發(fā)布時間：2018-01-16 13:36

  本文關鍵詞：我國發(fā)展非公有醫(yī)院的策略研究　出處：《華中科技大學》2010年博士論文　論文類型：學位論文

  更多相關文章： 非公有醫(yī)院 發(fā)展 策略

【摘要】： 研究目的 基于我國新的醫(yī)藥衛(wèi)生體制改革精神關于堅持公立醫(yī)療機構為主導,鼓勵和引導社會資本發(fā)展醫(yī)療衛(wèi)生事業(yè),形成公立醫(yī)院與非公有醫(yī)院相互促進、共同發(fā)展的多元辦醫(yī)格局的原則,為進一步促進我國非公有醫(yī)院健康和公平發(fā)展,從而真正形成優(yōu)質非公有醫(yī)院醫(yī)療資源,使非公有醫(yī)院能以可靠的質量和合理的費用不斷滿足人民群眾不同層次的醫(yī)療服務需求,深入調查研究目前我國非公有醫(yī)院存在和面臨的問題,以及各利益相關者對非公有醫(yī)院的評價和對其發(fā)展策略的觀點,并借鑒國外私立醫(yī)院發(fā)展經(jīng)驗,結合理論研究,探討和提出我國下一步發(fā)展非公有醫(yī)院的重點策略,為我國進一步完善非公有醫(yī)院政策提供參考。 研究方法 文獻研究：查閱大量國內外關于私立醫(yī)院發(fā)展存在問題、分類管理、政策支持、監(jiān)管等方面的主要做法及其經(jīng)驗方面的公開文獻和研究成果。 現(xiàn)場調查：通過調查表調查和問卷調查獲取定量資料,通過深度訪談和專題組討論獲得定性資料。對武漢市的7所非公有醫(yī)院和2所公立醫(yī)院做了典型調查并作比較,對山東省17個市的15所非公有醫(yī)院與41所公立醫(yī)院進行了醫(yī)療質量管理方面的專題典型調查并作比較。對武漢市400名醫(yī)生、360名居民和250名病人進行了問卷調查。對武漢市、上海市、寧波市、濟南市的衛(wèi)生局領導、非公有醫(yī)院負責人、公立醫(yī)院負責人、非公有及公立醫(yī)院的醫(yī)生和管理人員共做了33個深度訪談,召開2個專題組討論。 理論分析：借鑒委托代理理論、規(guī)制經(jīng)濟學理論(重點是激勵性規(guī)制合同設計理論和新規(guī)制經(jīng)濟學的規(guī)制俘獲理論)、博弈論、衛(wèi)生經(jīng)濟學理論等進行理論分析。 數(shù)據(jù)統(tǒng)計分析方法：包括描述性分析、x2檢驗、logistic回歸分析、兩樣本比較的Mann-Whitney U檢驗、組問比較的方差分析及Kruskal-Wallis H檢驗、兩兩比較的SNK法及Games-Howell法。所有數(shù)據(jù)分析采用SPSS for Windows 12.0專業(yè)統(tǒng)計軟件處理。 研究結果 1.部分非公有醫(yī)院發(fā)展較好,走上了良性發(fā)展的道路。 2.非公有醫(yī)院一定程度上滿足了群眾的部分醫(yī)療需求。 3.不少非公有醫(yī)院自身存在較多問題,并沒有真正形成優(yōu)質醫(yī)療資源。表現(xiàn)為：不少非公有醫(yī)院經(jīng)營理念上過于追求經(jīng)濟利益;多數(shù)非公有醫(yī)院難以吸引優(yōu)秀人才‘,人員技術力量薄弱；不少非公有醫(yī)院缺乏自律,誠信不足,醫(yī)療行為不規(guī)范甚至有欺騙行為。 4.多數(shù)民眾對非公有醫(yī)院認知不足,存在明顯信息不對稱。 5.部分政策或制度不完善,不利于非公有醫(yī)院公平健康發(fā)展。主要包括：非公有醫(yī)院面臨不公平待遇,加大了其發(fā)展難度；非公有醫(yī)院準入管理制度不完善；對非公有醫(yī)院的醫(yī)療價格(付費)管理制度不合理；非公有醫(yī)院分類管理的政策和措施不完善；非營利性非公有醫(yī)院對投資者缺乏吸引力,面臨籌資困難；醫(yī)療服務信息披露和公開制度不完善；稅收政策對營利性醫(yī)院賦稅較重,各地稅收標準不統(tǒng)一。 6.非公有醫(yī)院監(jiān)管體制和機制不完善,監(jiān)管乏力。主要包括：多頭監(jiān)管、權力分散；主要監(jiān)管機構缺乏獨立性和中立性；監(jiān)管體系不健全；監(jiān)管績效無考核、無問責機制,存在“監(jiān)管俘獲”；監(jiān)管方式與程序不合理；違規(guī)處罰力度較小,違規(guī)成本低。 7.公立醫(yī)院醫(yī)療行為監(jiān)管也不到位,對非公有醫(yī)院有影響。 研究結論 提出了以下幾個方面我國發(fā)展非公有醫(yī)院的策略： (一)總體思路 基于四個方面,第一,優(yōu)化非公有醫(yī)院人員技術力量；第二,規(guī)避非公有醫(yī)院道德風險行為；第三,營造非公有醫(yī)院公平發(fā)展環(huán)境；第四,完善監(jiān)管體制機制以提高監(jiān)管效力,提出我國發(fā)展非公有醫(yī)院的各項具體策略。并應該綜合采取多種措施,發(fā)揮協(xié)同作用,以最大限度地促進非公有醫(yī)院健康發(fā)展。 (二)各項具體策略 1.改進非公有醫(yī)院準入管理制度。調整非公有醫(yī)院機構設置和投資準入管理,加強醫(yī)務人員準入管理,提高醫(yī)務人員準入標準,加強醫(yī)療技術和醫(yī)療設備準入管理。 2.鼓勵社會資本參與現(xiàn)有醫(yī)院轉制。 3.鼓勵發(fā)展非營利性非公有醫(yī)院,謹慎合理發(fā)展營利性醫(yī)院。一是提出了鼓勵發(fā)展非營利性非公有醫(yī)院的措施,包括拓寬非營利性非公有醫(yī)院的籌資渠道,如發(fā)行免稅債券、鼓勵居民出資等；完善醫(yī)院分類管理中對非公有醫(yī)院性質的核定原則。二是提出加強對非營利性非公有醫(yī)院的財務監(jiān)管,保證其非營利性質。三是謹慎合理發(fā)展營利性醫(yī)院。合理確定其服務項目,主要允許其開展信息不對稱程度較輕的診療項目,或治療手段明確、療效確切,容易制定“臨床路徑”的疾病診療項目,或非基本醫(yī)療保險不予支付費用的美容、整形、不育(孕)癥、性功能障礙等特需服務項目。盡量減少其開展目前醫(yī)學上尚無明確特效療法、治療效果不確切或難以觀察的難治性慢性病診療項目等。調整和完善營利性醫(yī)院的稅收政策,免征營業(yè)稅及其附加；降低所得稅稅率；制定專門政策明確統(tǒng)一稅收標準和辦法。 4.政策上給予非公有醫(yī)院平等待遇,并且要改進政策執(zhí)行機制,如明確對執(zhí)行機構的具體操作要求和問責條款,以保證政策得到落實,營造其公平發(fā)展環(huán)境。 5.進一步完善非公有醫(yī)院醫(yī)療服務信息披露和公開制度。從信息披露和公開的內容、機構、程序和方式四個方面進行完善。 6.加強非公有醫(yī)院信用體系和制度建設。建立全國統(tǒng)一聯(lián)網(wǎng)的非公有醫(yī)院信用檔案系統(tǒng),積極推行非公有醫(yī)院不良執(zhí)業(yè)行為記分管理制度。 7.改進非公有醫(yī)院醫(yī)療價格(費用)管理制度。改變目前的按服務項目付費方式。對營利性醫(yī)院實行醫(yī)患雙方協(xié)商簽訂“單病種醫(yī)療總費用合約”制度,實行備案制,并向社會公開。對非營利性非公有醫(yī)院,在政府指導價基礎上,結合制定臨床路徑,形成單病種費用標準,實行單病種定額付費。對屬于醫(yī)療保險支付費用的服務項目,在費用支付總量上,宜實行人均定額付費制,并設置上限和下限,采取不同的結算方法,防止降低服務質量。 8.完善非公有醫(yī)院監(jiān)管體制和機制,提高監(jiān)管效力。一是構建聯(lián)席會議制度。應由衛(wèi)生行政部門聯(lián)合藥監(jiān)、醫(yī)保、財政、審計、物價、質監(jiān)、民政、工商、稅務部門等相關部門構建。二是進一步完善監(jiān)管體系。建立包括政府部門監(jiān)管、行業(yè)自律組織和消費者保護組織參與以及公眾輿論監(jiān)督在內的較完善的現(xiàn)代監(jiān)管體系。三是建立獨立的、專業(yè)化的監(jiān)管機構。四是提高監(jiān)管程序的透明度,改進監(jiān)管方式。讓公眾對監(jiān)管情況、監(jiān)管結果有所了解;在監(jiān)管方式上,適當應用“突擊式檢查”、“追蹤檢查法”、專(兼)職醫(yī)生巡回式駐點檢查。五是明確監(jiān)管重點,建立非公有醫(yī)院監(jiān)管績效考核和問責機制�？冃Э己吮O(jiān)管目標的設置要針對目前的薄弱環(huán)節(jié),重點包括醫(yī)療質量、醫(yī)療行為、醫(yī)療廣告、非營利性非公有醫(yī)院財務支配、醫(yī)療費用方面的指標；建立監(jiān)管失職問責制度,提高社會公眾參與水平,充分發(fā)揮消費者保護組織、行業(yè)自律組織和社會輿論的監(jiān)督作用,并接受公眾的有效問責。六是加大非公有醫(yī)院違規(guī)處罰力度,增加其違規(guī)代價。 9.對非公有醫(yī)院和公立醫(yī)院實行同步監(jiān)管。
[Abstract]:research objective
Based on China's new medical and health system reform of public medical institutions to adhere to the spirit of leading, encourage and guide social capital to the development of medical and health services in public hospitals and the non-public hospitals mutual promotion and common development of the diversified medical pattern principle, to further promote China's non-public hospitals health and equitable development, thus truly the formation of high-quality non-public hospital medical resources, the non public hospital with reliable quality and reasonable cost to satisfy the people's demand for medical services of different levels, in-depth investigation and study of our current non-public hospitals and problems, and all stakeholders have hospital evaluation and development strategy of the view of the the non-public, and learn from foreign experience in the development of private hospitals, combined with the theoretical research, discussion and proposed the key strategy of our hospitals next step in the development of non-public, for our country To further improve the policy of non-public hospitals to provide reference.
research method
Literature research: consult a large number of domestic and foreign public hospitals about the development of private hospitals, such as problems, classified management, policy support, supervision and so on.
Scene investigation: to obtain quantitative data through questionnaire survey and questionnaire survey, through in-depth interviews and focus group discussion to obtain qualitative data. In Wuhan City, 7 non-public hospitals and 2 public hospitals to do the typical survey, 15 non-public 17 city Shandong province hospitals and 41 public hospitals the medical quality management feature typical survey and comparison. The 400 doctors in Wuhan City, 360 residents and 250 patients were investigated. In Wuhan City, Shanghai City, Ningbo City, Ji'nan City Health Bureau, responsible person of non-public hospitals, public hospitals responsible person, and the non-public public hospital doctors and managers made a total of 33 interviews, held 2 special group discussion.
Theoretical analysis: Based on the principal-agent theory, the regulation economics theory is emphasized, especially the incentive regulation contract design theory and the regulatory capture theory of the new regulation economics, game theory, health economics theory and so on.
Statistical analysis methods: descriptive analysis, x2 test, logistic regression analysis, Mann-Whitney U test of two samples, ANOVA and Kruskal-Wallis H test to compare between groups, SNK method and Games-Howell method 22. All data were analyzed using SPSS for Windows 12 professional statistical software.
Research results
The 1. part of the non-public hospitals has developed well and embarked on the road of benign development.
2. non-public hospitals have met some of the people's medical needs to a certain extent.
3. a lot of non-public hospital has many problems itself, and not really the formation of high-quality medical resources. As follows: many non public hospital management idea over the pursuit of economic interests; the majority of non-public hospitals is difficult to attract talented people, "personnel technical force is weak; many non-public hospitals lack self-discipline, lack of integrity, health behavior is not normative and even cheating.
4. of the majority of the people are not aware of the non-public hospitals, and there is a clear information asymmetry.
The 5. part of the policy or system is not perfect, is not conducive to the healthy development of non-public hospitals. The fair includes: Non-public hospitals facing unfair treatment, increased the difficulty of its development; non-public hospital admission management system is not perfect; on non-public hospital medical price (Fu Fei) management system is not reasonable; non public policies and measures classification the hospital management is not perfect; there are non-profit non-public hospitals less attractive to investors, facing financing difficulties; medical services and public information disclosure system is not perfect; the tax policy on heavy profit hospital tax, local tax standards are not uniform.
6. non-public hospital management system and mechanism is not perfect, weak supervision. Include: long supervision, decentralization; main regulators lack of independence and neutrality; imperfect supervision system; supervision of performance appraisal, no accountability mechanism, the existence of regulatory capture; unreasonable regulatory methods and procedures of punishment; small, illegal and low cost.
7. the supervision of medical behavior in public hospitals is not in place, and it has an impact on non-public hospitals.
research conclusion
The strategies for the development of non-public hospitals in China are put forward in the following aspects:
(1) the general idea
Based on four aspects: first, the optimization of non-public hospital personnel and technical personnel; second, to avoid the moral hazard behavior of non-public hospitals; third, to create a fair environment for the development of non-public hospitals; fourth, improve the regulatory system and mechanisms to improve regulatory effectiveness, and puts forward the specific strategies for the development of non-public hospitals in our country have. And should be integrated to take various measures the synergistic effect, in order to maximize the promotion of healthy development of non-public hospitals.
(two) specific strategies
1., improve the access management system of non-public hospitals. Adjust the institutional setup and investment access management of non-public hospitals, strengthen the access management of medical personnel, improve the access standards of medical personnel, and strengthen the access management of medical technology and medical devices.
2. encourage social capital to participate in the transfer of existing hospitals.
3. to encourage the development of non-profit non-public hospitals, rationaldevelopment of for-profit hospitals. One is proposed to encourage the development of non-profit non-public hospital measures, including expanding non-profit non-public hospital funding sources, such as the issuance of tax exempt bonds, to encourage investment and other residents; improve the management of hospital classification principle of non-public hospitals approved. Two put forward to strengthen financial supervision on the non-profit non-public hospitals, to ensure their non-profit. Three is the rationaldevelopment of for-profit hospitals. Reasonably determine its services mainly, allowing it to carry out information asymmetry to a lesser extent treatment project, or treatment clear, effective, easy to develop "disease treatment project of clinical path", or basic medical insurance will not pay for beauty, plastic surgery, infertility (pregnant) disease, sexual dysfunction and other special needs services. Try to reduce its development There isno clear effects of current medical therapy, the treatment effect is not exact or difficult to observe the refractory chronic treatment projects. The tax policy adjustment and improvement of for-profit hospitals, exempt from business tax and additional; lower income tax rates; to develop specific policies to specific uniform tax standards and methods.
4., we should give equal treatment to non-public hospitals on policy, and improve policy implementation mechanism, such as making clear the specific operation requirements and accountability clauses of implementing agencies, so as to ensure the implementation of policies and create a fair development environment.
5., we should further improve the information disclosure and publicity system of non-public hospitals, and improve them from the following four aspects: information disclosure and open contents, institutions, procedures and ways.
6., we should strengthen the construction of credit system and system in non-public hospitals. We should establish a credit archives system for non-public hospitals nationwide, and actively promote the scoring management system in non-public hospitals.
7. improve the non-public hospital medical price (cost) management system. To change the current payment by way of service. The implementation of doctor-patient consultation between the two sides signed the "total medical expense of single disease contract" system of for-profit hospitals, filing system, and to the public. On the non-profit non-public hospitals, in government guidance based on the combination of the development of clinical pathways and the formation of single disease cost standard, the implementation of DRGs. Belonging to the medical insurance paid for services, fees paid in total, per capita should implement the quota payment system, and set the upper and lower limits, to take a different billing method, to prevent the lower quality of service.
8. to improve the monitoring system and mechanism of non-public hospitals, improve regulatory effectiveness. One is to construct a joint meeting system. The administrative department of health shall be borne by the joint drug administration, health care, finance, audit, price, quality supervision, industry and commerce, civil affairs, construction of the tax department and other related departments. The two is to further improve the regulatory system. Including the establishment of government regulation, industry self regulatory organizations and consumer protection organizations and public opinion supervision, perfect the modern regulatory system. The three is the establishment of independent regulatory agencies, professional. The four is to improve the transparency of regulatory procedures, improve the supervision mode. So that the public supervision, supervision results understanding; on the regulation, the proper use of "the commando style check", "check", specifically (and) the post doctor rotational stagnation inspection. The five is a clear regulatory focus, the establishment of non-public hospital performance assessment monitoring and accountability mechanisms. Performance test Nuclear regulatory objectives set to address the current weaknesses, including medical quality, medical behavior, medical advertising, non-profit non-public hospital financial dominance, the index of medical costs; establish a supervision system of accountability for dereliction of duty, improve the level of public participation, give full play to the supervisory role of the consumer protection organizations, industry self-regulation and public opinion, and accept public accountability and effective. The six is to increase the penalties for violations of non-public hospital efforts, increase the illegal cost.
9. the synchronous supervision of non-public hospitals and public hospitals.

【學位授予單位】：華中科技大學
【學位級別】：博士
【學位授予年份】：2010
【分類號】：R197.3

【引證文獻】

相關期刊論文 前2條

1 安徽省財政廳課題組;吳天宏;朱艾勇;徐玉明;梁繼鴻;;安徽省民營醫(yī)院發(fā)展狀況及相關扶持政策研究[J];衛(wèi)生經(jīng)濟研究;2012年01期

2 周小園;尹愛田;;醫(yī)改視角下社會辦醫(yī)發(fā)展的基本思路[J];中國衛(wèi)生經(jīng)濟;2014年04期

相關博士學位論文 前1條

1 劉小明;我國醫(yī)療服務業(yè)規(guī)制研究[D];西南財經(jīng)大學;2012年

相關碩士學位論文 前5條

1 黃端;我國非公立醫(yī)院發(fā)展戰(zhàn)略研究[D];天津醫(yī)科大學;2012年

2 夏昊;我國民營醫(yī)院發(fā)展的政策困境及突破[D];廣西師范大學;2013年

3 傅麒碧;昆明市民營醫(yī)院臨床科室主任群體結構現(xiàn)狀分析[D];云南大學;2013年

4 劉榮梅;私立醫(yī)療機構性質轉變的規(guī)制研究[D];北京協(xié)和醫(yī)學院;2013年

5 馬曉平;江西省民營醫(yī)院管理現(xiàn)狀及發(fā)展戰(zhàn)略研究[D];南昌大學;2013年

，

本文編號：1433368