我国医院社会责任研究：行为表现、指标体系及提升路径
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摘要
现有文献显示,我国医院社会责任的理论研究和实践活动都处于起步阶段。鉴于我国独有的体制和文化情景,尤其是处在新一轮医疗体制改革的关键时期,我国医院社会责任相关理论问题急需要去关注和研究,医院社会责任实践也需要相应理论和规章制度去指导和引领。
在社会责任相关理论指导下,本研究认为医院社会责任行为的本质就是能为社会产生社会效益,医院社会责任是指医院在维持自身生存和发展的基础上,为满足特定的社会需求,在维护公共卫生、保证医疗服务质量和可及性、完成政府指令性任务及其他提高社会效益方面所承担的责任。
结合内容分析法、文献研究、德尔菲法和层次分析法,本文认为我国医院社会责任的行为表现主要体现在以下13个方面：提供优质的医疗服务、坏账、税收、承担突发事件的救援任务、完成政府指令性任务、保护环境、具有外部正效应的医疗服务、价格优惠、低利润的医疗服务及廉价药品的提供、慈善医疗、教育科研、健康促进与健康教育和参与社会公益活动。基于我们提出的社会责任行为表现分级标准,上述13项行为中,前6项属于初级医院社会责任,中间3项为中级医院社会责任,最后4项为高级社会责任行为。医院社会责任定量评价指标体系的21个指标及权重如下：捐赠(0.1653)、健康讲座(0.1262)、医疗费用减免(0.1086)、义诊(0.0867)、人均住院费用(0.0859)、科研论文(0.0662)、防保部门的门诊人次(0.0521)、人均门诊费用(0.0489)、承担政府指令性任务的支出(0.0410)、突发事件的支出(0.039 0)、教育科研投入(0.0367)、环保支出(0.0354)、院内感染支出(0.0299)、实习生人次(0.0242)、危重病人抢救成功率(0.0111)、税收(0.0111)、出入院诊断符合率(0.0098)、坏账比例(0.008 0)、年门急诊总人次(0.0052)、病人满意度(0.0049)、无菌手术切口感染率(0.0038)。
当前各医院实施各行为表现按照数量递减趋势依次为：“向患者提供高质量的医疗服务”、“教育科研”、“健康促进与健康教育”、“承担突发事件的救援任务”、“完成政府指令性任务”、“参与社会公益活动”、“价格优惠”、“慈善医疗”。“完成政府指令性任务”和“承担突发事件的救援任务”间表现出了很强的相关关系,公立医院尤其如此。对公立医院而言,高级社会责任的4项行为表现(慈善医疗、健康促进与健康教育、教育科研和参与社会公益活动)表现出了很强的相关性,而民营医院则在以上两个方面没有表现出这种关系。
不同医院实证研究的结果表明,公立医院履行社会责任的情况明显优于民营医院,三级医院的履行数量要高于二级医院。无论是医院社会责任行为的总量、各层级的社会责任行为及7种具体的社会责任行为,三级医院的履行数量都要高于二级医院。由于三级医院和二级医院的定位、功能、规模等都是不同的,三级医院履行各行为的数量一般要高于二级医院。东部、中部、西部三个地区的医院社会责任行为在总量上显示出了差异性,但在具体行为上大部分没有统计差别。
本文还根据医院社会责任的部分评价指标,从宏观层面对我国和江苏省的医疗卫生行业的社会责任履行情况做了简单分析。从宏观数据来看,我国和江苏省的医疗卫生行业履行了较好的社会责任,为我国、江苏省的居民健康发挥出了巨大的作用。相对来说,医疗服务的价格逐年递增,尤其是2009年前医疗服务的价格已经成为社会对医药行业不满的主要原因之一
基于实证研究的结果和影响因素的分析,本文从政府、医院和社会三个方面去考察提升医院社会责任水平的路径和政策建议。政府层面强调提供制度保障,医院层面强调主体自觉,社会层面强调将医院置身于社会治理中。
本研究的主要贡献在于梳理了医院社会责任的本质并给出了医院社会责任的定义,研究了我国医院社会责任的行为表现及评价指标体系,同时分析了行为表现的分级、特征和相互关系。这些都将有力地推动我国医院社会责任的研究。而本文的部分实证研究发现及研究结论对于中国的卫生事业管理和医院管理实践有一定的借鉴意义。
由于作者的研究水平及数据来源限制等因素,本文不可避免地存在一些缺陷和不足。总体来说,由于国内医院社会责任研究刚刚起步,使得本研究研究基础不足、理论深度不够。在方法上,以定性为主,定量为辅,定量研究以相关分析和秩和检验为主,方法的前沿性和先进性不是很够。实证部分采用媒体公布的资料进行研究,其外在效度受到限制。
Literatures show that the theoretical research and practice activities of hospitals'social responsibility (HSR) in China are both in the initial stage. Under the background of China's unique institutional, cultural circumstances, and the critical period of the new health care reform, it is so urgent that the theoretical issues related to HSR in our country should receive immediate attention. Moreover, the practice of HSR also requires corresponding rules and regulations to guide and lead.
Under the guidance of related theories of HSR, this paper suggests that the essence of HSR means delivering social benefits. Besides maintaining its own survival and development, HSR means obligations of hospitals in maintaining public health, ensuring the quality and accessibility of medical services, accomplishing the government mandatory mission and other activities and programs to increase social benefits.
Using content analysis, literature review, the Delphi method and analytic hierarchy process, this paper puts forward that the behaviors of HSR in China are mainly embodied in the following thirteen aspects:providing high-qualified medical services to patients, bad debt, tax, undertaking rescues under emergencies, accomplishing government mandatory missions, environmental protection, health services with external positive effects, with favorable price, granting low-profit medical services and cheap drugs, charity care, education and research, health improvement and health education, and actively involved in social welfare activities. Among the above thirteen items, the first six belong to the primary HSR, the seventh to the ninth are the intermediate HSR, the last four are the senior HSR. The twenty-first indicators and weights of quantitative evaluation index system of HSR are as follows:Donation (0.1653), health care lectures (0.1262), price discount (0.1086), voluntary treatment (0.0867), average medical expenses per inpatient (0.0859), research papers (0.0662), outpatient visits of prevention and health care department (0.0521), average medical expenses per outpatient (0.0489), expenditures of undertaking government mandatory missions (0.0410), emergency expenditures (0.0390), expenditures in education and scientific research (0.0367), environmental protection expenditures (0.0354), nosocomial infection expenditures (0.0299), intern visits (0.0242), the survival rate of critically ill patients (0.0111), tax (0.0111), discharge and admission diagnose accordance rate (0.0098), bad debt ratio (0.0080), the annual visits of outpatients(0.0052), patient satisfaction (0.0049), sterilized surgical wound infection rate (0.0038).
Currently, the behaviors of HSR implemented by the hospitals are as follows by quantity digressive tendency:providing high-qualified medical services to patients, education and research, undertaking rescues under emergencies, accomplishing government mandatory missions, actively involved in social welfare activities, price discounts, charity care. Accomplishing government mandatory missions and undertaking rescues under emergencies show a strong relationship, especially in public hospitals. For public hospitals, the four senior behaviors of HSR (charity care, health improvement and health education, education and research, and actively involved in social welfare activities) are found significantly interrelated. However, there is not interrelated relationship in private hospitals.
The result of empirical research on different hospitals suggests that public hospitals' fulfillment of HSR was obviously better than the private hospitals; considering the total amount, all levels or the seven kinds of specific behaviors, the number of third-grade hospitals' performance was higher than the second-grade hospitals. As the orientation, function, size, etc. between the third-grade and second-grade hospitals are different, the third-grade hospitals are supposed to take more HSR generally. Behaviors of HSR in eastern, central and western regions show difference in the total amount, but there is no statistical difference in the specific behaviors for the majority.
According to part of hospitals' social responsibility evaluation index, this paper analyzes the fulfillment of hospitals' social responsibility in health care industry of China and Jiangsu Province at macro level. From the macro data point of view, China and Jiangsu Province had a good performance on hospitals' social responsibility, which plays a huge role in improving the health of residents. In contrast, the price of medical services increased year by year and it had become one of the most dissatisfied factors about the industry until 2009.
Based on the results of empirical research and analysis of influencing factors, this paper examines the path and policy recommendations to enhancing level of HSR from the government, hospital, and social aspects.
The main contributions of this paper are to sort out the nature and definition of hospitals' social responsibility, to examine the behavior and evaluation index system of hospitals'social responsibility and to analyze the classification, characteristics and relationships of the behavior. All this will make a great contribution to promote the study of hospitals'social responsibility. Part of the empirical findings and the research results can be uses as references for health care management.
Owing to the data sources and other factors, this paper is still at a preliminary stage yet to be conducted. Firstly, the study of hospitals'social responsibility in China has just taken a step, so this paper might not have sufficient theoretical background and therefore might not provide compelling arguments. Secondly, this paper mainly uses various qualitative methods and supplemented by quantitative methods, comparatively the methodology is not as advanced as expected. Thirdly, data in the empirical research is collected from published information in the media, so the external validity is restricted.
在社会责任相关理论指导下,本研究认为医院社会责任行为的本质就是能为社会产生社会效益,医院社会责任是指医院在维持自身生存和发展的基础上,为满足特定的社会需求,在维护公共卫生、保证医疗服务质量和可及性、完成政府指令性任务及其他提高社会效益方面所承担的责任。
结合内容分析法、文献研究、德尔菲法和层次分析法,本文认为我国医院社会责任的行为表现主要体现在以下13个方面：提供优质的医疗服务、坏账、税收、承担突发事件的救援任务、完成政府指令性任务、保护环境、具有外部正效应的医疗服务、价格优惠、低利润的医疗服务及廉价药品的提供、慈善医疗、教育科研、健康促进与健康教育和参与社会公益活动。基于我们提出的社会责任行为表现分级标准,上述13项行为中,前6项属于初级医院社会责任,中间3项为中级医院社会责任,最后4项为高级社会责任行为。医院社会责任定量评价指标体系的21个指标及权重如下：捐赠(0.1653)、健康讲座(0.1262)、医疗费用减免(0.1086)、义诊(0.0867)、人均住院费用(0.0859)、科研论文(0.0662)、防保部门的门诊人次(0.0521)、人均门诊费用(0.0489)、承担政府指令性任务的支出(0.0410)、突发事件的支出(0.039 0)、教育科研投入(0.0367)、环保支出(0.0354)、院内感染支出(0.0299)、实习生人次(0.0242)、危重病人抢救成功率(0.0111)、税收(0.0111)、出入院诊断符合率(0.0098)、坏账比例(0.008 0)、年门急诊总人次(0.0052)、病人满意度(0.0049)、无菌手术切口感染率(0.0038)。
当前各医院实施各行为表现按照数量递减趋势依次为：“向患者提供高质量的医疗服务”、“教育科研”、“健康促进与健康教育”、“承担突发事件的救援任务”、“完成政府指令性任务”、“参与社会公益活动”、“价格优惠”、“慈善医疗”。“完成政府指令性任务”和“承担突发事件的救援任务”间表现出了很强的相关关系,公立医院尤其如此。对公立医院而言,高级社会责任的4项行为表现(慈善医疗、健康促进与健康教育、教育科研和参与社会公益活动)表现出了很强的相关性,而民营医院则在以上两个方面没有表现出这种关系。
不同医院实证研究的结果表明,公立医院履行社会责任的情况明显优于民营医院,三级医院的履行数量要高于二级医院。无论是医院社会责任行为的总量、各层级的社会责任行为及7种具体的社会责任行为,三级医院的履行数量都要高于二级医院。由于三级医院和二级医院的定位、功能、规模等都是不同的,三级医院履行各行为的数量一般要高于二级医院。东部、中部、西部三个地区的医院社会责任行为在总量上显示出了差异性,但在具体行为上大部分没有统计差别。
本文还根据医院社会责任的部分评价指标,从宏观层面对我国和江苏省的医疗卫生行业的社会责任履行情况做了简单分析。从宏观数据来看,我国和江苏省的医疗卫生行业履行了较好的社会责任,为我国、江苏省的居民健康发挥出了巨大的作用。相对来说,医疗服务的价格逐年递增,尤其是2009年前医疗服务的价格已经成为社会对医药行业不满的主要原因之一
基于实证研究的结果和影响因素的分析,本文从政府、医院和社会三个方面去考察提升医院社会责任水平的路径和政策建议。政府层面强调提供制度保障,医院层面强调主体自觉,社会层面强调将医院置身于社会治理中。
本研究的主要贡献在于梳理了医院社会责任的本质并给出了医院社会责任的定义,研究了我国医院社会责任的行为表现及评价指标体系,同时分析了行为表现的分级、特征和相互关系。这些都将有力地推动我国医院社会责任的研究。而本文的部分实证研究发现及研究结论对于中国的卫生事业管理和医院管理实践有一定的借鉴意义。
由于作者的研究水平及数据来源限制等因素,本文不可避免地存在一些缺陷和不足。总体来说,由于国内医院社会责任研究刚刚起步,使得本研究研究基础不足、理论深度不够。在方法上,以定性为主,定量为辅,定量研究以相关分析和秩和检验为主,方法的前沿性和先进性不是很够。实证部分采用媒体公布的资料进行研究,其外在效度受到限制。
Literatures show that the theoretical research and practice activities of hospitals'social responsibility (HSR) in China are both in the initial stage. Under the background of China's unique institutional, cultural circumstances, and the critical period of the new health care reform, it is so urgent that the theoretical issues related to HSR in our country should receive immediate attention. Moreover, the practice of HSR also requires corresponding rules and regulations to guide and lead.
Under the guidance of related theories of HSR, this paper suggests that the essence of HSR means delivering social benefits. Besides maintaining its own survival and development, HSR means obligations of hospitals in maintaining public health, ensuring the quality and accessibility of medical services, accomplishing the government mandatory mission and other activities and programs to increase social benefits.
Using content analysis, literature review, the Delphi method and analytic hierarchy process, this paper puts forward that the behaviors of HSR in China are mainly embodied in the following thirteen aspects:providing high-qualified medical services to patients, bad debt, tax, undertaking rescues under emergencies, accomplishing government mandatory missions, environmental protection, health services with external positive effects, with favorable price, granting low-profit medical services and cheap drugs, charity care, education and research, health improvement and health education, and actively involved in social welfare activities. Among the above thirteen items, the first six belong to the primary HSR, the seventh to the ninth are the intermediate HSR, the last four are the senior HSR. The twenty-first indicators and weights of quantitative evaluation index system of HSR are as follows:Donation (0.1653), health care lectures (0.1262), price discount (0.1086), voluntary treatment (0.0867), average medical expenses per inpatient (0.0859), research papers (0.0662), outpatient visits of prevention and health care department (0.0521), average medical expenses per outpatient (0.0489), expenditures of undertaking government mandatory missions (0.0410), emergency expenditures (0.0390), expenditures in education and scientific research (0.0367), environmental protection expenditures (0.0354), nosocomial infection expenditures (0.0299), intern visits (0.0242), the survival rate of critically ill patients (0.0111), tax (0.0111), discharge and admission diagnose accordance rate (0.0098), bad debt ratio (0.0080), the annual visits of outpatients(0.0052), patient satisfaction (0.0049), sterilized surgical wound infection rate (0.0038).
Currently, the behaviors of HSR implemented by the hospitals are as follows by quantity digressive tendency:providing high-qualified medical services to patients, education and research, undertaking rescues under emergencies, accomplishing government mandatory missions, actively involved in social welfare activities, price discounts, charity care. Accomplishing government mandatory missions and undertaking rescues under emergencies show a strong relationship, especially in public hospitals. For public hospitals, the four senior behaviors of HSR (charity care, health improvement and health education, education and research, and actively involved in social welfare activities) are found significantly interrelated. However, there is not interrelated relationship in private hospitals.
The result of empirical research on different hospitals suggests that public hospitals' fulfillment of HSR was obviously better than the private hospitals; considering the total amount, all levels or the seven kinds of specific behaviors, the number of third-grade hospitals' performance was higher than the second-grade hospitals. As the orientation, function, size, etc. between the third-grade and second-grade hospitals are different, the third-grade hospitals are supposed to take more HSR generally. Behaviors of HSR in eastern, central and western regions show difference in the total amount, but there is no statistical difference in the specific behaviors for the majority.
According to part of hospitals' social responsibility evaluation index, this paper analyzes the fulfillment of hospitals' social responsibility in health care industry of China and Jiangsu Province at macro level. From the macro data point of view, China and Jiangsu Province had a good performance on hospitals' social responsibility, which plays a huge role in improving the health of residents. In contrast, the price of medical services increased year by year and it had become one of the most dissatisfied factors about the industry until 2009.
Based on the results of empirical research and analysis of influencing factors, this paper examines the path and policy recommendations to enhancing level of HSR from the government, hospital, and social aspects.
The main contributions of this paper are to sort out the nature and definition of hospitals' social responsibility, to examine the behavior and evaluation index system of hospitals'social responsibility and to analyze the classification, characteristics and relationships of the behavior. All this will make a great contribution to promote the study of hospitals'social responsibility. Part of the empirical findings and the research results can be uses as references for health care management.
Owing to the data sources and other factors, this paper is still at a preliminary stage yet to be conducted. Firstly, the study of hospitals'social responsibility in China has just taken a step, so this paper might not have sufficient theoretical background and therefore might not provide compelling arguments. Secondly, this paper mainly uses various qualitative methods and supplemented by quantitative methods, comparatively the methodology is not as advanced as expected. Thirdly, data in the empirical research is collected from published information in the media, so the external validity is restricted.
引文
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