基于新制度经济学的公立医院薪酬管理研究
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摘要
随着我国新一轮医疗卫生体制改革的逐步推进,解决公立医院薪酬管理的现存问题、提高薪酬管理效率具有越来越重要的现实意义,需要对此进行专门的理论研究。新制度经济学是以交易费用边际分析为特征的经济理论,对于现实问题具有较强的解释力。本文针对公立医院薪酬管理的现实问题,以新制度经济学相关理论为依据,从产权、制度、交易费用的角度对公立医院薪酬管理进行研究,力求发掘公立医院薪酬管理现实问题背后的深层原因,并提出相应的管理策略。
在公立医院薪酬管理的新制度经济学研究过程中,分别基于产权理论、合约理论和租值耗散理论构建了产权模型、合约模型和效率模型,对公立医院薪酬总量管理、薪酬分配管理和薪酬分配效率进行分析和评价,主要的工作成果包括:
1、将新制度经济学相关理论应用于公立医院薪酬管理,建立公立医院薪酬管理的新制度经济学研究框架。
2、建立公立医院薪酬总量管理的产权模型,提出公立医院产权归属的双重性导致了岗位人力资源需求的双重性,进而导致公立医院以自身垄断权利交换岗位所需的正常人力资源产权;公立医院岗位薪酬包括正常人力资源需求价值和垄断人力资源需求价值两部分,岗位薪酬的水平由垄断权利市场确定。
3、建立公立医院薪酬分配管理的合约模型,提出岗位人力资源需求的双重性导致了医院与岗位劳动合约的双重性,进而导致医院岗位追求垄断收益最大化;公立医院通过内、外部垄断权利市场分别实现了垄断权利的分配和价值实现,即岗位薪酬的分配也由垄断权利市场实现。
4、建立公立医院薪酬分配的效率模型,提出政府行政干预导致医院、医生产权制度的不完善,进而导致公立医院岗位人力资源发生了双重租值耗散,岗位员工减少租值耗散的行为增加了公立医院薪酬分配的交易费用,降低了薪酬分配的效率。
5、将公立医院薪酬管理模型应用于我国现实情况,论证了公立医院薪酬管理的问题实质上是计划体制和市场体制在医院薪酬管理领域冲突的具体表现,提出医院、政府层面改善薪酬管理的策略。公立医院一方面应消除内部垄断权利市场,采用医院直接获取垄断收益的方式,另一方面要建立动态绩效评价指标体系,实现垄断收益在医院内部的合理分配;政府应明确界定公立医院产权归属,建立适应医疗服务行业特点的市场价值,通过实现医院经营目的多元化、产权归属多元化实现医疗服务产品的高效率和高质量。
Along with the progressing of reformation of our national health care system, therunning model of public hospital ought to be changed. For the compensationmanagement is the important part of the running model, it is necessary to study on itand find out the reasons behind the problem, moreover to bring forward somemanagement suggestions. The study focuses the reality of the compensationmanagement of public hospital, and based on the New Institutional Economics, to findout the reasons of the problems and come up with some management policies.
The study have constructed property right model/agreement model/efficiencymodel based on the property right theory/agreement theory/rent dissipation theorywhich are from New Institutional Economics, this models are the consequences of theanglicizing to the compensation management of public hospital. The main progeniesof this paper are listed below.
1. Applying New Institutional Economics to the compensation management ofpublic hospital, the study builds a new analysis frame.
2. Constructing the property right model of compensation gross management inhospital, it’s bring forward that the dualism of property of public hospital result in thedualism of human resource requirement of positions. In order to balance thecompensation gross, the public hospitals use the right of monopoly to exchange thenormal human resource requirement of positions. The position compensation equalsthe marketable value of human resource which is including normal requirement andmonopoly requirement.
3. Constructing the agreement model of compensation distribution managementin hospital, it’s bring forward that the dualism of human resource requirement ofpositiones, and further result in hospital’s positiones chasing the maximum monopolyprofit. The inner and outer monopoly right market of public hospitals fulfills themonopoly right’s contribution in hospital’s positiones, so the position compensation ismade by monopoly right market.
4. Constructing the efficiency model of compensation distribution efficiencyassessment, it’s bringing forward that government’s over-administration result in thedualism of rent dissipation of position’s human resource. The behaviors of hospital’semployees what have been done is to reduce the rent dissipation result in thelow-efficiency of compensation distribution system of public hospital, it adds huge economic burden to patients.
5. The study draws the conclusion that the problems of the compensationmanagement of public hospital is the phenomena of conflict between the planningsystem and market system which takes place in the public hospitals. The publichospitals should eliminate the inner monopoly right market, and change the way bywhich hospitals get monopoly profit. On the other hand, hospitals should build a newperformance measure system to distribute the monopoly profit in a reasonable way；Our government should make the boundary of hospital’s property more clear, andbuild a health care market including all kinds of hospitals, such asgovernment-owned and person-owned, for-profit and not-for-profit.
在公立医院薪酬管理的新制度经济学研究过程中,分别基于产权理论、合约理论和租值耗散理论构建了产权模型、合约模型和效率模型,对公立医院薪酬总量管理、薪酬分配管理和薪酬分配效率进行分析和评价,主要的工作成果包括:
1、将新制度经济学相关理论应用于公立医院薪酬管理,建立公立医院薪酬管理的新制度经济学研究框架。
2、建立公立医院薪酬总量管理的产权模型,提出公立医院产权归属的双重性导致了岗位人力资源需求的双重性,进而导致公立医院以自身垄断权利交换岗位所需的正常人力资源产权;公立医院岗位薪酬包括正常人力资源需求价值和垄断人力资源需求价值两部分,岗位薪酬的水平由垄断权利市场确定。
3、建立公立医院薪酬分配管理的合约模型,提出岗位人力资源需求的双重性导致了医院与岗位劳动合约的双重性,进而导致医院岗位追求垄断收益最大化;公立医院通过内、外部垄断权利市场分别实现了垄断权利的分配和价值实现,即岗位薪酬的分配也由垄断权利市场实现。
4、建立公立医院薪酬分配的效率模型,提出政府行政干预导致医院、医生产权制度的不完善,进而导致公立医院岗位人力资源发生了双重租值耗散,岗位员工减少租值耗散的行为增加了公立医院薪酬分配的交易费用,降低了薪酬分配的效率。
5、将公立医院薪酬管理模型应用于我国现实情况,论证了公立医院薪酬管理的问题实质上是计划体制和市场体制在医院薪酬管理领域冲突的具体表现,提出医院、政府层面改善薪酬管理的策略。公立医院一方面应消除内部垄断权利市场,采用医院直接获取垄断收益的方式,另一方面要建立动态绩效评价指标体系,实现垄断收益在医院内部的合理分配;政府应明确界定公立医院产权归属,建立适应医疗服务行业特点的市场价值,通过实现医院经营目的多元化、产权归属多元化实现医疗服务产品的高效率和高质量。
Along with the progressing of reformation of our national health care system, therunning model of public hospital ought to be changed. For the compensationmanagement is the important part of the running model, it is necessary to study on itand find out the reasons behind the problem, moreover to bring forward somemanagement suggestions. The study focuses the reality of the compensationmanagement of public hospital, and based on the New Institutional Economics, to findout the reasons of the problems and come up with some management policies.
The study have constructed property right model/agreement model/efficiencymodel based on the property right theory/agreement theory/rent dissipation theorywhich are from New Institutional Economics, this models are the consequences of theanglicizing to the compensation management of public hospital. The main progeniesof this paper are listed below.
1. Applying New Institutional Economics to the compensation management ofpublic hospital, the study builds a new analysis frame.
2. Constructing the property right model of compensation gross management inhospital, it’s bring forward that the dualism of property of public hospital result in thedualism of human resource requirement of positions. In order to balance thecompensation gross, the public hospitals use the right of monopoly to exchange thenormal human resource requirement of positions. The position compensation equalsthe marketable value of human resource which is including normal requirement andmonopoly requirement.
3. Constructing the agreement model of compensation distribution managementin hospital, it’s bring forward that the dualism of human resource requirement ofpositiones, and further result in hospital’s positiones chasing the maximum monopolyprofit. The inner and outer monopoly right market of public hospitals fulfills themonopoly right’s contribution in hospital’s positiones, so the position compensation ismade by monopoly right market.
4. Constructing the efficiency model of compensation distribution efficiencyassessment, it’s bringing forward that government’s over-administration result in thedualism of rent dissipation of position’s human resource. The behaviors of hospital’semployees what have been done is to reduce the rent dissipation result in thelow-efficiency of compensation distribution system of public hospital, it adds huge economic burden to patients.
5. The study draws the conclusion that the problems of the compensationmanagement of public hospital is the phenomena of conflict between the planningsystem and market system which takes place in the public hospitals. The publichospitals should eliminate the inner monopoly right market, and change the way bywhich hospitals get monopoly profit. On the other hand, hospitals should build a newperformance measure system to distribute the monopoly profit in a reasonable way；Our government should make the boundary of hospital’s property more clear, andbuild a health care market including all kinds of hospitals, such asgovernment-owned and person-owned, for-profit and not-for-profit.
引文
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