我国医疗服务业规制研究
发布时间：2018-11-04 10:06
【摘要】：在现代文明社会中,医疗卫生服务变得日益重要,这从各国卫生总费用占GDP比例逐年上升这个简单事实即可看出。人们选择用更多的收入投入到购买医疗服务之中,不仅仅是因为生命健康的重要,而医疗服务提供者选择更昂贵的手段提供医疗服务也不仅仅是因为其拥有优势的交易地位。生产者和消费者的选择,都受所面临的现有生产体系和市场环境限制。对于医疗服务业,政府对其的规制制度体系及其制度体系的变迁过程,决定了当前医疗服务体系市场特征。当前医疗服务业中所存在的费用快速上涨,公平性、方便性和医疗质量问题,都可以政府的规制制度上找到原因。 本文回顾了我国医疗体制的演进过程,分析了建国后四个主要阶段我国医疗服务体系中存在的问题及其制度原因,并利用产业组织的方法分析了我国当前医疗服务业的市场集中度、产品竞争特点、进入壁垒、行业结构特点和区域分布特征,并结合与国际上典型国家的医疗服务体系比较,得出了我国的医疗服务业区域市场集中度过高、大型公立医院垄断势力太大、进入壁垒较大、城乡二元结构等特点导致了市场竞争强度不够的结论。 为了找到形成我国具有如此特点的医疗服务产业体系的原因,本文深入分析了我国政府对医疗服务行业的准入、布局规划、价格和质量规制制度,并通过近几年来的医疗服务业的各项统计和调查数据考察其规制的规制成效,发现了准入制度不完善、作为监管主体的政府直接办医、扭曲的医药价格规制措施和还未形成有效的质量监管体系的等因素是造成医疗服务业布局不合理、“以药养医”和医疗质量问题的直接原因。 为了解决当前医疗服务业中存在的问题,一些地区进行了各种探索,本文通过总结各地以“管办分开”和“医院集团”化为代表的公立医院改革试验经验,并结合近年来基本药物制度实施效果,公立医院改革方案和医疗保障体系的建设经验等改措施的分析,提出了加大向需方投入、政府退出直接办医、放松布局规制、调整准入制度、弱化医药直接定价、完善医师培养制度,把医疗服务的支付方式从按项目转到总额预付制等规制政策建议。
[Abstract]:In modern civilized society, health service is becoming more and more important, which can be seen from the simple fact that the proportion of total health expenditure to GDP is increasing year by year. People choose to invest more of their income in the purchase of medical services not only because of the importance of life and health, but also because health care providers choose more expensive means to provide medical services, not only because they have an advantageous trading position. The choice of producers and consumers is limited by the existing production system and market environment. For the medical service industry, the government's regulatory system and its changing process determine the market characteristics of the current medical service system. At present, the cost of medical service industry is rising rapidly, the problems of fairness, convenience and medical quality can be found out in the regulation system of the government. This paper reviews the evolution process of China's medical system, analyzes the problems existing in the medical service system in the four main stages after the founding of the people's Republic of China and the causes of the system. Using the method of industrial organization, this paper analyzes the market concentration, product competition, entry barriers, industry structure and regional distribution of medical service industry in China, and compares with the medical service system of typical countries in the world. It is concluded that the regional market concentration of medical service industry in China is too high, the monopoly power of large public hospitals is too large, the barriers to entry are large, and the dualistic structure of urban and rural areas leads to insufficient market competition. In order to find out the reasons for forming the medical service industry system with such characteristics in our country, this paper makes a thorough analysis of the government's access, layout planning, price and quality regulation system to the medical service industry. And through the statistics and investigation data of medical service industry in recent years to investigate the regulation effect of its regulation, it is found that the admission system is not perfect, and the government, as the main body of supervision, runs medical treatment directly. The distorted medical price regulation measures and the lack of effective quality supervision system are the direct causes of unreasonable distribution of medical service industry, "raising medicine with medicine" and medical quality problems. In order to solve the problems existing in the current medical service industry, some regions have carried out various explorations. This paper sums up the experience of the public hospital reform experiment, which is represented by the separation of management and the "hospital group". Based on the analysis of the effect of the implementation of the essential drugs system in recent years, the reform scheme of public hospitals and the experience in the construction of the medical security system, it is proposed that the government should increase the input to the demand side, the government should withdraw from running the medical treatment directly, and the layout regulation should be relaxed. To adjust the admission system, weaken the direct pricing of medicine, perfect the training system of doctors, and transfer the payment method of medical service from the item to the total advance system, and so on.
【学位授予单位】：西南财经大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：F719;R197.1
本文编号：2309499
[Abstract]:In modern civilized society, health service is becoming more and more important, which can be seen from the simple fact that the proportion of total health expenditure to GDP is increasing year by year. People choose to invest more of their income in the purchase of medical services not only because of the importance of life and health, but also because health care providers choose more expensive means to provide medical services, not only because they have an advantageous trading position. The choice of producers and consumers is limited by the existing production system and market environment. For the medical service industry, the government's regulatory system and its changing process determine the market characteristics of the current medical service system. At present, the cost of medical service industry is rising rapidly, the problems of fairness, convenience and medical quality can be found out in the regulation system of the government. This paper reviews the evolution process of China's medical system, analyzes the problems existing in the medical service system in the four main stages after the founding of the people's Republic of China and the causes of the system. Using the method of industrial organization, this paper analyzes the market concentration, product competition, entry barriers, industry structure and regional distribution of medical service industry in China, and compares with the medical service system of typical countries in the world. It is concluded that the regional market concentration of medical service industry in China is too high, the monopoly power of large public hospitals is too large, the barriers to entry are large, and the dualistic structure of urban and rural areas leads to insufficient market competition. In order to find out the reasons for forming the medical service industry system with such characteristics in our country, this paper makes a thorough analysis of the government's access, layout planning, price and quality regulation system to the medical service industry. And through the statistics and investigation data of medical service industry in recent years to investigate the regulation effect of its regulation, it is found that the admission system is not perfect, and the government, as the main body of supervision, runs medical treatment directly. The distorted medical price regulation measures and the lack of effective quality supervision system are the direct causes of unreasonable distribution of medical service industry, "raising medicine with medicine" and medical quality problems. In order to solve the problems existing in the current medical service industry, some regions have carried out various explorations. This paper sums up the experience of the public hospital reform experiment, which is represented by the separation of management and the "hospital group". Based on the analysis of the effect of the implementation of the essential drugs system in recent years, the reform scheme of public hospitals and the experience in the construction of the medical security system, it is proposed that the government should increase the input to the demand side, the government should withdraw from running the medical treatment directly, and the layout regulation should be relaxed. To adjust the admission system, weaken the direct pricing of medicine, perfect the training system of doctors, and transfer the payment method of medical service from the item to the total advance system, and so on.
【学位授予单位】：西南财经大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：F719;R197.1
【参考文献】
相关期刊论文 前10条
1 李科珍;;我国外资准入制度的现状、问题及其重构[J];北方法学;2011年01期
2 刘晶;;医改得的到底是哪国病?[J];北方经济;2005年15期
3 朱恒鹏;;还医生以体面:医疗服务走向市场定价[J];财贸经济;2010年03期
4 李丽;;医疗服务市场政府规制研究述评[J];产业经济研究;2006年05期
5 王绍光;人民的健康也是硬道理[J];读书;2003年07期
6 马维胜;;医疗改革的核心问题和未来出路[J];中国工业经济;2006年04期
7 王延中;冯立果;;中国医疗卫生改革何处去——“甩包袱”式市场化改革的资源集聚效应与改进[J];中国工业经济;2007年08期
8 田玲;李冬梅;梁晓捷;;国外医师制度及培养过程[J];国外医学情报;2005年07期
9 徐芬;李国鸿;;国外医疗服务体系研究(二)[J];国外医学(卫生经济分册);2005年04期
10 黄慧英;美国诊断相关分类法的综合介绍[J];国外医学(医院管理分册);1990年04期
相关博士学位论文 前2条
1 夏冕;利益集团博弈与我国医疗卫生制度变迁研究[D];华中科技大学;2010年
2 陈良侠;我国发展非公有医院的策略研究[D];华中科技大学;2010年
，本文编号：2309499
本文链接：https://www.wllwen.com/jingjilunwen/fwjj/2309499.html
