广西民营医院多元监管机制构建的研究

发布时间：2018-03-03 19:49

本文选题：多元视角　切入点：广西　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：【目的】本研究旨在对广西壮族自治区民营医院现状调查及基础上,通过文献分析法,了解目前广西壮族自治区民营医院发展的主要特点、发展中存在的问题以及广西壮族自治区民营医院监管的现状,对广西壮族自治区目前监督管理民营医院进程中存在的问题展开分析,找出问题产生的原因,建立符合广西特点的民营医院多元监管机制并分析其实现策略,并提供政策建议,推动广西壮族自治区民营医院快速而稳定、健康且可持续发展。【方法】本研究结合了理论研究与实证研究方法。首先,本研究通过文献研究法收集整理相关文献资料,总结借鉴国内外医院监管的有利经验,以及我国民营医院监督管理概况及未来发展方向。综合运用不完备法律理论、激励规制理论、监管博弈理论等理论,探讨构建广西壮族自治区民营医院多元监管机制。其次,通过查阅、收集、整理广西民营医院的基本信息、卫生统计数据及监管情况,并通过专家访谈法和利益相关者分析法,探索研究和分析目前广西壮族自治区民营医院监管过程存在的缺陷和主要问题,为探讨广西壮族自治区民营医院的多元监管策略奠定基础。【结果】(1)民营医院多元监管主体及其职责界定。民营医院多元监管机制是强调多方协作、资源整合的一种监管机制。该监管机制中政府是主导者,政府承担的主要是针对民营医院监管方面法律法规的制定和督促法治规范的执行。除了政府外,监管主体还包括行业协会、医疗保险机构、第三方评估团体、社会公众、医院内部治理等。医疗保险机构主要负责监督评估民营医院医疗服务行为的合法性与合理性;行业协会负责参与政策制定、规范执业标准、信息披露和使用非法律性措施惩罚违规民营医院;第三方评估机构则受政府监督部门委托,对民营医院某方面施行专业的监督与评估,构建公正与公平的监督环境,推进信息公开;以新闻媒体和消费者协会为公众监督的典型部门,主要负责引导正确的社会价值观,对违法违规行为的曝光以及对先进机构和个人的舆论宣传,保障患者的合法权益等;医院内部则设立理事会和监管会,作为医院与外部监督机构的衔接部门。(2)广西民营医院发展的现状分析。2011-2015年,广西壮族自治区民营医院在医院总数、医院编制床位数、医院卫生人力资源数等方面呈现逐年上升的趋势,年平均增长率分别为9.95%、18.45%和6.42%。医疗服务量也有了逐渐提升,门、急诊服务量和住院服务量年均增长率为5.07%和24.6%。但较公立医院来说,广西民营医院总体发展还处于起步阶段,尤其是发展规模、服务量等方面与公立医院相比还存在明显的差距。(3)广西民营医院监管现状分析。当前,广西民营医院在监管过程中存在的问题主要有:缺乏系统性和针对性的法律法规及相关政策;医疗监督管理执法队伍力量不足;医院信息公开机制不健全;民营医院监管评估机制尚未健全,违法成本低;不完善的民营医院监管机制,监管缺乏持续性和整体性;监管主体局限,政府外多元监管主体未能发挥优势等。【对策】构建广西壮族自治区多元监管机制,充分发挥各多元监管主体的监督职责。第一,政府部门联合行业协会,要建立健全民营医院监管法律保障制度,加大违规惩处力度,对民营医院运行过程中的各个活动环节起到硬性约束的作用。民营医院监管相关法律法规及规则体系主要应包含民营医院运行法律制度、监管机构建立与运行法规、监管机构监督执行规则,以及监管问责法律制度等。第二,量化分级管理,建立统一的卫生服务信息平台。在日常监督或专项检查中,根据检查结果对各民营医院进行分级量化评价,确立不同的等级,并依照不同的评价等级采取不同的监督检查频率。此外,完善广西壮族自治区民营医院的医疗信息公开制度,向社会公开公示民营医院的医疗具体信息和监管结果,加强信息的透明度,不仅有利于督促民营医院进行诚信合法经营,还有利于促进医疗服务市场的公平竞争。第三,健全民营医院监管评估机制,以防止发生民营医院监管部门滥用权力等的现象,不断纠正监管过程中的偏差并改进监管中存在的主要问题。第四,培育行业组织,发挥行业监管的力量。由于行业协会因在其行业领域中是具有一定的权威性,通常能够参与制定与本行业相关的法规、政策,具备一定的法规制定和管理权限。因此,要在保证第三方行业监管组织的独立性与权威性情况下,鼓励民间成立专业化的医疗行业监管机构,培育广西民营医院的社会监管力量。第五,完善民营医院退出机制,促进良性竞争。为了能真正发挥民营医院在医疗服务市场上的作用,在逐步放宽民营医院的准入限制的同时,还应完善民营医院的退出机制,避免大量低水平的民营医院间无序地在低层次上的竞争,才能保证民营医院保持良好的软硬件设施,为社会公众提供更好的医疗服务。
[Abstract]:[Objective] the purpose of this study is to the investigation on the current situation of the private hospitals in the Guangxi Zhuang Autonomous Region and on the basis of the literature analysis, understand the main features of the development of private hospitals in the Guangxi Zhuang Autonomous Region at present, the problems existing in the development and current situation of supervision of private hospitals in the Guangxi Zhuang Autonomous Region, the Guangxi Zhuang Autonomous Region on the supervision of private hospital management problems in the process of analysis, find out the causes of the problem and establish the Guangxi private hospital characteristics of multiple regulatory mechanisms and the analysis of its implementation strategy, and provide policy recommendations to promote the private hospitals in the Guangxi Zhuang Autonomous Region rapid and stable, healthy and sustainable development. [method] the study combines theoretical research and empirical research methods. Firstly, this study through the literature research method to collect relevant literature summary from the beneficial experience at home and abroad for hospital supervision, and I Overview of the supervision and management of private hospitals and the future direction of development. The comprehensive use of incomplete law theory, incentive regulation theory, regulation game theory, to explore the construction of private hospitals in the Guangxi Zhuang Autonomous Region multiple regulatory mechanism. Secondly, through inspection, collection of basic information of camp Guang Ximin hospital, health statistics and supervision, and through expert interviews and the stakeholder analysis method, research and analysis of defects in the current the Guangxi Zhuang Autonomous Region private hospitals and the main problems existing in the process of supervision, to lay the foundation of multiple regulation strategy for the study of the Guangxi Zhuang Autonomous Region civilian battalion hospital. [results] (1) multiple regulatory bodies and responsibilities of private hospitals defined. Private hospital multi regulatory mechanism is emphasized the cooperation of a the supervision mechanism of resource integration. The government supervision mechanism is dominant, the government is mainly aimed at The formulation of laws and regulations and supervise the private hospital supervision of the rule of law enforcement. Apart from the government, the regulatory body also includes industry association, medical insurance organization, the third party evaluation group, the public hospital internal governance. Medical insurance agency is responsible for supervision and assessment of the private hospital medical service behavior of the legitimacy and rationality; Industry Association is responsible for participate in policy formulation, standard practice standards, information disclosure and use legal measures to punish illegal private hospitals; third party assessment agencies entrusted by the government supervision departments, a private hospital on aspects of the implementation of supervision and assessment of professional, fair and equitable environment construction supervision, and promote information disclosure; in the news media and Consumer Association as a typical Department of public supervision, mainly responsible for guiding the correct social values, the illegal behavior of exposure as well as the advanced institutions and individuals The propaganda of public opinion, safeguard the legitimate rights and interests of patients; hospital set up the Council and the supervision department as the hospital, cohesion and external supervision mechanism. (2) analysis of the current situation of the development of Guangxi private hospital in.2011-2015, the Guangxi Zhuang Autonomous Region private hospital in the total hospital beds, hospitals, health human resources with respect to the number of year by year the rising trend, the average annual growth rates were 9.95%, 18.45% and 6.42%., the amount of medical services has gradually improved, the door, emergency services and inpatient services with an average annual growth rate of 5.07% and 24.6%. but lower than the public hospitals, the overall development of the Guangxi private hospital is still at the starting stage, especially the development of the scale, service quantity etc. compared with public hospitals, there is still a significant gap. (3) analysis of Guangxi private hospital supervision. Currently, Guangxi private hospital in the supervision of the existing problems in the process of the main To: the lack of systematic and specific laws and regulations and related policies; the medical supervision and management of law enforcement personnel shortage; hospital information disclosure mechanism is not perfect; private hospital supervision and evaluation mechanism is not perfect, the illegal cost is low; the private hospital supervision mechanism is not perfect, supervision of the lack of continuity and integrity; supervision of the main limitations. The government failed to give full play to the advantages of multiple regulatory body. [] on construction of the Guangxi Zhuang Autonomous Region multi supervision mechanism, give full play to the supervisory duties of the multiple regulatory body. First, government departments Joint Industry Association, to establish and perfect the supervision legal system of private hospitals, increase illegal punishment, to a rigid constraint function to each step of operation process of private activities in the hospital. Private hospitals supervision of relevant laws and regulations and rules of the system mainly should include private hospital operation of the legal system, regulatory mechanism The establishment and operation of laws and regulations, regulatory supervision of the implementation of rules, supervision and accountability of the legal system. Second, quantitative classification management, establish a unified information platform for health service. In the daily supervision or special inspection, the quantitative classification and evaluation of each private hospital according to the inspection results, the establishment of different levels, and in accordance with the different evaluation take the supervision and inspection of different frequency levels. In addition, to improve the medical information disclosure system of the Guangxi Zhuang Autonomous Region private hospitals, private hospitals to the public announcement of medical information and specific supervision results, strengthen the transparency of information, not only conducive to supervise the private hospital for legitimate business integrity, and to promote the fair competition of the medical service market. Third, improve the private hospital supervision and evaluation mechanism, to prevent regulatory departments of private hospitals in abuse of power phenomenon, continue to correct the regulatory process The deviation and improve the main problems existed in supervision. Fourth, cultivate industry organizations, play industry regulatory power. As the Industry Association for its industries have a certain authority, usually able to participate in the development of the industry and the relevant laws and regulations, policies, regulations and management have a certain authority. So to ensure the supervision organization, in third industries of the independence and authority of the circumstances, the medical industry regulators encouraged the establishment of private professional cultivation, social supervision power of Guangxi private hospital. Fifth private hospitals, improve the exit mechanism, and promote healthy competition. In order to really play the role of private hospitals in the medical service market. In the access of private hospitals gradually relax the restrictions at the same time, should also improve the exit mechanism of private hospitals, to avoid a lot of low levels of private hospitals in order to lower the level of competition, We can ensure that private hospitals maintain good hardware and software facilities and provide better medical services for the public.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.3

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