提升医院绩效研究
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摘要
进入20世纪80年代,发达国家在政府的支持下,基本建立了医疗保险体系和医疗服务提供体系,以保障公众享受医疗服务的权力。而要长期维持这种享受医疗服务的公平,政府将会面临很大的财政压力。鉴于此,不少发达国家通过增加私人部门的活动以及引入市场竞争机制以提升医院绩效。在这个过程中,各国都面临着如何选择有利于提升医院绩效的制度安排问题。
20世纪80年代初,迫于政府财力缺乏、公立医院表现出的不良绩效等压力,中国亦采取了对公立医院的产权和允许民营医院进入医疗服务市场等在内的改革措施。改革的目的是减轻政府的财政负担以及提升医院绩效。然而,通过这些年的改革,中国目前仍广泛存在医院绩效不良的问题。
针对各国面临的提升医院绩效这个难题,本文从提升医院绩效的特殊性出发,以产权理论、交易成本理论为视角,研究有利于提升医院绩效的组织形式。通过权衡不同制度安排交易成本的高低,为医疗服务提供组织形式的选择提供基本的理论依据与实证资料。本文研究可让政策制定者认识到,盲目地把医疗服务推向市场或简单地通过政府直接控制医院对提升医院绩效都是不利的。医疗改革必须从医疗服务市场交易的基本规律出发,在确定医院所有权格局的基础上,通过市场与管制间的有机融合达到有效提升医院绩效的目的。鉴于此,本文可为中国政府相关部门制定医院改革政策提供基本思路。
基于以上研究背景和研究目的,本文的主要内容如下:
第一章,导论。从研究背景与意义出发,对提升医院绩效的相关研究进行较全面的梳理,继而阐述本文的研究内容、研究方法以及本文的研究创新和不足之处。
第二章,所有权、市场与管制安排的一般理论分析。探讨所有权激励和企业治理结构对医院绩效的影响。从交易成本理论出发,分析在进行企业与市场组织以及市场与管制组织间选择时交易成本的决定性作用。基于交易成本分析的基础上,借助可竞争性与可度量性矩阵模型以及制度可能性边界模型对不同制度安排进行比较分析。
第三章,医疗服务市场的交易特征。医院绩效提升的制度安排取决于医疗服务市场的特殊性。首先,医疗服务市场中最典型的特征就是信息的不完备性以及由此产生的委托代理关系;其次,医疗服务市场表现出明显的垄断性、非价格竞争以及特有的可竞争性;再次,医疗服务是具有外部性的公共物品,同时又是具有竞争性和排他性的私人物品。
第四章,提升医院绩效制度安排的理论框架。本文围绕提升医院绩效问题,通过比较提升医院绩效的内部方法和外部方法,强调了外部方法对提升医院绩效的特殊作用。进而针对外部方法中的市场和管制对医院的激励和约束作用,阐明市场与管制间的关系。然后从所有权对医院绩效的激励作用,以及市场与管制间的权衡全面分析提升医院绩效的理论框架。
第五章,发达国家提升医院绩效的制度安排:以美国和英国为例。围绕提升医院绩效问题,各国采取了在市场与管制间权衡的不同政策,其中以美国和英国最具有代表性。本文通过对美国和英国为提升医院绩效的医疗改革实践的梳理,总结出可以为中国借鉴的经验。
第六章,提升中国医院绩效的制度安排。本文在对中国医院改革的演变历史进行简单回顾的基础上,分析目前中国医院改革面临的困惑。基于所有权对医院绩效的激励作用,研究建立符合中国实际的医院所有权格局和公立医院法人治理结构,进而设计市场与管制相融合的有利于提升医院绩效的模式及其制度框架。
基于以上分析,本文得到以下结论:
1.提升医院绩效是确保公众享受医疗服务公平性的基本前提;
2.由于医疗服务市场的多种不完备性,提升医院绩效具有特殊性;
3.提升医院绩效的制度安排应以交易成本最小化为基本原则;
4.基于市场机制提升医院绩效,应不断完善法规以及提高管制效率;
5.通过竞争促进医院绩效提升应考虑引入市场竞争的层面;
6.应以交易成本最小化构建具有中国特色的提升医院绩效的制度安排。
本文采用的主要方法有:理论与实践相结合的研究方法、实证分析和规范分析相结合的研究方法以及制度分析方法。
本文研究的创新主要有:
1.以产权理论和交易成本理论的视角,深入系统地研究了提升医院绩效的制度安排问题。国内对医院绩效研究主要从医院微观经营管理角度分析较多,尚缺乏从制度角度的分析。而关于如何通过不同的制度安排提升医院绩效问题,从国外研究来看,目前尚处于探索阶段,亦是个较新的课题。
2.提出并论证了应根据医疗服务的特征选择不同的提升医院绩效的制度安排。由于各种医疗服务市场的可竞争性与可度量性的组合特征存在差异,本文提出在考虑提升医院绩效制度安排的过程中,应通过医疗服务市场可竞争性与医疗服务的可度量性矩阵模型对医疗服务进行分类,根据这种分类对不同医疗服务所选择的制度安排进行界定,政府对不同医疗服务控制程度应实施差异性政策,这种区分可以防止政府在实施医院改革过程中的盲目性。
3.构建了所有权、市场与管制有机融合的医院绩效提升模式。在发达国家,为提升医院绩效,政府的改革政策往往会对医院所有权格局进行调整,并在市场与管制间进行权衡。在医院所有权格局既定的情况下,在特定时期,政府政策可能会过多倾向于管制;而另一个阶段则会偏重于引入市场竞争,这种改革的结果很难全面提升医院绩效。因此,本文从中国实际出发,建议应通过在医院所有权格局进行调整的基础上,构建市场与管制有机融合起来的全面提升医院绩效的模式。
4.提出中国应实施反应灵敏型的“多元化”医院管制政策。根据交易成本理论,不同制度安排所表现出的交易成本高低与市场发育程度、政府管制效率以及组织本身的管理水平存在密切的关系。一方面,与落后地区(城市)相比,中国发达地区(城市)的市场发育较成熟,且政府管制效率较高。因此,政府政策制定过程中,在进行市场与管制安排的选择时,应根据市场发育程度以及政府管制效率地域上的“多元化”特征,实施区别对待的反应灵敏型的医院管制政策。另一方面,由于不同的医院组织的内部管理能力的差异,医院发展亦存在“多元化”特征,政府在实施管制政策时亦应该区别对待。
In the 1980s, under the government support, healthcare insurance system and health care service delivery and provision system are built in developed countries to ensure the right of public's access to the healthcare service. To maintain the equity of the access to healthcare service, the government will face a great fiscal financial pressure. In many developed countries, substantial private sector activities in healthcare provision to improve hospital performance. Every country faces the problem of institution arrangement of hospital performance improvement.
Since the early of the 1980s, under the pressure of the shortage of fiscal financial, and the poor performance of public hospital, Chinese government took the measures of the reform of public hospital property right and the private hospital involved in the financing, delivery and provision of healthcare services. The goals of reform are to decrease the fiscal finance pressure and to improve hospital performance. However, the hospital performance is still poor after the reform in China.
Facing the problem of hospital performance improvement, this paper discuss the form that fit for the hospital performance improvement based on the property right theory and transaction cost theory according to the particularity of hospital performance improvement. After trading off the transaction cost of different institution arrangement, the theory and practice information can be obtained for the choice of healthcare organization. Furthermore, the paper can remind the policy constitutor of avoiding to privatize completely blindly or to control under government directly simply. Healthcare reform must follow the rule of the healthcare service market transaction. Based on the form of hospital ownership, the market and regulation must be combined to improve the hospital performance. This paper can provide the basic idea of establishing policies by the government sector.
According the background information and the goals, this study includes the contents as follows:
Chapter one does a theoretic preparation for the whole thesis. This chapter discusses the background and the significance of hospital performance improvement. Literatures of the studies about hospital performance improvement are concluded. Then the content, method, innovation and deficiency are illustrated.
Chapter two is about the general theory analysis of ownership, market and regulation arrangement. This thesis discusses the influence of ownership incentives and the firm governance structure. Based on the transaction cost theory, the role of transaction cost is analyzed during the discussion of the choice between the firms and market organization, and between the market and the regulation organization. Then the different institution arrangements are compared by the models of contestable-measurable matrix and the models of frontier of the institutional possibility.
Chapter three analyzes the characters of healthcare services market. The institutional arrangement of the hospital performance improvement is dependent on the particularity of the healthcare service market. The typical characters are the incomplete information and the principal-agent relationship. In the healthcare service market, hospitals have the market power, non-price competition and contestable. Healthcare service is the public goods that have externality. At the same time, it is the private goods that are rival and exclusive.
Chapter four illustrates the theory framework of institutional arrangement of hospital performance improvement. This chapter emphasize the external approaches have the special role for hospital performance improvement by comparing the internal approaches with the external approaches. Furthermore, it discusses the roles of market incentives and regulation constraint, and illustrates the relationship between the market and regulation. Based on the discussion of incentives of ownership for the hospital performance and trading-off between the market and the regulation, this chapter states the institutional framework that benefits for hospital performance improvement
Taking the examples of America and England, Chapter five concludes the international experience of institutional arrangement of improving hospital performance. To improve the hospital performance, each country took different policies. Based on the practices of American and British institutional arrangement for hospital performance improvement, this chapter concludes the experience that can be used for reference by China.
Chapter six discusses the institutional arrangement of hospital performance improvement of China. After retrospection the history of healthcare reform simply, this chapter analyses the puzzles of the reform of healthcare service provision in China. Considering the incentives of ownership, the forms of hospital ownership and public hospital governance structure should be considered. Furthermore, the model that market and regulation are combined and the institutional framework are designed.
Based on these above, the conclusions can be summarized as follows:
1. Hospital performance improvement is the basic precondition that publics access to healthcare service;
2. As the healthcare service market has varieties of incompletion, hospital performance improvement is special.
3. The basic principle of the institutional arrangement of hospital performance improvement is the transaction cost minimization.
4. The perfect law and high efficient regulation are benefits for the hospital performance improvement through the market mechanism.
5. The competition level must be considered when hospital performance is improved by the market competition.
6. The institution arrangement of hospital performance improvement of China should be framed based on the transaction cost minimization.
This paper bases its analysis on the approach of theory and practice combination, positive statement and normative statement combined, and the approach of institutional analysis.
The main innovations of the paper can be summarized as follows:
1. The institutional arrangement of hospital performance improvement is deeply analyzed by the theory of property right and transaction cost. In China, most studies about the hospital performance improvement are from the management science, not from the institutional economics. This topic is also a new area in other countries.
2. The paper illustrates that the different institutional arrangement of hospital performance improvement is chosen by the character of healthcare service. Because the combinations of contestable and measurable of varieties of healthcare service market are different, this paper holds that the healthcare services must be classified by the combinations of contestable and measurable when the institutional arrangement of hospital performance improvement is chosen. The policy should be different according to classification. Doing so, the blindness can be avoided when government implement the hospital reform.
3. The model has been built based on the combination of ownership, market and regulation. To improve the hospital performance, the formation of hospital ownership is often adjusted, and market mechanism and regulation must be traded off by the reform policy in developed country. Given the ownership of hospital, government may be inclined to regulation during some special period, but next they may lay particular stress on market competition. The result is that the hospital performance is improved incompletely. Therefore, this study gives a suggestion that the model of complete hospital performance improvement is built based on the formation of ownership, and the combination of market mechanism and regulation.
4. The paper states that the hospital regulation policy must be 'pluralistic'. The transaction cost of different institutional arrangements is related with the development of market, the efficiency of regulation and the level of organization management. On the one hand, the market is more developed and the regulation is more efficiency in developed areas than the underdeveloped areas in China. Therefore, the government should implement the responsive regulation policy according to the character of 'pluralistic' when they constitute the policies. On the other hand, the level of each hospital management is different, the hospital development is also 'pluralistic', and thus the policy of regulation must be different among hospitals.
20世纪80年代初,迫于政府财力缺乏、公立医院表现出的不良绩效等压力,中国亦采取了对公立医院的产权和允许民营医院进入医疗服务市场等在内的改革措施。改革的目的是减轻政府的财政负担以及提升医院绩效。然而,通过这些年的改革,中国目前仍广泛存在医院绩效不良的问题。
针对各国面临的提升医院绩效这个难题,本文从提升医院绩效的特殊性出发,以产权理论、交易成本理论为视角,研究有利于提升医院绩效的组织形式。通过权衡不同制度安排交易成本的高低,为医疗服务提供组织形式的选择提供基本的理论依据与实证资料。本文研究可让政策制定者认识到,盲目地把医疗服务推向市场或简单地通过政府直接控制医院对提升医院绩效都是不利的。医疗改革必须从医疗服务市场交易的基本规律出发,在确定医院所有权格局的基础上,通过市场与管制间的有机融合达到有效提升医院绩效的目的。鉴于此,本文可为中国政府相关部门制定医院改革政策提供基本思路。
基于以上研究背景和研究目的,本文的主要内容如下:
第一章,导论。从研究背景与意义出发,对提升医院绩效的相关研究进行较全面的梳理,继而阐述本文的研究内容、研究方法以及本文的研究创新和不足之处。
第二章,所有权、市场与管制安排的一般理论分析。探讨所有权激励和企业治理结构对医院绩效的影响。从交易成本理论出发,分析在进行企业与市场组织以及市场与管制组织间选择时交易成本的决定性作用。基于交易成本分析的基础上,借助可竞争性与可度量性矩阵模型以及制度可能性边界模型对不同制度安排进行比较分析。
第三章,医疗服务市场的交易特征。医院绩效提升的制度安排取决于医疗服务市场的特殊性。首先,医疗服务市场中最典型的特征就是信息的不完备性以及由此产生的委托代理关系;其次,医疗服务市场表现出明显的垄断性、非价格竞争以及特有的可竞争性;再次,医疗服务是具有外部性的公共物品,同时又是具有竞争性和排他性的私人物品。
第四章,提升医院绩效制度安排的理论框架。本文围绕提升医院绩效问题,通过比较提升医院绩效的内部方法和外部方法,强调了外部方法对提升医院绩效的特殊作用。进而针对外部方法中的市场和管制对医院的激励和约束作用,阐明市场与管制间的关系。然后从所有权对医院绩效的激励作用,以及市场与管制间的权衡全面分析提升医院绩效的理论框架。
第五章,发达国家提升医院绩效的制度安排:以美国和英国为例。围绕提升医院绩效问题,各国采取了在市场与管制间权衡的不同政策,其中以美国和英国最具有代表性。本文通过对美国和英国为提升医院绩效的医疗改革实践的梳理,总结出可以为中国借鉴的经验。
第六章,提升中国医院绩效的制度安排。本文在对中国医院改革的演变历史进行简单回顾的基础上,分析目前中国医院改革面临的困惑。基于所有权对医院绩效的激励作用,研究建立符合中国实际的医院所有权格局和公立医院法人治理结构,进而设计市场与管制相融合的有利于提升医院绩效的模式及其制度框架。
基于以上分析,本文得到以下结论:
1.提升医院绩效是确保公众享受医疗服务公平性的基本前提;
2.由于医疗服务市场的多种不完备性,提升医院绩效具有特殊性;
3.提升医院绩效的制度安排应以交易成本最小化为基本原则;
4.基于市场机制提升医院绩效,应不断完善法规以及提高管制效率;
5.通过竞争促进医院绩效提升应考虑引入市场竞争的层面;
6.应以交易成本最小化构建具有中国特色的提升医院绩效的制度安排。
本文采用的主要方法有:理论与实践相结合的研究方法、实证分析和规范分析相结合的研究方法以及制度分析方法。
本文研究的创新主要有:
1.以产权理论和交易成本理论的视角,深入系统地研究了提升医院绩效的制度安排问题。国内对医院绩效研究主要从医院微观经营管理角度分析较多,尚缺乏从制度角度的分析。而关于如何通过不同的制度安排提升医院绩效问题,从国外研究来看,目前尚处于探索阶段,亦是个较新的课题。
2.提出并论证了应根据医疗服务的特征选择不同的提升医院绩效的制度安排。由于各种医疗服务市场的可竞争性与可度量性的组合特征存在差异,本文提出在考虑提升医院绩效制度安排的过程中,应通过医疗服务市场可竞争性与医疗服务的可度量性矩阵模型对医疗服务进行分类,根据这种分类对不同医疗服务所选择的制度安排进行界定,政府对不同医疗服务控制程度应实施差异性政策,这种区分可以防止政府在实施医院改革过程中的盲目性。
3.构建了所有权、市场与管制有机融合的医院绩效提升模式。在发达国家,为提升医院绩效,政府的改革政策往往会对医院所有权格局进行调整,并在市场与管制间进行权衡。在医院所有权格局既定的情况下,在特定时期,政府政策可能会过多倾向于管制;而另一个阶段则会偏重于引入市场竞争,这种改革的结果很难全面提升医院绩效。因此,本文从中国实际出发,建议应通过在医院所有权格局进行调整的基础上,构建市场与管制有机融合起来的全面提升医院绩效的模式。
4.提出中国应实施反应灵敏型的“多元化”医院管制政策。根据交易成本理论,不同制度安排所表现出的交易成本高低与市场发育程度、政府管制效率以及组织本身的管理水平存在密切的关系。一方面,与落后地区(城市)相比,中国发达地区(城市)的市场发育较成熟,且政府管制效率较高。因此,政府政策制定过程中,在进行市场与管制安排的选择时,应根据市场发育程度以及政府管制效率地域上的“多元化”特征,实施区别对待的反应灵敏型的医院管制政策。另一方面,由于不同的医院组织的内部管理能力的差异,医院发展亦存在“多元化”特征,政府在实施管制政策时亦应该区别对待。
In the 1980s, under the government support, healthcare insurance system and health care service delivery and provision system are built in developed countries to ensure the right of public's access to the healthcare service. To maintain the equity of the access to healthcare service, the government will face a great fiscal financial pressure. In many developed countries, substantial private sector activities in healthcare provision to improve hospital performance. Every country faces the problem of institution arrangement of hospital performance improvement.
Since the early of the 1980s, under the pressure of the shortage of fiscal financial, and the poor performance of public hospital, Chinese government took the measures of the reform of public hospital property right and the private hospital involved in the financing, delivery and provision of healthcare services. The goals of reform are to decrease the fiscal finance pressure and to improve hospital performance. However, the hospital performance is still poor after the reform in China.
Facing the problem of hospital performance improvement, this paper discuss the form that fit for the hospital performance improvement based on the property right theory and transaction cost theory according to the particularity of hospital performance improvement. After trading off the transaction cost of different institution arrangement, the theory and practice information can be obtained for the choice of healthcare organization. Furthermore, the paper can remind the policy constitutor of avoiding to privatize completely blindly or to control under government directly simply. Healthcare reform must follow the rule of the healthcare service market transaction. Based on the form of hospital ownership, the market and regulation must be combined to improve the hospital performance. This paper can provide the basic idea of establishing policies by the government sector.
According the background information and the goals, this study includes the contents as follows:
Chapter one does a theoretic preparation for the whole thesis. This chapter discusses the background and the significance of hospital performance improvement. Literatures of the studies about hospital performance improvement are concluded. Then the content, method, innovation and deficiency are illustrated.
Chapter two is about the general theory analysis of ownership, market and regulation arrangement. This thesis discusses the influence of ownership incentives and the firm governance structure. Based on the transaction cost theory, the role of transaction cost is analyzed during the discussion of the choice between the firms and market organization, and between the market and the regulation organization. Then the different institution arrangements are compared by the models of contestable-measurable matrix and the models of frontier of the institutional possibility.
Chapter three analyzes the characters of healthcare services market. The institutional arrangement of the hospital performance improvement is dependent on the particularity of the healthcare service market. The typical characters are the incomplete information and the principal-agent relationship. In the healthcare service market, hospitals have the market power, non-price competition and contestable. Healthcare service is the public goods that have externality. At the same time, it is the private goods that are rival and exclusive.
Chapter four illustrates the theory framework of institutional arrangement of hospital performance improvement. This chapter emphasize the external approaches have the special role for hospital performance improvement by comparing the internal approaches with the external approaches. Furthermore, it discusses the roles of market incentives and regulation constraint, and illustrates the relationship between the market and regulation. Based on the discussion of incentives of ownership for the hospital performance and trading-off between the market and the regulation, this chapter states the institutional framework that benefits for hospital performance improvement
Taking the examples of America and England, Chapter five concludes the international experience of institutional arrangement of improving hospital performance. To improve the hospital performance, each country took different policies. Based on the practices of American and British institutional arrangement for hospital performance improvement, this chapter concludes the experience that can be used for reference by China.
Chapter six discusses the institutional arrangement of hospital performance improvement of China. After retrospection the history of healthcare reform simply, this chapter analyses the puzzles of the reform of healthcare service provision in China. Considering the incentives of ownership, the forms of hospital ownership and public hospital governance structure should be considered. Furthermore, the model that market and regulation are combined and the institutional framework are designed.
Based on these above, the conclusions can be summarized as follows:
1. Hospital performance improvement is the basic precondition that publics access to healthcare service;
2. As the healthcare service market has varieties of incompletion, hospital performance improvement is special.
3. The basic principle of the institutional arrangement of hospital performance improvement is the transaction cost minimization.
4. The perfect law and high efficient regulation are benefits for the hospital performance improvement through the market mechanism.
5. The competition level must be considered when hospital performance is improved by the market competition.
6. The institution arrangement of hospital performance improvement of China should be framed based on the transaction cost minimization.
This paper bases its analysis on the approach of theory and practice combination, positive statement and normative statement combined, and the approach of institutional analysis.
The main innovations of the paper can be summarized as follows:
1. The institutional arrangement of hospital performance improvement is deeply analyzed by the theory of property right and transaction cost. In China, most studies about the hospital performance improvement are from the management science, not from the institutional economics. This topic is also a new area in other countries.
2. The paper illustrates that the different institutional arrangement of hospital performance improvement is chosen by the character of healthcare service. Because the combinations of contestable and measurable of varieties of healthcare service market are different, this paper holds that the healthcare services must be classified by the combinations of contestable and measurable when the institutional arrangement of hospital performance improvement is chosen. The policy should be different according to classification. Doing so, the blindness can be avoided when government implement the hospital reform.
3. The model has been built based on the combination of ownership, market and regulation. To improve the hospital performance, the formation of hospital ownership is often adjusted, and market mechanism and regulation must be traded off by the reform policy in developed country. Given the ownership of hospital, government may be inclined to regulation during some special period, but next they may lay particular stress on market competition. The result is that the hospital performance is improved incompletely. Therefore, this study gives a suggestion that the model of complete hospital performance improvement is built based on the formation of ownership, and the combination of market mechanism and regulation.
4. The paper states that the hospital regulation policy must be 'pluralistic'. The transaction cost of different institutional arrangements is related with the development of market, the efficiency of regulation and the level of organization management. On the one hand, the market is more developed and the regulation is more efficiency in developed areas than the underdeveloped areas in China. Therefore, the government should implement the responsive regulation policy according to the character of 'pluralistic' when they constitute the policies. On the other hand, the level of each hospital management is different, the hospital development is also 'pluralistic', and thus the policy of regulation must be different among hospitals.
引文
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[1]与一般市场相比,医院市场中有较强的信誉机制。例如,通过研究发现.医院市场集中度的提高不一定会增加医院成,这可能是医院产业中强信誉机制在起作用(Hass-Wilson,1990),这是信誉机制阻止了医院滥用垄断势力。
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[2]这正是中国目前医院改革面临的问题。由于管制效率低下,因此有学者主张应该完全由政府控制医疗服务的提供。显然,通过市场提供医疗服务的前提是提高管制效率。
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[1]从经济学的角度看,公共健康医疗服务具有公共产品的特性,而治疗性医疗服务是一种私人物品。本文主要讨论治疗性医疗服务。
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[1]引自 N.Manning,Unbundling the State:Autonomous Agencies and Service Delivery,Draft World Bank Discussion Paper,1998.
[2]产品和服务性质的约束在关于可竞争性/可度量性的分析中作了详细的讨论。
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[1]英国的医疗服务内部市场与美国的管理型医疗服务的具体内容将在第五章进行讨论。
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[1]包括OECD中的美国、英国、日本、意大利、德国、法国和加拿大等7国。
[2]转引自David M.Curler,Equality,Efficiency,and Market Fundamentals:The Dynamics of International Medical-Care Reform,Journal of Economic Literature,Vo1.40,No.3.Sep.,2002,p.889.
[1]一部分原因是美国总体工资水平高于其他国家,但没有高出这么多。美国人均GDP要高于7国中的其他国家的10%-20%。
[1]尤其是高质量的大公立医院。
[2]医生用公共预算购买设备,但是在私人业务中使用这些设备。
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[2]美国雇主(他们为其雇工选择保险)现在常常履行健康服务代理购买者的职能,供给方竞争可能更集中在雇主和保险公司而不是忠者本人。
[1]转引自Kieran Walsh,Regulating Health Care:A Prescription for improvement? Open University Press.2003.pp.50-51.
[2]美国于1965年施行了医疗照顾保险计划和医疗辅助保险计划。前者是对65岁以上的老年人和残障者的医疗保险,是由联邦政府提供;后者是对低收入人群的医疗保险,是由联邦政府和州政府共同资助的。
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[4]在第三章的分析中,由于医生在关于医疗服务治疗质量、结果方面的信息占有优势,如果向医生进行的支付是纯粹的人头费用,医生可能存在使用其信息优势减少治疗的激励。
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[2]HMO与PPO都是由保险费提供资金的组织,对于在一定经济、地理和职业范围内自愿参加的人及其家庭成员,由组织的医生及职业人员提供治疗和预防性的药品。
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[2]转引自 Kieran Walshe,Regulating Health Care:A Prescription for Improvement? Open University Press,2003,p.3.
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[3]这些是自我精选出来的群体,他们覆盖那些其曾提供基本医疗服务的患者,并获得一些预算支付给那些销售医疗服务的提供者。
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[1]前面已经分析,竞争并不总是与价格或成本下降有联系。来自美国的证据说明,当医疗服务购买者存在软预算约束,高质量、高成本且一般是更高价格与竞争存在联系。
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[1]转引自 Richard B.Saltman,Regulation Incentives:the Past and Present Role of the State in Health Care Systems,Social Science & Medicine 54,2002,p.1682.
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[1]前面对美国医疗服务体系的分析已经指出,在美国,目前患者的治疗由他们所处的网络决定,网络提供者几乎为交易提供了保障。
[1]卫生部统计信息中心:《2003-2007年我国卫生发展情况简报》,中华人民共和国卫生部,www.moh.gov.cn,2008年1月15日。
[2]卫生部统计信息中心:《2007年我国卫生事业发展统计公报(1)》,中华人民共和国卫生部,www.moh.gov.cn,2008年4月8日。
[1]沈思玮:《医疗制度改革的经济分析》(博士论文),中国优秀博硕士学位论文全文数据库,1999年5月。
[1]卫生部统计信息中心:《2005年中国卫生事业发展情况统计公报》,中华人民共和国卫生部,www.moh.gov.cn,2006年4月25日。
[1]转引自《国务院发展研究中心对中国医疗卫生体制改革的评价与建议调研报告》,《中国发展评论》,2005年增刊1期,第42页。
[2]转引自梁中堂:《宏观视野下的我国医疗卫生体制改革》,经济问题,2006年第3期。
[1]卫生部统计信息中心:《2007年我国卫生事业发展统计公报(1)》,中华人民共和国卫生部,www.moh.gov.cn,2008年4月8日。
[2]某药房做的一次“百姓缺药调查”发现,百姓想用却买不到的大多是政府降过价的药品或者价钱便宜、疗效明显的药品,其中70%的药品早已不生产了。
[3]《国务院发展研究中心对中国医疗卫生体制改革的评价与建议调研报告》,《中国发展评论》,2005年增刊1期,第42页。
[1]资料来源:《卫生部1949—1988年卫生统计资料汇编》,2003年卫生统计摘要。
[2]汪伟:《拯救公立医院》,《新民周刊》,2007年第49期。
[1]《宿州9患者眼球被摘调查:医疗事故的原因何在》,http://news.sohu.com,2005年12月23日。
[1]转引自顾昕:《中国城市医疗体制的转型:国家与市场关系的演化》,《比较》,2005年,第19期,第46页。
[1]新华社:《无锡市探索“管办分离”重构医疗卫生格局》,国研网,2007年9月13日。
[1]《南京药房托管试点全面启动》,2006年4月12日,http://www.jschina.com.cn。
[2]《南京药房托管成效初显》,2006年11月5日,新华报业网。
[1]姜涛:《宿迁医疗卫生改革:尝试“政府管医、社会办医”》,国研网,2007年8月30日。
[2]李玲:《北大课题组宿迁医改调研报告》,《中国青年报》,2006年6月22日。
[1]周勤、时巨涛:《江苏三医改模式共生之谜》,国研网,2007年5月30日。
[1]闵元:《新一轮医疗收费改革难点重重》,《医院领导决策参考》,2004年第5期。
[1]由于医疗服务市场的特殊性,公众一般都比较认可公立医院。例如,南方周末和新浪网联合推出关于医疗改革问题的相关调查,其中一题是,“你是否赞成用产权改革的方式,让部分公立医院私有化。”对此作出的反馈中,“不赞成”占52.91%,“赞成”占37.54%,“无所谓”占9.55%。显然,患者更信任公立医院是因为公立医院有国家在经济上给予支持,而对民营医院的信任程度要比公有医院小许多。魏雪义:《万人调查:见证医疗卫生体制改革失败》,新浪网,2006年2月27日。
[2]顾昕:《中国城市医疗体制的转型—国家与市场关系的演化》,《比较》,中信出版社,2005年第19期,第52页。
[1]东南大学产业经济研究所:《江苏三医改模式共生之谜》,国研网,2007年5月30日。
[2]承担公共卫生服务的医院(例如,传染病院、结核病院、精神病院、戒毒所、性病和艾滋病的治病机构等:代表医学发展方向的示范医院、教学医院等)不应该退出。具有公共卫生服务性质的医院,政府非但不能退出,而且一定要大力加强。因此说政府的“退出”并非完全退让,是有选择的退出。本文讨论不包括公共卫生服务医院。
[1]卫生部:《医德考评结果较差医务人员将受查处》,中国新闻网,2007年12月20日。
[1]闵元:《新一轮医疗收费改革难点重重》,《医院领导决策参考》,2004年第5期。
[1]《我卫生服务出现良好变化 住院费用首现负增长来源》,卫生部网站,2007年6月7日。
[2]卫生部网站公布《院务公开目录(征求意见稿)》,《北京晨报》,2007年9月26日。
[3]《降低看病费用“北京医院门诊收费七月起全程监控”》,《北京青年报》,2007年5月10日。
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[1]米尔格罗姆等著:《经济学、组织与管理》,费方域主译,经济科学出版社,2004年版,第306-308页。
[1]张维迎:《产权·激励与公司治理》,经济科学出版社,2005年版,第84页。
[1]P.Milgrom and J.Roberts,Economics of Organization and Management,Englewood Cliffs,NJ:Prentice-Hall,1992,ch.9.
[1]关于交易成本经济理论的详细资料参考:Eirik Furubotn and Rudolf Richter,Institutions and Economics,University of Michigan Press,1997;Oliver Williamson,The Mechanisms of Governance,Oxford University Press,1996.
[1]米尔格罗姆、罗伯茨:《经济学、组织与管理》,费方域主译,经济科学出版社,2004年版,第137页。
[1]张维迎:《产权·激励与公司治理,经济科学出版社》,2005年版,第65-71页。
[2]威廉姆森、温特编:《企业的性质:起源、演变和发展》,姚海鑫、刑源源译,商务印书馆,2007年版,第165-166页。
[1]张维迎:《博弈论与信息经济学》,上海三联书店、上海人民出版社1997年版,第3页。
[1]Ronald Coase,The Problem of Social Cost,Journal of Law and Economics,3,1960,pp.1-44.
[2]威廉姆森、温特编:《企业的性质:起源、演变和发展》,姚海鑫、刑源源译,商务印书馆,2007年版,第159-160页。
[1]W.G.Shepherd.Contestability vs.Competition-Once More,Land Economics 72:3,Aug.,1995,pp.299-309.
[2]王俊豪:《政府管制经济学导论》,商务印书馆,2001年版,第142页。
[1]Alexander S.Preker,The Economics of Public and Private Roles in Health Care:Insights from Institutional Economics and Organizational Theory.World Bank.,2001,p.11.
[1]详见第四章关于私立营利性、私立非营利性和公立医院的界定。
[2]A.J.Auerbach and M.Feldstein,Handbook of Public Economics,Volume4.Elsevier Science R V.,2002,p.2148.
[3]道格拉斯.C.诺思:《制度、制度变迁与经济绩效》,上海三联书店1994年版,第111-122页。
[1]与一般市场相比,医院市场中有较强的信誉机制。例如,通过研究发现.医院市场集中度的提高不一定会增加医院成,这可能是医院产业中强信誉机制在起作用(Hass-Wilson,1990),这是信誉机制阻止了医院滥用垄断势力。
[2]米尔格罗姆、罗伯茨:《经济学、组织与管理》,费方域主译,2004年版,第140页。
[3]张维迎:《产权·激励与公司治理》,经济科学出版社,2005年版,第54页。
[1]科斯、哈特、斯蒂格利茨等著:《契约经济学》,李风圣主译,经济科学出版社,1999年版,第78页。
[1]张维迎:《产权·激励与公司治理》,经济科学出版社,2005年版,第237页。
[1]张维迎:《产权·激励与公司治理》,经济科学出版社,2005年版,第239页。
[2]这正是中国目前医院改革面临的问题。由于管制效率低下,因此有学者主张应该完全由政府控制医疗服务的提供。显然,通过市场提供医疗服务的前提是提高管制效率。
[1]Djankov et al.,The New Comparative Economics,Journal of Comparative Economics 31,2003,pp.595-619.
[1]P.Milgrom and J.Roberts,Bargaining Costs,in J.Alt and K.Shepsle,(eds.),Perspectives on Positive Political Economy,Cambridge University Press,1990,pp.57-89.
[1]Henry Hansmann,"The Role of Nonprofit Enterprise".Yale Law Journal.Vol.89.1980.pp.835-901.
[2]不对称信息是指两个或更多的经济行为主体拥有不同的信息水平(基于数量、质量等)。Bcsanko、Dranove和Shanlet(1996)对不对称信息的定义如下:即使相关主体能预测到可能发生的事件,且可以确定并衡量相关绩效,契约可能仍然是不完备的,因为相关主体没有获取与契约相关的所有信息的同等机会。如果一方了解的信息比其他方更多,则可能会扭曲信息。
[1]Mark Chassin et al.,Variations in the Use of Medical and Surgical Services by the Medicare Population,New England Journal of Medicine,1986,pp.285-290.
[2]Kenneth J.Arrow,Uncertainty and the Welfare Economies of Medical Care,The American Economic Review,Vol.53.No.5.Dec.1963,pp.941-973.
[1]维克托.R.福克斯:《谁将生存?健康、经济学和社会选择》,上海人民出版社,2000年版,第170页。
[1]泰勒尔:《产业组织理论》,张维迎总译校,中国人民大学出版社,1997年版,第122-123页。
[1]维克托.R.福克斯:《谁将生存?健康、经济学和社会选择》,上海人民出版社,2000年版,第156页。
[1]从经济学的角度看,公共健康医疗服务具有公共产品的特性,而治疗性医疗服务是一种私人物品。本文主要讨论治疗性医疗服务。
[1]Kieran Walsh,Regulating Health Care:A Prescription for improvement? Open University Press,2003,p.6.
[1]OECD.Regulation Reform,Privatization and Competition Policy(Paris:OECD),1992,p.17.
[2]顾昕:《中国城市医疗体制的转型;国家与市场关系的演化》,《比较》,中信出版社,第19期,2005年版,第32页。
[1]引自 N.Manning,Unbundling the State:Autonomous Agencies and Service Delivery,Draft World Bank Discussion Paper,1998.
[2]产品和服务性质的约束在关于可竞争性/可度量性的分析中作了详细的讨论。
[1]Alexander S.Preker,April Harding,The Economics of Public and Private Roles in Health Care:Insights from Institutional Economics and Organizational Theory.World Bank.2001,p.11.
[1]N.Manning,Unbundling the State:Autonomous Agencies and Service Delivery,Draft World Bank Discussion Paper,1998.
[1]英国的医疗服务内部市场与美国的管理型医疗服务的具体内容将在第五章进行讨论。
[2]Hurwicz L.Outcome functions yielding Walrasian and Lindahl allocation at Nash equilibrium points,Review of Economic Studie 46,1979,pp.217-225.
[3]D.E.Sappington,Incentives in Principal-Agent Relationship,Journal of Economics Perspectives,5:2,1991,pp.45-66.
[1]A.Harding and A.S.Preker(eds.),Private Participation Toolkit,Washington:World Bank.2000.
[1]Kieran Walshe,Regulating Healthcare:Aprescripition for improvement? Open University Press,2003,pp.24-25.
[1]Benson,Boyd and Walshe,Learning from CHI:the impact of healthcare regulation,Interim Report,Manchester Centre for Healthcare Management University of Manchester,March 2004,p.6.
[1]Lawrence Benson,Alan Boyd and Kieran Walshe,Learning from CHI:the impact of healthcare regulation,Interim Report,Manchester Centre for Healthcare Management University of Manchester,March 2004,p.7.
[1]刘学、史录文:《医疗费用上涨与医德医风下降:组织架构变革角度的解释》,《管理世界》,2005年第10期。
[1]David Weil,Archon Fung,Mary Graham,Elena Fagotto,The Effectiveness of Regulatory Disclosure Policies,Journal of Policy Analysis and Management,May 2005.
[1]新华社:《美国推出电子医疗计划》,国研网,2004年9月1日。
[1]Judith Healy and John Braithwaite,Designing safer health care through responsive regulation,The Medical Journal of Australia,Feb.,2006.
[1]Parker C.The open corporation:effective self-regulation and democracy.Cambridge:Cambridge University Press,2002.
[1]David M.Cutler,Equality,Efficiency,and Market Fundamental:the dynamics of international medical care reform,Journal of Economic Literature,Vol.40,No.3.Sep.,2002,p.884.
[1]David M.Cutler,Equality,Efficiency,and Market Fundamentals:The Dynamics of International Medical-Care Reform,Journal of Economic Literature;Vol.40,No.3.Sep,2002,p886.
[1]包括OECD中的美国、英国、日本、意大利、德国、法国和加拿大等7国。
[2]转引自David M.Curler,Equality,Efficiency,and Market Fundamentals:The Dynamics of International Medical-Care Reform,Journal of Economic Literature,Vo1.40,No.3.Sep.,2002,p.889.
[1]一部分原因是美国总体工资水平高于其他国家,但没有高出这么多。美国人均GDP要高于7国中的其他国家的10%-20%。
[1]尤其是高质量的大公立医院。
[2]医生用公共预算购买设备,但是在私人业务中使用这些设备。
[3]Kieran Walshe,Regulating Healthcare:A prescripition for improvement? Open University Press,2003,p3.
[1]F.Miller,Vertical Restraints and Powerful Health Insurers:Exclusionary Conduct Masquerading as Managed Care? Law and Contemporary Problems 51,1988,pp.203-206.
[2]美国雇主(他们为其雇工选择保险)现在常常履行健康服务代理购买者的职能,供给方竞争可能更集中在雇主和保险公司而不是忠者本人。
[1]转引自Kieran Walsh,Regulating Health Care:A Prescription for improvement? Open University Press.2003.pp.50-51.
[2]美国于1965年施行了医疗照顾保险计划和医疗辅助保险计划。前者是对65岁以上的老年人和残障者的医疗保险,是由联邦政府提供;后者是对低收入人群的医疗保险,是由联邦政府和州政府共同资助的。
[1]Ellen Campbell and Gary Fournier,Certificate of Need Deregulation and Indigent Hospital Care,Journal of Health Politics,Policy,and Law 18,1993,p.905.
[1]American Hospital Association,Hospital Statistics(1996-97 Edition),Chicgo,Illinois;U.S.
[2]Ellen Campbell and Gary Foumier,Certificate of Need Deregulation and Indigent Hospital Care,Journal of Health Pliicics,Policy,and Law 18,1993,pp.904-925.
[1]David S.Salkever,Regulation of Price and Investment in Hospitals in the United States,Handbook of Health Economics,Volumel,Edited by A.J.Culyer and J.P.Newhouse,Elsevier Science B.V.2000,pp.1491-1492.
[2]Frank Sooan,Rate Regulation as a Strategy for Hospital Cost Control:Evidence from the Last Decade,Milbank Quarterly 61,1983,p195.
[1]Per J.Agrell,Dea-Based Regulation of Health Care Systems,Seventh European Workshop on Efficiency and Productivity Analysis,Ovideo,Oct25-29,2001.
[1]John J.Antel,Robert L.Ohsfeldt,Edmund R.Becket,1995,State Regulation and Hospital Costs,The Review of Economics and Statistics,Vol.77,No.3.Aug.,1995,pp.416-442.
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[1]American Hospital Association,Hospital Statistics(1996-97 Edition) Chicgo,Illinois;U.S.
[2]Frank Sloan,Regulation and the Rising Cost of Hospital Care,Review of Economics and Statistics 63,1981,pp.479-478.
[3]Frank Sloan and Bruce Steinwald,The Effects of Regulation on Hospital Costs and Input Use,Journal of Law and Economics 23,1980,pp.81-110.
[1]Robin Allen and Paul Gertler,Regulation and the Provision of Ouality to Heterogenous Consumers:The Case of Prospective Pricing of Medical Services,Journal of Regulatory Economics 3,1991,pp.361-375.
[1]David Smith,Stephanic McFall,and Michael Pine,State Rate Regulation and Inpatient Mortality Rates,Inquiry 30,1993,pp.23-33.
[2]Coulam,Robert F.,and Gary L.Gaumer,Medicare's Prospective Payment System:A Critical Appraisal,Health Care Financing Review Annual Supplement,1991,pp.45-77.
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[4]在第三章的分析中,由于医生在关于医疗服务治疗质量、结果方面的信息占有优势,如果向医生进行的支付是纯粹的人头费用,医生可能存在使用其信息优势减少治疗的激励。
[1]Martin Gaynor,Deborah Haas-Wilson,Change,Consolidation,and Competition in Health Care Markets,The Journal of Economic Perstpectives,Vol.13,No.1.1999,pp.141-164.
[2]HMO与PPO都是由保险费提供资金的组织,对于在一定经济、地理和职业范围内自愿参加的人及其家庭成员,由组织的医生及职业人员提供治疗和预防性的药品。
[1]Anil Bamezai,Jack Zwanziger,Glenn A.Melnick and Joyce M.Mann,Price Competition and Hospital Cost Growth in the United States(1989-1994),Health Economics 8,1999,pp.233-234.
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[3]David M.Culter,Equality,Efficiency,and Market Fundamentals:The Dynamics of International Medical-Care Reform,Journal of Economic Literature,Vol.40,No.3.,Sep.,2002,p.901.
[1]Clark Havighurst,Health Care Choices:Private Contracts as Instruments of Health Reform,Washington DC:The AEI Press,1995.
[2]转引自 Kieran Walshe,Regulating Health Care:A Prescription for Improvement? Open University Press,2003,p.3.
[1]John Schneider,Cost Estimates of Pending California Managed Care Reform Legislation,Reseach Brief,California Association of Health Plans.1999.
[1]Ewan B.Ferlie;Stephen M.Shortell,Improving the Quality of Health Care in the United Kingdom and the United States:A Framework for Chang,The Milbank Quarterly,Vol.79,No.2,2001,pp.301-302.
[1]Troyen A.Brennan,The Role of Regulation in Quality Improvement,The Milbank Quarterly,Vol.76,No.4,1998,pp.709-731.
[1]转引自 Kieran Walsh,Regulating Health Care:A Prescription for improvement? Open University Press,2003,pp.106-107.
[1]AJ.Culyer and J.P.Newhouse,Handbook of Health Economics,Elsevier Science B.V.2000,p 1177.
[2]曹丽君:《英国医疗初探》,国研网,2005年8月23日。
[1]M.Vita,J.Langenfeld,P.Butler and L.Miller,Economic Analysis in Health Care Antitrust,Journal of Contempt Health Law &Policy,73,1991.
[2]Frances Miller,Competition Law and Anticompetitive Professional Behaviour Affecting Health care,The Modern Law Review,Vol.55,No.4.Jul.,1992,pp.453-481.
[3]这些是自我精选出来的群体,他们覆盖那些其曾提供基本医疗服务的患者,并获得一些预算支付给那些销售医疗服务的提供者。
[1]Frances Miller,Competition Law and Anticompetitive Professional Behaviour Affecting Health Care,The Modern Law Review,Vol.55,No.4.,Jul.,1992,p.459.
[2]Pauline Allen,Contracts in the National Health Service Internal Market,The Modern Law Review,Vol.58,No.3.1995,pp.321-342.
[1]前面已经分析,竞争并不总是与价格或成本下降有联系。来自美国的证据说明,当医疗服务购买者存在软预算约束,高质量、高成本且一般是更高价格与竞争存在联系。
[2]Carol Propper,Deborah Wilson,Neil Soderlund,The effects of regulation and competigion in the NHS internal market:the case of general practice fundholder prices,Journal of Health Economics,17,1998,p.650.
[3]根据地理位置医院市场的定义是标准的,把30分钟的行程半径作为市场的地理边界(Dranove等1993:Gruber,1992;Noether,1998)。
[1]Martin Chalkley,James M.Malcomson,competition in NHS quasi-markets,Oxford Review of Economic Policy,Vol.12,No.4,1999.
[2]Carol Propper,Simon Burgess,Denise Gossage,Competition and quality:Evidence from the NHS Internal Market 1991-1999,The Economic Journal,January,2008.
[1]Kieran Walshe,Regulating Healthcare:A prescription for improvement? Open University Press,2003,pp.126-127.
[1]David M.Cutler,Equality,Efficiency,and Market Fundamentals:The Dynamics of International Medical-Care Reform,Journal of Economic Literature,Vol.40,No.3.Sep.,2002,p.904.
[1]L.ilani Kumaranayake,The Role of Regulation:Influencing Private Sector Activity Whithin Health Sector Reform,Journal of International Development,Vol.,No.4,1997,p.645.
[1]转引自 Richard B.Saltman,Regulation Incentives:the Past and Present Role of the State in Health Care Systems,Social Science & Medicine 54,2002,p.1682.
[2]Lilani Kumaranayake,Effective Regulation of Private Sector Health Service Providers,Paper prepared for the World Bank Mediterranean Development Forum Ⅱ,Moroeeo,Sep.,1998.
[1]Michael E.Porter and Elizabeth Olmsted Teisberg,Redefining Competition in Health Care,Harvard Business Review,June,2004.
[1]前面对美国医疗服务体系的分析已经指出,在美国,目前患者的治疗由他们所处的网络决定,网络提供者几乎为交易提供了保障。
[1]卫生部统计信息中心:《2003-2007年我国卫生发展情况简报》,中华人民共和国卫生部,www.moh.gov.cn,2008年1月15日。
[2]卫生部统计信息中心:《2007年我国卫生事业发展统计公报(1)》,中华人民共和国卫生部,www.moh.gov.cn,2008年4月8日。
[1]沈思玮:《医疗制度改革的经济分析》(博士论文),中国优秀博硕士学位论文全文数据库,1999年5月。
[1]卫生部统计信息中心:《2005年中国卫生事业发展情况统计公报》,中华人民共和国卫生部,www.moh.gov.cn,2006年4月25日。
[1]转引自《国务院发展研究中心对中国医疗卫生体制改革的评价与建议调研报告》,《中国发展评论》,2005年增刊1期,第42页。
[2]转引自梁中堂:《宏观视野下的我国医疗卫生体制改革》,经济问题,2006年第3期。
[1]卫生部统计信息中心:《2007年我国卫生事业发展统计公报(1)》,中华人民共和国卫生部,www.moh.gov.cn,2008年4月8日。
[2]某药房做的一次“百姓缺药调查”发现,百姓想用却买不到的大多是政府降过价的药品或者价钱便宜、疗效明显的药品,其中70%的药品早已不生产了。
[3]《国务院发展研究中心对中国医疗卫生体制改革的评价与建议调研报告》,《中国发展评论》,2005年增刊1期,第42页。
[1]资料来源:《卫生部1949—1988年卫生统计资料汇编》,2003年卫生统计摘要。
[2]汪伟:《拯救公立医院》,《新民周刊》,2007年第49期。
[1]《宿州9患者眼球被摘调查:医疗事故的原因何在》,http://news.sohu.com,2005年12月23日。
[1]转引自顾昕:《中国城市医疗体制的转型:国家与市场关系的演化》,《比较》,2005年,第19期,第46页。
[1]新华社:《无锡市探索“管办分离”重构医疗卫生格局》,国研网,2007年9月13日。
[1]《南京药房托管试点全面启动》,2006年4月12日,http://www.jschina.com.cn。
[2]《南京药房托管成效初显》,2006年11月5日,新华报业网。
[1]姜涛:《宿迁医疗卫生改革:尝试“政府管医、社会办医”》,国研网,2007年8月30日。
[2]李玲:《北大课题组宿迁医改调研报告》,《中国青年报》,2006年6月22日。
[1]周勤、时巨涛:《江苏三医改模式共生之谜》,国研网,2007年5月30日。
[1]闵元:《新一轮医疗收费改革难点重重》,《医院领导决策参考》,2004年第5期。
[1]由于医疗服务市场的特殊性,公众一般都比较认可公立医院。例如,南方周末和新浪网联合推出关于医疗改革问题的相关调查,其中一题是,“你是否赞成用产权改革的方式,让部分公立医院私有化。”对此作出的反馈中,“不赞成”占52.91%,“赞成”占37.54%,“无所谓”占9.55%。显然,患者更信任公立医院是因为公立医院有国家在经济上给予支持,而对民营医院的信任程度要比公有医院小许多。魏雪义:《万人调查:见证医疗卫生体制改革失败》,新浪网,2006年2月27日。
[2]顾昕:《中国城市医疗体制的转型—国家与市场关系的演化》,《比较》,中信出版社,2005年第19期,第52页。
[1]东南大学产业经济研究所:《江苏三医改模式共生之谜》,国研网,2007年5月30日。
[2]承担公共卫生服务的医院(例如,传染病院、结核病院、精神病院、戒毒所、性病和艾滋病的治病机构等:代表医学发展方向的示范医院、教学医院等)不应该退出。具有公共卫生服务性质的医院,政府非但不能退出,而且一定要大力加强。因此说政府的“退出”并非完全退让,是有选择的退出。本文讨论不包括公共卫生服务医院。
[1]卫生部:《医德考评结果较差医务人员将受查处》,中国新闻网,2007年12月20日。
[1]闵元:《新一轮医疗收费改革难点重重》,《医院领导决策参考》,2004年第5期。
[1]《我卫生服务出现良好变化 住院费用首现负增长来源》,卫生部网站,2007年6月7日。
[2]卫生部网站公布《院务公开目录(征求意见稿)》,《北京晨报》,2007年9月26日。
[3]《降低看病费用“北京医院门诊收费七月起全程监控”》,《北京青年报》,2007年5月10日。
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