我国城镇医疗卫生体制改革问题及对策研究
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摘要
由于受计划经济体制的影响,加之医疗卫生事业具有人道性、福利性、专业性等特点,使得医疗卫生体制改革受到诸多因素的影响和制约,改革的步伐相对滞后,已经不能很好的满足人民群众日益增长的医疗卫生服务需求,对医疗卫生管理体制和运行机制进行改革势在必行。
本文主要运用比较分析、归纳演绎等研究方法,以组织变革理论、公共产品理论等为基础,从我国城镇医疗卫生事业发展和改革的现状入手,分析了当前城镇医疗卫生体制改革的制约因素。文中重点运用组织分析法和标杆瞄准法,从宏观角度对中外医疗服务体系、中外医院管理模式进行了比较研究。通过对比分析,借鉴国外医疗卫生管理体制和运行机制的先进经验和做法,本着公平、效率、质量三者兼顾的原则和以人为本的思想,提出了我国城镇医疗卫生体制改革的基本对策。
目前,我国的医疗卫生体制改革,必须将政府作用与市场机制相结合,有针对性地解决好我国医疗卫生领域的出现的政府职能错位现象,充分发挥市场调节和资源配置功能,政府要建立平民医院、公共卫生服务机构和一些大型教学医院,对现有医疗资源进行科学重组,积极支持民营医疗卫生机构的建立和发展,建立健全医疗救助制度,完善医疗保险制度。医疗卫生机构内部要实行现代法人治理结构,以提高运行质量和资源利用效率。医疗卫生体制改革与医疗保险制度改革、药品流通体制改革要相互协调,三改联动,促进我国医疗卫生事业健康、可持续发展。
The Planning economic system has been making a notable impact, and the humanity, benefit,specialization is the hospital and health services peculiarity, etc. All of the reason brings lotsof influence and restriction. So the reforming of the hospital and health services system hasbeen relatively dropped behind. It couldn't meet the people's different kinds of the medicaland health needs. To reform the hospital and health services system must be done in time.The author uses the comparison and analysis methods in the thesis. Based on theorganization reforming and public product theories, etc, the author analyzes therestriction factor of the reforming the hospital and health services system, andcompares the reforming strategies and the management of the hospital of Chinesewith other country. Considering the fair, efficiency, and the quality, the authorconstructs a plan of the reforming of the hospital and health services system inChinese cities.At present, It must integrate the government effect with market function in the reforming, and it can resolve the government function demerit and develop the role of regulation and resource allocation through the market. The aim of the reforming is to institute the hospital for poor people, health services of the public health, and other hospitals to study. Many other hospital should be reorganized .The state should support the no-stated hospital and should construct the rescue institution to help the poor mass. In other side, for improving the efficiency of management, the hospital should imitate the modern enterprise management system. Last, the author thinks that the health service system reforming should be done with the reforming of medical guarantee system and the drug circulation system.
本文主要运用比较分析、归纳演绎等研究方法,以组织变革理论、公共产品理论等为基础,从我国城镇医疗卫生事业发展和改革的现状入手,分析了当前城镇医疗卫生体制改革的制约因素。文中重点运用组织分析法和标杆瞄准法,从宏观角度对中外医疗服务体系、中外医院管理模式进行了比较研究。通过对比分析,借鉴国外医疗卫生管理体制和运行机制的先进经验和做法,本着公平、效率、质量三者兼顾的原则和以人为本的思想,提出了我国城镇医疗卫生体制改革的基本对策。
目前,我国的医疗卫生体制改革,必须将政府作用与市场机制相结合,有针对性地解决好我国医疗卫生领域的出现的政府职能错位现象,充分发挥市场调节和资源配置功能,政府要建立平民医院、公共卫生服务机构和一些大型教学医院,对现有医疗资源进行科学重组,积极支持民营医疗卫生机构的建立和发展,建立健全医疗救助制度,完善医疗保险制度。医疗卫生机构内部要实行现代法人治理结构,以提高运行质量和资源利用效率。医疗卫生体制改革与医疗保险制度改革、药品流通体制改革要相互协调,三改联动,促进我国医疗卫生事业健康、可持续发展。
The Planning economic system has been making a notable impact, and the humanity, benefit,specialization is the hospital and health services peculiarity, etc. All of the reason brings lotsof influence and restriction. So the reforming of the hospital and health services system hasbeen relatively dropped behind. It couldn't meet the people's different kinds of the medicaland health needs. To reform the hospital and health services system must be done in time.The author uses the comparison and analysis methods in the thesis. Based on theorganization reforming and public product theories, etc, the author analyzes therestriction factor of the reforming the hospital and health services system, andcompares the reforming strategies and the management of the hospital of Chinesewith other country. Considering the fair, efficiency, and the quality, the authorconstructs a plan of the reforming of the hospital and health services system inChinese cities.At present, It must integrate the government effect with market function in the reforming, and it can resolve the government function demerit and develop the role of regulation and resource allocation through the market. The aim of the reforming is to institute the hospital for poor people, health services of the public health, and other hospitals to study. Many other hospital should be reorganized .The state should support the no-stated hospital and should construct the rescue institution to help the poor mass. In other side, for improving the efficiency of management, the hospital should imitate the modern enterprise management system. Last, the author thinks that the health service system reforming should be done with the reforming of medical guarantee system and the drug circulation system.
引文
[1] 谭力文,徐珊,李燕萍.管理学.武汉大学出版社,2000.2:185-186
[2] 李金明,戴冒钧.标杆瞄准.天津人民出版社,1996:6-7
[3] 张德,陈国权.组织行为学.清华大学出版社,2000.10:254-255
[4] 程晓明,罗五金.卫生经济学.人民卫生出版社,2003.8:63
[5] 梁万年,郝模.卫生事业管理.人民卫生出版社,2003.7:43
[6] 曹荣桂,陈洁.医院管理学(经营管理分册).人民卫生出版社,2003.1:128
[7] Thomas R.Dye.Understanding Public Policy.北京:在国人民大学出版社,2004:111
[8] 梁万年,郝模.卫生事业管理.人民卫生出版社,2003.7:72
[9] Dilnot, Andrew. The Economic of Social Security. New York: Oxford University Press, 1989.1:89
[10] Titmuss, M. Commitment to welfare .Unwin University Books, 1998.5:34
[11] 丁兰.医院院长工作全书.吉林人民出版社,2001.556
[12] 乌日图.医疗保障制度国际比较.化学工业出版社,2003.3:174
[13] 周庆行,周立.公共卫生事业管理.重庆大学出版社,2003.12:75
[14] 刘新明,陈啸宏.城镇医药卫生体制改革政策问答.中国协和医科大学出版社,2001.5
[15] 魏志春.公共事业管理.上海教育出版社,2004.3:62
[16] 复旦大学公共卫生学院经济学教研室.美国卫生组织服务变革的介绍.中华医院管理,2001,17:571-572
[17] 曹达洪.加快国有医院产权和内部治理结构改革的思考.中国卫生,2003.6:33
[18] 车江洪.改革公共部门.华东师范大学出版社,2001.10:20
[19] 方佩英.创建基本现代化医院的实践与思考.中国卫生,2003.10:56
[20] 周文贞,秦永方等著.医院成本核算.中国经济出版社,2002.2:100
[21] 吴福胜.提高国有医院核心竞争力的途径探讨.中国卫生,200:3.6:47
[22] Hanchak, NAN.Schlackman. U.S.Health care'squality-based compensation model.Health Care Financing Review, 1996.1:103
[23] 郑雪倩,万欣.公立医院在改制中应注意的问题.中国卫生,2004.5:23
[24] 邵国富,徐捷等著.医院集团化与连锁经营.哈尔滨出版社,2003.2:51
[25] 乐斤圣.医疗卫生机构改制上市的策略.中华医院管理,2001.11:692-694
[26] 丁涵章,马骏,陈洁,主编.现代医院管理全书.杭州:杭州出版社,1999.2:46-47
[27] 周传章,赵淮跃等.民营医院生存状况调查.中国卫生,2004.11:59
[28] 曹荣桂,陈洁.医院管理学(经营管理分册).人民卫生出版社,2003.1:155
[29] Claxton, GJ.Feder. Public policy issues in nonprofit con-versions:An overview. Health Affairs, 1997.3:27
[30] 丁书琴,黄建明,何丽华,吴金泉.新世纪医院发展的创新战略.中华医院管理,2004.12:695
[31] 季健.医疗保障制度改革对医院的影响与适应.中华医院管理,2000.10:172-173
[2] 李金明,戴冒钧.标杆瞄准.天津人民出版社,1996:6-7
[3] 张德,陈国权.组织行为学.清华大学出版社,2000.10:254-255
[4] 程晓明,罗五金.卫生经济学.人民卫生出版社,2003.8:63
[5] 梁万年,郝模.卫生事业管理.人民卫生出版社,2003.7:43
[6] 曹荣桂,陈洁.医院管理学(经营管理分册).人民卫生出版社,2003.1:128
[7] Thomas R.Dye.Understanding Public Policy.北京:在国人民大学出版社,2004:111
[8] 梁万年,郝模.卫生事业管理.人民卫生出版社,2003.7:72
[9] Dilnot, Andrew. The Economic of Social Security. New York: Oxford University Press, 1989.1:89
[10] Titmuss, M. Commitment to welfare .Unwin University Books, 1998.5:34
[11] 丁兰.医院院长工作全书.吉林人民出版社,2001.556
[12] 乌日图.医疗保障制度国际比较.化学工业出版社,2003.3:174
[13] 周庆行,周立.公共卫生事业管理.重庆大学出版社,2003.12:75
[14] 刘新明,陈啸宏.城镇医药卫生体制改革政策问答.中国协和医科大学出版社,2001.5
[15] 魏志春.公共事业管理.上海教育出版社,2004.3:62
[16] 复旦大学公共卫生学院经济学教研室.美国卫生组织服务变革的介绍.中华医院管理,2001,17:571-572
[17] 曹达洪.加快国有医院产权和内部治理结构改革的思考.中国卫生,2003.6:33
[18] 车江洪.改革公共部门.华东师范大学出版社,2001.10:20
[19] 方佩英.创建基本现代化医院的实践与思考.中国卫生,2003.10:56
[20] 周文贞,秦永方等著.医院成本核算.中国经济出版社,2002.2:100
[21] 吴福胜.提高国有医院核心竞争力的途径探讨.中国卫生,200:3.6:47
[22] Hanchak, NAN.Schlackman. U.S.Health care'squality-based compensation model.Health Care Financing Review, 1996.1:103
[23] 郑雪倩,万欣.公立医院在改制中应注意的问题.中国卫生,2004.5:23
[24] 邵国富,徐捷等著.医院集团化与连锁经营.哈尔滨出版社,2003.2:51
[25] 乐斤圣.医疗卫生机构改制上市的策略.中华医院管理,2001.11:692-694
[26] 丁涵章,马骏,陈洁,主编.现代医院管理全书.杭州:杭州出版社,1999.2:46-47
[27] 周传章,赵淮跃等.民营医院生存状况调查.中国卫生,2004.11:59
[28] 曹荣桂,陈洁.医院管理学(经营管理分册).人民卫生出版社,2003.1:155
[29] Claxton, GJ.Feder. Public policy issues in nonprofit con-versions:An overview. Health Affairs, 1997.3:27
[30] 丁书琴,黄建明,何丽华,吴金泉.新世纪医院发展的创新战略.中华医院管理,2004.12:695
[31] 季健.医疗保障制度改革对医院的影响与适应.中华医院管理,2000.10:172-173
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