發(fā)布時(shí)間：2018-09-04 15:05

【摘要】：公立醫(yī)院改革是惠及全民、關(guān)系民生的事業(yè),也是一項(xiàng)世界性難題。新中國成立以來,我國公立醫(yī)院經(jīng)歷了以市場(chǎng)化改革為目標(biāo)的老醫(yī)改和以“公益性回歸”為目標(biāo)的新醫(yī)改兩次不同價(jià)值取向的醫(yī)改歷程。現(xiàn)階段還處在新醫(yī)改試點(diǎn)階段的公立醫(yī)院改革,經(jīng)過三年多的探索已積累了一定經(jīng)驗(yàn),但在一些方面依然面臨著公平與效率關(guān)系失衡的困難和挑戰(zhàn)：一是價(jià)值取向上的失衡,主要是公益性缺失,具體表現(xiàn)為群眾醫(yī)療負(fù)擔(dān)過重、就醫(yī)的時(shí)間和地理可及性較差和醫(yī)患關(guān)系惡化；二是外部環(huán)境中的失衡,突出表現(xiàn)為政府政策環(huán)境不協(xié)調(diào)和市場(chǎng)競(jìng)爭(zhēng)環(huán)境不完善；三是公立醫(yī)院的自身管理上的失衡,具體表現(xiàn)為管理決策過失、運(yùn)行成本虛高和人事問題突出等方面。造成這些失衡的原因是多方面的,目前我國公立醫(yī)院在客觀上醫(yī)療資源總量不足與配置失衡并存,在價(jià)值取向上存在政策、公立醫(yī)院及醫(yī)務(wù)人員等多種價(jià)值偏差,在實(shí)際改革中存在政府與市場(chǎng)雙重失靈,在公立醫(yī)院內(nèi)部管理上存在管理體制混亂、成本管理薄弱、人力資源管理失當(dāng)?shù)榷喾綔�后。從處理公平與效率、政府與市場(chǎng)關(guān)系的國外公立醫(yī)院改革經(jīng)驗(yàn)來看,英國模式(政府主導(dǎo)的公平導(dǎo)向型)與美國模式(市場(chǎng)主導(dǎo)的效率導(dǎo)向型)較為典型,兩者取得了各自的成效,也都遇到了改革障礙,結(jié)合這些經(jīng)驗(yàn)與教訓(xùn),我國應(yīng)當(dāng)探索公平與效率均衡的公立醫(yī)院改革路徑：一是在價(jià)值取向上要尋求公平與效率的適度均衡,二是在實(shí)踐模式上要建立政府與市場(chǎng)合作模式,三是在改革過程中須警惕盲目模仿和路徑依賴。
[Abstract]:The reform of public hospitals is a worldwide problem which benefits the whole people and concerns people's livelihood. Since the founding of the people's Republic of China, the public hospitals in our country have experienced two different value orientations: the old medical reform with the goal of market-oriented reform and the new medical reform with the goal of "the return of public welfare". The public hospital reform, which is still in the pilot stage of the new medical reform, has accumulated some experience after more than three years of exploration, but it still faces the difficulties and challenges of the imbalance between fairness and efficiency in some aspects: first, the imbalance in value orientation. The main lack of public welfare is the overburden of medical care for the masses, the poor time and geographical accessibility to medical treatment and the deterioration of doctor-patient relations; the second is the imbalance in the external environment. The third is the imbalance in the management of public hospitals, which is manifested in the fault of management decision, the high operating cost and the outstanding personnel problems. The causes of these imbalances are various. At present, the total amount of medical resources and the imbalance of allocation of public hospitals coexist objectively. There are many value deviations in value orientation, such as the policy of value orientation, public hospitals and medical personnel, etc. In the actual reform, there are double failures of government and market, confusion of management system in the internal management of public hospitals, weak cost management, mismanagement of human resources, and so on. From the experience of foreign public hospital reform dealing with fairness and efficiency and the relationship between government and market, the British model (government-led fairness oriented model) and the American model (market-led efficiency oriented model) are more typical. Both of them have made their own achievements and met with the obstacles of reform. In combination with these experiences and lessons, our country should explore the reform path of fair and efficient public hospitals: first, we should seek an appropriate balance between fairness and efficiency on the value orientation. The second is to establish the mode of cooperation between government and market in practice, and the third is to be on guard against blind imitation and path dependence in the course of reform.
【學(xué)位授予單位】：南京師范大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R197.3

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本文編號(hào)：2222522