摘要
2009年以来的新医改虽然在一定程度上缓解了群众"看病难,看病贵"问题,但作为中国医疗服务供给的核心主体,公立医院的扩张问题仍然缺乏有效控制。既有研究主要从发展逻辑和规制逻辑对公立医院扩张提出了解释,但缺乏从历时、综合的视角对医院扩张行为进行分析,无法充分揭示公立医院为何保持持续的扩张冲动和非理性的扩张方式。本文运用医院间三维竞争理论模型来展示中国公立医院扩张的基本特征和行动逻辑。研究发现,医院间竞争是中国公立医院持续扩张的动力所在。中国转型时期医疗保险政策体系不完善、政府主导的医疗卫生机构管理体制不健全,以及公众医疗卫生知识缺乏是使公立医院在不同维度的竞争脱离价格竞争、效率竞争轨道,走向规模扩张的关键制度诱因。文章最后探讨了公立医院扩张的逻辑及其治理对深化我国行政体制改革和提升国家治理能力的启示和意涵。
The new wave of health reform in China ever since 2009 has, to some extent, addressed the problem of ＂difficult and expensive health＂ faced by the ordinary people to access the medical service since 2009, but the rampant public hospital expansions have not been put under effective control and this has hindered the formation of the new health system. Existing studies on explanations for public hospitals＇ expansion focus mainly on the logic of development or regulation. They fail to provide sound explanations on why public hospitals maintain the sustaining expansionary impulse and expand in an unfettered way. Adopting the three-dimensional competitive model, this paper seeks to explain the logic of and fundamental reasons for public hospital expansion in China. It concludes by showing that competitions among public hospitals are the driving force behind the continuous public hospitals expansions. Factors such as insufficient health insurance, poor management in health care system, and lack of health care knowledge among citizens are attributed to the vicious competitions among public hospitals in China. All this sheds light on how the Chinese government makes countermeasures against public hospital expansion and carries implications for further administrative reforms and improvement of state governance capacity in China.
作者
李文敏
朱亚鹏
Li Wenmin, Zhu Yapeng Li Wenmin(1 School of Government, Sun Yat-sen University;2 Centre for Chinese Public Administration and Professor at School of Government, Sun Yat-sen University. Guangzhou 51027)
出处
《中国行政管理》
CSSCI
北大核心
2018年第5期77-82,共6页
Chinese Public Administration
基金
教育部人文社科重点研究基地重大项目“资产为本的社会政策研究”(编号：14JJD630014)
国家社科基金重大项目“中国特色现代社会福利制度框架设计研究”(编号：15ZDA050)
教育部人文社会科学重点研究基地重大项目《社会政策创新与共享发展》(编号：16JJD630011)
关键词
公立医院
医院扩张
医疗竞争
治理
public hospital
scale expansion
competition in the health service
governance
