公平与效率均衡：我国公立医院改革的路径选择
发布时间：2018-09-04 15:05
【摘要】：公立医院改革是惠及全民、关系民生的事业,也是一项世界性难题。新中国成立以来,我国公立医院经历了以市场化改革为目标的老医改和以“公益性回归”为目标的新医改两次不同价值取向的医改历程。现阶段还处在新医改试点阶段的公立医院改革,经过三年多的探索已积累了一定经验,但在一些方面依然面临着公平与效率关系失衡的困难和挑战：一是价值取向上的失衡,主要是公益性缺失,具体表现为群众医疗负担过重、就医的时间和地理可及性较差和医患关系恶化；二是外部环境中的失衡,突出表现为政府政策环境不协调和市场竞争环境不完善；三是公立医院的自身管理上的失衡,具体表现为管理决策过失、运行成本虚高和人事问题突出等方面。造成这些失衡的原因是多方面的,目前我国公立医院在客观上医疗资源总量不足与配置失衡并存,在价值取向上存在政策、公立医院及医务人员等多种价值偏差,在实际改革中存在政府与市场双重失灵,在公立医院内部管理上存在管理体制混乱、成本管理薄弱、人力资源管理失当等多方滞后。从处理公平与效率、政府与市场关系的国外公立医院改革经验来看,英国模式(政府主导的公平导向型)与美国模式(市场主导的效率导向型)较为典型,两者取得了各自的成效,也都遇到了改革障碍,结合这些经验与教训,我国应当探索公平与效率均衡的公立医院改革路径：一是在价值取向上要寻求公平与效率的适度均衡,二是在实践模式上要建立政府与市场合作模式,三是在改革过程中须警惕盲目模仿和路径依赖。
[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.
【学位授予单位】：南京师范大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.3
本文编号：2222522
[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.
【学位授予单位】：南京师范大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.3
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