Key Words: Social Enterprise, Public-owned Hospital ，Economical

Behavior, Resource Conformity

中文摘要

ABSTRACT

第一章绪论...................................................................................................................2

§1.1 本文的研究背景及意义 ...................................................................................... 2

§1.2 文献综述 .............................................................................................................. 3

§1.2.1 医疗改革文献综述........................................................................................3

§1.2.2 医院产业特性文献综述................................................................................9

§1.2.3 医院行为经济学文献综述..........................................................................19

§1.2.4 公立医院资源整合文献综述......................................................................20

§1.3 本文研究的目的 ................................................................................................ 22

§1.4 本文研究的方法和结构 .................................................................................... 22

第二章相关概念的界定及其特征分析.......................................................................25

§2.1 社会性企业概念及其特征分析 ........................................................................ 25

§2.1.1 社会性企业概念..........................................................................................25

§2.1.2 社会性企业特征分析..................................................................................26

§2.2 公立医院界定及其特征分析 ............................................................................ 27

§2.2.1 公立医院的三分类......................................................................................27

§2.2.2 三种公立医院的区别和联系......................................................................29

§2.2.3 社会性企业型公立医院..............................................................................30

§2.3 公立医院资源整合的界定 ................................................................................ 30

§2.3.1 公立医院资源整合的宏观制度环境..........................................................30

§2.3.2 公立医院资源整合的宏观布局环境..........................................................31

§2.3.3 公立医院资源整合的界定..........................................................................32

§2.4 本章小结 ............................................................................................................ 32

第三章国内外医院体系及医疗保障体系研究...........................................................33

§3.1 国外医院体系及医疗保障体系研究 ................................................................ 33

§3.2 我国医院体系及医疗保障体系研究 ................................................................ 43

§3.2.2 我国医疗保障体系的现状分析..................................................................45

§3.2.3 医保与看病贵的关系分析..........................................................................47

§3.3 国内外公立医院及医疗保障体系比较分析 .................................................... 50

§3.3.1 与英国加拿大医疗体系的比较分析...........................................................50

§3.3.2 与德国新加坡的医疗体系比较分析..........................................................50

§3.3.3 与美国医疗体系的比较分析......................................................................50

第四章我国公立医院特性及经济行为研究...............................................................51

§4.1 公立医院的特性分析 ........................................................................................ 51

§4.1.1 公益性是公立医院的首要特征..................................................................51

§4.1.2 政府对公立医院负有重大监管责任..........................................................52

§4.1.3 公立医院服务产品不同于一般服务产品..................................................52

§4.1.4 公立医院服务市场具有信息不对称性......................................................53

§4.2 影响我国公立医院经济行为的因素分析 ........................................................ 54

§4.2.1 公立医院“公益性”弱化的成因分析.......................................................54

§4.2.2 政府干预对公立医院经济行为的影响分析..............................................55

§4.2.3 运营体制对公立医院经济行为的影响分析..............................................58

§4.2.4 患者评价对公立医院经济行为的影响分析..............................................59

§4.2.5 医疗保险机构与公立医院相互关系分析..................................................61

§4.2.6 医药生产企业与公立医院的利益关系分析..............................................62

§4.3 强化公立医院公益性之政策启示 .................................................................... 64

§4.3.1 前一时期公医院公益性弱化的政策原因分析..........................................64

§4.3.2 公立医院回归公益性的政策保障分析......................................................64

§4.3.3 保障公立医院公益性的制度安排..............................................................65

§4.4 本章小结 ............................................................................................................ 66

第五章我国公立医院的制度环境及资源整合研究...................................................69

§5.1 公立医院资源整合的医疗卫生制度约束 ........................................................ 69

§5.1.1 公立医院资源整合的医疗保障制度..........................................................69

§5.1.2 公立医院资源整合的医药管理制度..........................................................71

§5.2 公立医院资源整合的宏观布局约束 ................................................................ 72

5.2.1 济困型和企业型公立医院的布局................................................................73

5.2.2 我国主体公立医院的布局............................................................................75

§5.3 公立医院资源整合方式及参与主体的行为研究 ............................................ 76

§5.3.1 经营国家划拨医院资产..............................................................................76

§5.3.2 接受委托经营医院......................................................................................78

§5.3.3 兼并收购其他医院......................................................................................79

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摘要：

摘要本文对国内医疗卫生改革、医院产业化倾向、医院经济行为和公立医院资源整合文献进行了回顾，深入研究了我国公立医院所处的制度环境和其主体特性，重点分析了医院产业化倾向问题和医院资源整合参与主体的行为，重新认识医疗卫生系统的特殊性以及公立医院在我国所处的特殊位置和特殊作用。本文认为，前一时期医疗卫生体制改革中之所以出现了医院产业化倾向，是由于改革管理层和理论界有意或无意地将公立医院视为了社会性企业，而且过分强调了其“企业性”所致。为此，本文从社会性企业的角度对公立医院在该阶段经济行为及资源整合进行分析。本文认为对公立医院的研究及其行为分析，既不能把它当成只追求利润而不考虑社会公益性的企业来看待，也...

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