我国医院社会责任评价指标体系的研究
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摘要
近年来,伴随着医疗服务行业运用市场化手段进行改革,医院出现了片面追求经济利益,忽视自身社会责任的现象。“大处方”诱导需求、滥检查等现象屡见不鲜,医患纠纷不断出现。医院社会责任的缺失已经严重影响了我国医疗卫生事业的发展,医院的公益性不断受到质疑。目前,我国学术界还未形成关于医院社会责任的系统理论,如何科学地确立社会责任的评价指标体系,如何保证医院履行社会责任都是急需解决的问题。
本文的核心问题是研究如何确定医院社会责任评价的指标体系。其中测量指标的选择主要运用文献研究法、问卷调查法、专家咨询法,指标权重的确定是采用层次分析法(AHP),并且通过SPSS软件及EXCEL对回收的问卷数据进行了处理,最终确定了22个医院社会责任测量指标及其权重,在此指标体系中赋予了初级和高级医院社会责任较大的权重。研究中还了解到,目前我国医院社会责任的履行情况并不乐观,尤其在药品价格、医疗服务可及性及患者满意度上表现较差。所以,政府部门应建立医院社会责任的评价考核机制,尤其是对公立医院要进行治理、补偿、监管和绩效考核等制度方面的设计,来保障医院社会责任的履行。
In recent years, with reform in medical service by means of market mechanism, the following phenomenon was occurred in the hospital. The hospital pursuits economic interests unilaterally and ignores its social responsibility. "Great recipe" induces demand, excessive checks occur commonly. Doctor-patient disputes are on the rise. Absence of social responsibility of the hospital already has a serious impact on the development of medical and health services and public welfare of the hospitals is challenged constantly.At present, academic circle in our country has not formed systems theory of hospital's social responsibility. All the following problems are urgent to solve, such as how to establish a scientifical evaluation index system and design a relevant mechanism to ensure the fulfillment of hospital social responsibility.
Core issue of this paper is how to determine the measurement and evaluation index system of hospital social responsibility. The paper uses the literature study, questionnaire survey and expert consultation to determine the measurement index. AHP is used to determine the index weight. Through SPSS and excel software for data processing,22 indexes of hospital social responsibility are established, among which primary and advanced hospital social responsibility are given a greater weight. Studies have also learned that the current performance of the hospital social responsibility is not optimistic, especially in drug prices, health care accessibility and poor performance on patient satisfaction. Therefore, government should establish the hospital's assessment and evaluation mechanism of social responsibility, especially for public hospitals to designe the governance, compensation, regulatory mechanism and other systems to ensure social responsibility.
本文的核心问题是研究如何确定医院社会责任评价的指标体系。其中测量指标的选择主要运用文献研究法、问卷调查法、专家咨询法,指标权重的确定是采用层次分析法(AHP),并且通过SPSS软件及EXCEL对回收的问卷数据进行了处理,最终确定了22个医院社会责任测量指标及其权重,在此指标体系中赋予了初级和高级医院社会责任较大的权重。研究中还了解到,目前我国医院社会责任的履行情况并不乐观,尤其在药品价格、医疗服务可及性及患者满意度上表现较差。所以,政府部门应建立医院社会责任的评价考核机制,尤其是对公立医院要进行治理、补偿、监管和绩效考核等制度方面的设计,来保障医院社会责任的履行。
In recent years, with reform in medical service by means of market mechanism, the following phenomenon was occurred in the hospital. The hospital pursuits economic interests unilaterally and ignores its social responsibility. "Great recipe" induces demand, excessive checks occur commonly. Doctor-patient disputes are on the rise. Absence of social responsibility of the hospital already has a serious impact on the development of medical and health services and public welfare of the hospitals is challenged constantly.At present, academic circle in our country has not formed systems theory of hospital's social responsibility. All the following problems are urgent to solve, such as how to establish a scientifical evaluation index system and design a relevant mechanism to ensure the fulfillment of hospital social responsibility.
Core issue of this paper is how to determine the measurement and evaluation index system of hospital social responsibility. The paper uses the literature study, questionnaire survey and expert consultation to determine the measurement index. AHP is used to determine the index weight. Through SPSS and excel software for data processing,22 indexes of hospital social responsibility are established, among which primary and advanced hospital social responsibility are given a greater weight. Studies have also learned that the current performance of the hospital social responsibility is not optimistic, especially in drug prices, health care accessibility and poor performance on patient satisfaction. Therefore, government should establish the hospital's assessment and evaluation mechanism of social responsibility, especially for public hospitals to designe the governance, compensation, regulatory mechanism and other systems to ensure social responsibility.
引文
[1]蒋祥虎.公立医院运行机制改革创新研究[M].北京：中国经济出版社,2005：1.
[2]王勇,许庆瑞.以战略为中心的业绩评价理论框架研究[J].科研管理,2001, (5)：128-135.
[3]Clarkson. A Stakeholder Framework for Analyzing and Evaluating Corporate Social Performance[J]. The Academy Of Management Review,1995 Jan:20.
[4]李淑英.社会契约论视野中的企业社会责任[J].中国人民大学学报,2007,2(2)：51-57.
[5]席建国.企业社会责任：我国企业发展史上的一场革命[J].上海企业,2005,12：62-67.
[6]欧阳润平,宁亚春.西方企业社会责任战略管理相关研究述评[J].湖南大学学报(社会科学版),2009,23(2)：48-52.
[7]赵琼.国外企业社会责任理论述评——企业与社会的关系视角[J].广东社会科学,2007,4：172-177.
[8]Carroll, A B. The Pyramid of Corporate Social Responsibility:Toward the Moral Management of Organizational Stakeholders[J]. Business Horizon, July-August 1991:50.
[9]周国银,张少标.SA8000：2001社会责任国际标准实施指南[M].深圳：海天出版社,2002：24.
[10]Sandrick K. Defining & measuring community benefit[J]. Hospitals & Health Networks, 2006,80 (11):66.
[11]Buchmueller T C, Feldstein P J. Hospital community benefits other than charity care: Implications for tax exemption and public policy[J]. Hospital & Health Services Administration, 1996,41 (4):461.
[12]冯斌.社会效益的最大化与适度经济效益的统一[J].中国卫生经济,2001, (3)：37.
[13]Buczko, William. Factors Affecting Charity Care and Bad Debt Charges in Washington Hospitals[J]. Hospital&Health Services Administration,summer 1994; 39,2:179-191.
[14]Clement Jan p; Smith Dean G:Wheeler John R C. What do we want and what do we get from not-for-profit hospitals [J]. Hospital & Health Services Administration,1994,39(2):159.
[15]Ginn, G.0. and Moseley, C. B. The Impact of State Community Benefit Laws on the Community Health Orientation and Health Promotion Services of Hospitals[J]. Journal of Health Politics, Policy and Law, April 2006,31 (2):321-345.
[16](Nicholson S.; Pauly M. V.; Burns L. R.; Agnieshka, B.; Asch D. A. Measuring community benefits provided by for-profit and nonprofit hospitals[J]. Health Affairs, Nov/Dec 2000,19 (6):168-177.
[17]徐雪梅.对非营利性组织社会责任测度的构想[J].管理世界,2005,(4)：145-146.
[18]王朝英,王承馨,于润吉.医院经营方式应体现公益性原则[J].中国卫生经济,2006, (7)66-67.
[19]李立清.企业社会责任评价理论与实证研究：以湖南省为例[J].南方经济,2006,(1)：105-118.
[20]辛杰.基十利益相关者的企业社会责任指标与表现评价[J].山东社会科学,2008,(11)84-86.
[21]Edith M Lentz. Hospital Administration-One of a Species[J].Administrative Science Quarterly,1957,1 (4):444-463.
[22]徐爱军,周春红.转型时期我国医院的社会责任及其影响因素[J].中国卫生经济,2009,28(1)：18-20.
[23]王俊华.以社会责任为目标引领我国医疗服务机构改革[J].中国卫生事业管理,2005,(4)：196—198.
[24]刘鸣义,王文举.社会责任与医院竞争力[J].中华现代医院管理杂志,2004, (8)：22-23.
[25]杨群.医院的经济效益及两个效益最佳结合的模式[J].中国卫生经济,1997, (4)：12-13.
[26]Rosko, Michael D. The Supply of Uncompensated Care in Pennsylvania Hospitals:Motives and Financial Consequences[J]. Health Care Management Review,2004,29 (3):229-239.
[27][美]舍曼·富兰德,艾伦·古特曼,迈伦·斯坦诺.卫生经济学[M].王健、孟庆跃译.北京：中国人民大学出版社,2004：406.
[28]余锋.浅谈院长在医院管理中的主导作用[J].中华医院管理杂志,1995, (12)：759-760.
[29]许树强,和晋予.现代医院治理结构探索[J].中国卫生经济,2003,(11)：42-43.
[30]徐爱军.医院社会责任和治理结构：一个整合的视角[J].中国卫生事业管理,2009,(6)：387-388.
[31]黄晓光.关于医院建立董事会制度及完善法人治理结构的思考[J].中国卫生经济,2003,7：43-45.
[32]Clement, Jan p, Smith, Dean G, Wheeler, John R C. What do we want and what do we get from not-for-profit hospitals[J]. Hospital & Health Services Administration,1994,39, 2:159.
[33]Ginn, Gregory 0.; Moseley, Charles B.. The Impact of State Community Benefit Laws on the Community Health Orientation and Health Promotion Services of Hospitals[J]. Journal of Health Politics, Policy and Law:April 2006,31(2):321-345.
[34]Thorpe, Kenneth E.; Phelps, Charles E. The Social Role of Not-for-Profit Organizations: Hospital Provision of Charity care[J]. Economic Inquiry, Jul 1991,29,3:472-484.
[35]刘东.微观经济学新论[M].南京：南京大学出版社,2007：227.
[36]Horwitz, Jill R. Does Nonprofit Ownership Matter[J]. Yale Journal on Regulation, 2007,24,1:183.
[37]李从东,沈凯,汤勇力.公立非营利医院补偿方对医院的内外部治理研究[J].现代医院,2009,9(7)：1-4.
[38]余绪鹏.英、美、新、德四国医疗体制对我国的启示[J].中国药业,2007,16(12)：1-3.
[39]郭国庆,刘彦平.国外非营利机构的发展及其管理趋势[J].北京行政学院学报,2003,(4)：50-54.
[40]许星莹,夏萍,邱鸿钟.我国医院医疗质量监督评价指标体系的循证评价[J].现代预防医学,2009,36(6)：1076-1078.
[41]徐爱军,杨学伟,谢蓉蓉.基十分级模型的医院社会责任内容探讨[J].中国医院管理,2010,30(7)：15-17.
[42]谢蓉蓉,徐爱军,卜胜娟.医院社会责任测量、研究思路和指标体系[J].中国医院管理,2010,30(7)：18-20.
[43]黄卫军,陶红兵.对公立医院公益性的内涵及外延的分析[J].医学与社会,2009,22(4)：28-30.
[44]卫生部.医院管理评价指南[M].北京：中国法制出版社,2008：27.
[45]黄宝中.科技指标预测方法探讨[J].统计与决策,2008, (2)：159-160.
[46]平卫伟,谭红专.Delphi法的研究进展及其在医学中的应用[J].疾病控制杂志,2003,7(3)：243-246.
[47]万景,师少军.我国临床药师工作难度的思考[J].中国药师,2004,7(5)：353-355.
[48]曹洪军,赵翔,黄少坚.企业自主创新能力评价体系研究[J].中国工业经济,2009, (9)：105-114.
[49]彭国甫,李树丞.应用层次分析法确定政府绩效评估指标权重研究[J].中国软科学,2004,(6)：136-139.
[50]杜栋,庞庆华.现代综合评价方法与案例精选[M].北京：清华大学出版社,2005：10-33.
[51]杨静,党勇,张丽芳.我国社区卫生服务机构绩效评估指标体系[J].中国卫生经济,2010,29(4)：52-54.
[2]王勇,许庆瑞.以战略为中心的业绩评价理论框架研究[J].科研管理,2001, (5)：128-135.
[3]Clarkson. A Stakeholder Framework for Analyzing and Evaluating Corporate Social Performance[J]. The Academy Of Management Review,1995 Jan:20.
[4]李淑英.社会契约论视野中的企业社会责任[J].中国人民大学学报,2007,2(2)：51-57.
[5]席建国.企业社会责任：我国企业发展史上的一场革命[J].上海企业,2005,12：62-67.
[6]欧阳润平,宁亚春.西方企业社会责任战略管理相关研究述评[J].湖南大学学报(社会科学版),2009,23(2)：48-52.
[7]赵琼.国外企业社会责任理论述评——企业与社会的关系视角[J].广东社会科学,2007,4：172-177.
[8]Carroll, A B. The Pyramid of Corporate Social Responsibility:Toward the Moral Management of Organizational Stakeholders[J]. Business Horizon, July-August 1991:50.
[9]周国银,张少标.SA8000：2001社会责任国际标准实施指南[M].深圳：海天出版社,2002：24.
[10]Sandrick K. Defining & measuring community benefit[J]. Hospitals & Health Networks, 2006,80 (11):66.
[11]Buchmueller T C, Feldstein P J. Hospital community benefits other than charity care: Implications for tax exemption and public policy[J]. Hospital & Health Services Administration, 1996,41 (4):461.
[12]冯斌.社会效益的最大化与适度经济效益的统一[J].中国卫生经济,2001, (3)：37.
[13]Buczko, William. Factors Affecting Charity Care and Bad Debt Charges in Washington Hospitals[J]. Hospital&Health Services Administration,summer 1994; 39,2:179-191.
[14]Clement Jan p; Smith Dean G:Wheeler John R C. What do we want and what do we get from not-for-profit hospitals [J]. Hospital & Health Services Administration,1994,39(2):159.
[15]Ginn, G.0. and Moseley, C. B. The Impact of State Community Benefit Laws on the Community Health Orientation and Health Promotion Services of Hospitals[J]. Journal of Health Politics, Policy and Law, April 2006,31 (2):321-345.
[16](Nicholson S.; Pauly M. V.; Burns L. R.; Agnieshka, B.; Asch D. A. Measuring community benefits provided by for-profit and nonprofit hospitals[J]. Health Affairs, Nov/Dec 2000,19 (6):168-177.
[17]徐雪梅.对非营利性组织社会责任测度的构想[J].管理世界,2005,(4)：145-146.
[18]王朝英,王承馨,于润吉.医院经营方式应体现公益性原则[J].中国卫生经济,2006, (7)66-67.
[19]李立清.企业社会责任评价理论与实证研究：以湖南省为例[J].南方经济,2006,(1)：105-118.
[20]辛杰.基十利益相关者的企业社会责任指标与表现评价[J].山东社会科学,2008,(11)84-86.
[21]Edith M Lentz. Hospital Administration-One of a Species[J].Administrative Science Quarterly,1957,1 (4):444-463.
[22]徐爱军,周春红.转型时期我国医院的社会责任及其影响因素[J].中国卫生经济,2009,28(1)：18-20.
[23]王俊华.以社会责任为目标引领我国医疗服务机构改革[J].中国卫生事业管理,2005,(4)：196—198.
[24]刘鸣义,王文举.社会责任与医院竞争力[J].中华现代医院管理杂志,2004, (8)：22-23.
[25]杨群.医院的经济效益及两个效益最佳结合的模式[J].中国卫生经济,1997, (4)：12-13.
[26]Rosko, Michael D. The Supply of Uncompensated Care in Pennsylvania Hospitals:Motives and Financial Consequences[J]. Health Care Management Review,2004,29 (3):229-239.
[27][美]舍曼·富兰德,艾伦·古特曼,迈伦·斯坦诺.卫生经济学[M].王健、孟庆跃译.北京：中国人民大学出版社,2004：406.
[28]余锋.浅谈院长在医院管理中的主导作用[J].中华医院管理杂志,1995, (12)：759-760.
[29]许树强,和晋予.现代医院治理结构探索[J].中国卫生经济,2003,(11)：42-43.
[30]徐爱军.医院社会责任和治理结构：一个整合的视角[J].中国卫生事业管理,2009,(6)：387-388.
[31]黄晓光.关于医院建立董事会制度及完善法人治理结构的思考[J].中国卫生经济,2003,7：43-45.
[32]Clement, Jan p, Smith, Dean G, Wheeler, John R C. What do we want and what do we get from not-for-profit hospitals[J]. Hospital & Health Services Administration,1994,39, 2:159.
[33]Ginn, Gregory 0.; Moseley, Charles B.. The Impact of State Community Benefit Laws on the Community Health Orientation and Health Promotion Services of Hospitals[J]. Journal of Health Politics, Policy and Law:April 2006,31(2):321-345.
[34]Thorpe, Kenneth E.; Phelps, Charles E. The Social Role of Not-for-Profit Organizations: Hospital Provision of Charity care[J]. Economic Inquiry, Jul 1991,29,3:472-484.
[35]刘东.微观经济学新论[M].南京：南京大学出版社,2007：227.
[36]Horwitz, Jill R. Does Nonprofit Ownership Matter[J]. Yale Journal on Regulation, 2007,24,1:183.
[37]李从东,沈凯,汤勇力.公立非营利医院补偿方对医院的内外部治理研究[J].现代医院,2009,9(7)：1-4.
[38]余绪鹏.英、美、新、德四国医疗体制对我国的启示[J].中国药业,2007,16(12)：1-3.
[39]郭国庆,刘彦平.国外非营利机构的发展及其管理趋势[J].北京行政学院学报,2003,(4)：50-54.
[40]许星莹,夏萍,邱鸿钟.我国医院医疗质量监督评价指标体系的循证评价[J].现代预防医学,2009,36(6)：1076-1078.
[41]徐爱军,杨学伟,谢蓉蓉.基十分级模型的医院社会责任内容探讨[J].中国医院管理,2010,30(7)：15-17.
[42]谢蓉蓉,徐爱军,卜胜娟.医院社会责任测量、研究思路和指标体系[J].中国医院管理,2010,30(7)：18-20.
[43]黄卫军,陶红兵.对公立医院公益性的内涵及外延的分析[J].医学与社会,2009,22(4)：28-30.
[44]卫生部.医院管理评价指南[M].北京：中国法制出版社,2008：27.
[45]黄宝中.科技指标预测方法探讨[J].统计与决策,2008, (2)：159-160.
[46]平卫伟,谭红专.Delphi法的研究进展及其在医学中的应用[J].疾病控制杂志,2003,7(3)：243-246.
[47]万景,师少军.我国临床药师工作难度的思考[J].中国药师,2004,7(5)：353-355.
[48]曹洪军,赵翔,黄少坚.企业自主创新能力评价体系研究[J].中国工业经济,2009, (9)：105-114.
[49]彭国甫,李树丞.应用层次分析法确定政府绩效评估指标权重研究[J].中国软科学,2004,(6)：136-139.
[50]杜栋,庞庆华.现代综合评价方法与案例精选[M].北京：清华大学出版社,2005：10-33.
[51]杨静,党勇,张丽芳.我国社区卫生服务机构绩效评估指标体系[J].中国卫生经济,2010,29(4)：52-54.