我国政府购买医疗服务的必要性研究

发布时间：2018-01-15 09:09

本文关键词：我国政府购买医疗服务的必要性研究　出处：《东北财经大学》2014年硕士论文　论文类型：学位论文

【摘要】：政府购买医疗服务是我国近年来比较关注的一项重大举措,尤其是在当今社会,看病难和看病贵已成为困扰人们生活的热点问题,鼓励社会资本办医,打破公立医院垄断提供格局,允许民营医疗机构享受与公立医院相同的政策待遇,形成医疗服务提供方的竞争格局,发挥市场在调节医疗资源配置中的基础性作用,是实现医疗服务价格由市场供需决定,从而缓解看病贵问题,以及实现患者分流,缓解公立医院排队等候时间过长等看病难问题的关键。西方政府在政府购买医疗服务方面的实践较早,已经形成了比较完善的购买体制,我国政府购买医疗服务起步较晚,加之医疗领域的特殊性和行政命令体制,还有待各方共同努力探索适合中国国情的市场化方式,近年来,我国政府在政府购买医疗服务方面也出台了一些相关的政策和法令,为进一步扩大购买范围和规模奠定了法律基础,对于突破医疗服务购买领域缺乏法律依据的困境迈出了重要的一步。学界对政府购买医疗服务的文献研究大多集中于以下几个方面：政府购买医疗服务的概念、购买方式研究、购买过程中政府角色、如何实现医疗资源均等化配置等。本文对一些相关的重要文献进行了借鉴和参考,综合运用了经济学、统计学等相关学科的理论知识,就我国近年来的医疗市场现状进行了客观分析,力求理论与实践相结合,深入分析了现存医疗体制走向市场化的现实障碍和完善的途径。本文重点关注我国医疗服务市场的现状是否达到市场化标准,并站在经济学的角度得出非市场化竞争状态的不良后果,利用统计网数据进行了实证分析,验证提出的假设正确性,对于分析现存医疗体制缺陷,并提出针对性的解决方案具有重要的现实意义,本文行文结构如下：第一部分绪论：主要介绍了本文的研究背景、研究意义、研究方法、国内外文献综述。第二部分政府购买医疗服务的内涵及理论依据：从公共服务的界定以及政府购买公共服务的内涵出发,从政府治理和经济运行两个角度介绍了相关的理论依据,引用政府失灵论、比较优势论和服务型政府论分析政府购买医疗服务同购买其他公共服务一样,都可以利用市场优势,提高质量和效率。进而阐述了医疗服务的购买。第三部分政府购买医疗服务的国内外发展现状：站在政策和立法的角度分析了我国政府购买医疗服务方面的探索,以安徽省为例指出购买活动已经开始被地方政府提上实践日程。分析了国际社会上普遍实行的两种购买机制,一种是以英国为代表的内部市场制,另一种是以德国为代表的有管理的市场化,并对美国的以市场为导向模式进行阐述。第四部分我国医疗服务市场现状的实证分析：阐述了医疗服务市场化的具体概念,从现实的角度对其必要性进行分析,通过回归模型对医疗供需现状进行分析,得出医疗服务市场并没有实现市场化的客观现实是导致看病难问题的原因所在。第五部分我国政府购买医疗服务面临的困境：从两个方面分析了政府购买过程中的困境,一方面是来自服务方的困境,民营医院本身力量薄弱、实力较差,另一方面是来自购买方的困境,国家政策如税收政策上没有实现民营医院和公立医院的同等待遇,导致竞争力不强,另外,管办不分现象仍然普遍存在,政府充当直接付费者的角色,难以兼顾效率。第六部分改善我国政府购买医疗服务的几点建议：提出要合理划分购买范围,借鉴国外经验,引入第三方购买机制,完善政府、第三方和患者共同监督机制,提高民营医院服务水平,实现医疗资源均等化,并建立完善的风险防范和监督机制。
[Abstract]:The government purchase of medical services is an important measure of our country in recent years of concern, especially in today's society, medical treatment is difficult and expensive problem has become the focus of people's lives, encourage social capital to do medicine, breaking the monopoly of public hospitals to provide pattern, allowing private medical institutions to enjoy the same public hospital policy treatment, the formation of the health service providers play in regulating the market competition, the fundamental role in the allocation of medical resources, is the realization of the medical service price determined by market supply and demand, so as to alleviate the problem of expensive, and the realization of patient triage, the key to ease public hospital long waiting time and other difficult problems.
Western governments practice in the government purchase of medical services earlier, has formed a relatively perfect purchase system, our government purchase medical services started late, and the particularity of the medical field and administrative command system, needs the joint efforts of all parties to explore the market, suitable for Chinese situation of our country in recent years, the Chinese government in the government the purchase of medical services also issued some relevant policies and regulations to further expand laid a legal foundation for the scope and scale of purchase, the lack of legal basis for medical services in the field of breakthrough predicament has taken an important step. The academic research literature on the government purchase of medical services are mostly concentrated on the following aspects: the concept of government the purchase of medical service, the purchase of the role of government, the purchase process, how to achieve the equalization of medical resources allocation. This paper related to some of the The reference of literature, comprehensive use of theoretical knowledge of economics, statistics and other related disciplines, objectively analyzes the status quo of China's medical market in recent years, strives to combine theory with practice, analyzes the existing obstacles of medical system into market and perfect way.
This article focuses on the current situation of medical service market in China is up to the market standard, and that the station gets adverse consequences of non market competition in the perspective of economics, empirical analysis is conducted by using the statistical data, verify the correctness of the proposed hypothesis, analysis of the defects in the existing medical system, and put forward the solutions with the important practical significance, the structure of this paper are as follows:
The first part of the introduction: the main introduction of the research background, research significance, research methods, literature review at home and abroad.
The connotation and theoretical basis of the second part of the government to buy Medical Services: the connotation of the purchase of public service from the public service as well as to define the government, from two angles of government governance and economic operation introduces the relevant theoretical basis, citing government failure theory, comparative advantage theory and service oriented government theory to analyze the government purchase of medical services as well as the purchase of other public service, can take advantage of the market, improve the quality and efficiency of medical service. Then elaborated the purchase.
The development status of the third part of the government to purchase medical services at home and abroad: standing on the point of legislation and policy analysis to explore China's government purchase medical services, taking Anhui Province as an example that the purchase has been put on the agenda of local government practice. Analysis of two kinds of purchase mechanism generally implement the international community, a is the internal market system represented by the United Kingdom, the other is the representative of Germany as a market management, and for the United States market oriented model in this paper.
Fourth part of the empirical analysis of the status quo of China's medical service market, expounds the concrete concept of the medical service market, analyzes its necessity from the angle of reality, based on the current situation of medical supply and demand analysis of regression model, the medical service market and did not realize the objective reality of the market is the reason which causes the difficult problem.
The fifth part of our government purchase medical services dilemma: from the two aspects of government purchase in the process of the plight of the one hand from the service side of the plight of private hospitals is weak, poor strength, on the other hand, from the purchase of the plight of national policies such as the equal treatment of private hospitals and public hospitals no implementation of tax policy, resulting in less competitive, in addition, tubes do not divide the phenomenon still exists, the government plays the role of direct payments, it is difficult to give consideration to efficiency.
Some suggestions to improve the sixth part of our government purchase medical services: put forward to a reasonable division of the purchase scope, learn from foreign experience, the introduction of third party purchasing mechanism, improve the government, and the third party with common supervision mechanism, improve the service level of private hospitals, medical resources equalization, and establish and improve the risk prevention and supervision mechanism.

【学位授予单位】：东北财经大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.1;F812.45

【参考文献】