新加坡医疗服务管办分离改革及对我国的启示
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摘要
我国目前的管办分离改革主要停留在分离行政机构的层面,与国际上以企业管理为基础的管办分离还有差距。新加坡管办分离在保持公立医院国有的基础上,通过公司化改革,实现所有权与经营权分离,使医院成为独立运作的公司法人,医院活力得以激发,服务效率得以提升。政府通过医疗费用筹资模式改革和财政补贴,实现公共开支与私人负担的合理配置,确保医疗服务的可及性与公平性。对我国而言,管办分离的关键是要打破公立医院与政府间的行政管理关系,重塑政府在医疗服务中的作用,在保持公立医院产权国有的基础上,通过公立医院去行政化改革,实现公共部门与私营部门管理的有效结合,政府与市场作用的充分发挥,以最大限度地提高公立医院的绩效。
At present,the reform of separating regulation from operation of public hospitals in China mainly focuses on separation of administrative organs, which lags far behind the advanced global practices based on independent enterprise management.On the basis of maintaining state ownership,medical reform concerning this aspect in Singapore has been conducted through corporatization of public hospitals, making them independent corporate.Meanwhile, in order to ensure the accessibility and fairness of medical services, the government has carried out financing reform,provided subsidies, and tried to balance public expenditure and private financial responsibility.For our country,the key is to break the administrative relationship between public hospitals and the government, to reshape the role of the government in medical services, to realize the effective combination of public and private sector management, and to fully play the roles of government and market without changing the state ownership.Only by de-administration reform can we achieve the maximum performance of public hospitals.
At present,the reform of separating regulation from operation of public hospitals in China mainly focuses on separation of administrative organs, which lags far behind the advanced global practices based on independent enterprise management.On the basis of maintaining state ownership,medical reform concerning this aspect in Singapore has been conducted through corporatization of public hospitals, making them independent corporate.Meanwhile, in order to ensure the accessibility and fairness of medical services, the government has carried out financing reform,provided subsidies, and tried to balance public expenditure and private financial responsibility.For our country,the key is to break the administrative relationship between public hospitals and the government, to reshape the role of the government in medical services, to realize the effective combination of public and private sector management, and to fully play the roles of government and market without changing the state ownership.Only by de-administration reform can we achieve the maximum performance of public hospitals.
引文
[1]李文敏.我国公立医院管办分离改革实证研究---以上海与无锡两地的改革为例[J].国家行政学院学报,2010,(6).
[2]孙晓明.发达国家和地区医疗体制与保险制度[M].上海:上海科学技术出版社,2005.
[3]和经纬.“医改”的政策学习与政策工具---中国公立医院改革与新加坡经验[J].东南学术,2010,(3).
[4]Phua K,Hong F.Attacking Hospital Performanceon T ow F ronts:Network Corporatization and F inancingre-forms in Singapore[J].Innovations in Health Service Delivery,2003,(10).
[5]April Harding,Alexander S.Preker.Understanding Organizational Reforms:the Corporatization of Public Hospitals[M].Washington,DC:T he World Bank,2000.
[6]冯鹏程,荆涛.新加坡保健储蓄计划研究及启示[J].社会保障研究,2013,(6).
[7]Ezra Klein.Is Singapore’s“Miracle”Health Care System the Answer for America?[DB/OL].https://www.vox.com/policy-and-politics/2017/4/25/153-5611/singapore-health-care-system-explained,2017-04-25.
(1)新加坡保健公司后来改为卫生部控股公司(MOHHoldings,MOHH)。
(2)享受政府高补贴额的B2和C级病房占公立医院病床数的81%,而低补贴和无补贴的A和B1级病房只占公立医院病床数的19%。参见新加坡卫生部网站:https://www.moh.gov.sg/content/moh_web/home/our_halthcare_system/Healthcare_Services/Hospitals.html,2018年8月12日。
(3)目前,新加坡私立诊所已经达到1600间。参见新加坡卫生部网站:https://www.moh.gov.sg/content/moh_w eb/home/our_healthcare_system/Healthcare_Services/Primary_Care.html,2018年8月12日。
(4)新加坡公立医疗机构规模较大,提供病床数从185张到2010张不等;民营医院规模较小,病床数从20张到345张不等。参见新加坡卫生部网站:https://www.moh.gov.sg/content/moh_web/home/ourhealthcaresystem/Healthcare_Services/Hospitals.html,2018年8月12日。
[2]孙晓明.发达国家和地区医疗体制与保险制度[M].上海:上海科学技术出版社,2005.
[3]和经纬.“医改”的政策学习与政策工具---中国公立医院改革与新加坡经验[J].东南学术,2010,(3).
[4]Phua K,Hong F.Attacking Hospital Performanceon T ow F ronts:Network Corporatization and F inancingre-forms in Singapore[J].Innovations in Health Service Delivery,2003,(10).
[5]April Harding,Alexander S.Preker.Understanding Organizational Reforms:the Corporatization of Public Hospitals[M].Washington,DC:T he World Bank,2000.
[6]冯鹏程,荆涛.新加坡保健储蓄计划研究及启示[J].社会保障研究,2013,(6).
[7]Ezra Klein.Is Singapore’s“Miracle”Health Care System the Answer for America?[DB/OL].https://www.vox.com/policy-and-politics/2017/4/25/153-5611/singapore-health-care-system-explained,2017-04-25.
(1)新加坡保健公司后来改为卫生部控股公司(MOHHoldings,MOHH)。
(2)享受政府高补贴额的B2和C级病房占公立医院病床数的81%,而低补贴和无补贴的A和B1级病房只占公立医院病床数的19%。参见新加坡卫生部网站:https://www.moh.gov.sg/content/moh_web/home/our_halthcare_system/Healthcare_Services/Hospitals.html,2018年8月12日。
(3)目前,新加坡私立诊所已经达到1600间。参见新加坡卫生部网站:https://www.moh.gov.sg/content/moh_w eb/home/our_healthcare_system/Healthcare_Services/Primary_Care.html,2018年8月12日。
(4)新加坡公立医疗机构规模较大,提供病床数从185张到2010张不等;民营医院规模较小,病床数从20张到345张不等。参见新加坡卫生部网站:https://www.moh.gov.sg/content/moh_web/home/ourhealthcaresystem/Healthcare_Services/Hospitals.html,2018年8月12日。