私立医疗机构性质转变的规制研究

发布时间：2018-02-22 09:59

本文关键词： 私立医疗机构营利性非营利性性质转变规制监管建议　出处：《北京协和医学院》2013年硕士论文　论文类型：学位论文

【摘要】：研究目的了解私立医疗机构经营性质转变及监管中存在的问题,提出改善措施,为中国私立医疗机构性质转变的规制提供参考政策。研究内容引用私立医疗机构性质转变规制的相关理论,总结美国私立医疗机构转变规制的内容与方法；通过总结中国私立医疗机构发展特点、梳理国家相关政策及案例研究,分析中国私立医疗机构性质转变及存在的问题；对比分析中国与美国私立医疗机构性质转变及规制的差异,在此基础上,对中国私立医疗机构性质转变的规制提供参考政策。研究方法本研究使用概念化方法,界定私立医疗机构性质转变的概念；通过文献综述,总结美国私立医疗机构性质转变规制的内容和方法；采用案例研究和深度访谈法对中国发生性质转变的医疗机构的院长、高层管理人员,卫生部门主管人员访谈,利用主题框架分析法对访谈内容进行分析；并通过对比分析方法分析中国与美国私立医疗机构性质转变及规制的差异,从而合理借鉴美国私立医疗机构性质转变规制的内容与方法。结果与分析界定中国私立医疗机构性质转变的概念。私立医疗机构由于购买(出售)、兼并(合并)、组建有限公司等形式导致医疗机构经营目的改变,或者私立医疗机构经营者出于改变医疗机构经营目的向政府部门申请性质转变,而发生的医疗机构从营利性转换成非营利性或者从非营利性转换成营利性的转变。从规制理论、新公共管理理论、私立医疗机构与监管部门的博弈理论等方面阐述了政府对私立医疗机构性质转变的监管的必要性与注意要点。总结美国私立医疗机构性质转变规制的内容和方法。美国主要从普通法、成文法,联邦、州法律、法规对私立医疗机构性质转变进行立法保障与规范；规定州检察长、卫生部门、保险部门、国税局等政府部门,法院、及医院董事会等部门职责；规范私立医疗机构性质转变的程序、医院提交的具体申请材料、政府部门批准转变的标准；规定私立非营利性医院按照“社区利益标准”接受税务部门的免税资格的核定,并对从非营利转向营利性的医疗机构根据不同的转变方式采取不同的资产处置形式。中国私立医疗机构性质转变及存在问题的分析。中国性质转变的原因多种多样、转变过程欠规范、投资者对净资产处置的认识差异较大、政府部门对私立医疗机构性质转变的监管不健全。对比分析中国与美国私立医疗机构性质转变及规制差异。主要从私立医疗机构性质转变的原因、性质转变的准入、监管方式、监管内容、监管的透明程度、群众参与程度等方面进行比较,从而合理的借鉴美国私立医疗机构性质转变规制的内容与方法。讨论合理界定私立医疗机构性质转变有利于明确政府监管裁量权,保护公众及转变各方的合法权益；私立医疗机构性质转变缺乏规制体系,外部监管和内部制度约束都存在缺陷,无法保证私立医疗机构运营中坚持“非营利性”的原则,并探讨了治理结构监管体系不完善的深层次原因；通过案例研究及文献调研,本文认为中国缺少针对性的法律、法规规范私立医疗机构性质转变,转变时资金退出及净资产处置不明确,转变过程尚缺乏公开透明原则。本研究明确了研究对象和范围,明确监管主体需要完善私立医疗机构的治理结构,建立私立医疗机构性质转变规制体系是当务之急,私立医疗机构性质转变需要立法与政策支持,透明化是监管的客观要求。研究中还存在一定的偏倚性,研究内容涉及面广,但研究不够深入,有待进一步完善；私立医疗机构性质转变的多种转变形式,有待对多种转变形式进行案例研究。建议多部门分工监管,明确并落实监管部门及其职责；建全私立医疗机构“非营利性”的监管制度；规范私立医疗机构性质转变的过程；明确非营利性机构的净资产归属；注重监管信息透明化。
[Abstract]:research objective
Objective to understand the transformation of the nature of private medical institutions and the problems in supervision, and put forward improvement measures, so as to provide reference policies for the regulation of the nature transformation of private medical institutions in China.
research contents
The nature of the related theory of private medical institutions change regulation of the content and methods of private medical institutions in the United States change regulation; through summing up the development characteristics of private medical institutions Chinese, combing the relevant national policies and case study, analysis of the nature of private medical institutions China change and existing problems; comparative Analysis on Transformation of Chinese and private medical institutions in the United States properties and the regulation, on this basis, to provide reference for policy regulation changes in the nature of private medical institutions China.
research method
This study uses a conceptual method, defining the concept of changing the nature of private medical institutions; through literature review, summarizes the contents and methods of American private medical institutions change the nature of regulation; using case study and depth interview method for medical institutions to change the nature of the occurrence of Chinese hospital long, senior management, health department staff interviews, analysis analysis on the contents of the interview method based on topic framework; and through comparative analysis method to analyze the changes and differences of private medical institutions in the United States China nature and regulation, thus reasonably from the contents and methods of the changing nature of regulation of the structure of American private medical machine.
Results and analysis
Defining the concept of changing the nature of private medical institutions Chinese. Private medical institutions as a result of the purchase (sale), merger (merger), the form of limited company as a result of business purposes, medical institutions or medical institutions, private medical institutions change operators for business purposes to the government for a change in nature, medical institutions and the occurrence of the profit into nonprofit or from for-profit non-profit into change. From the theory of regulation, the theory of new public management, private medical institutions and regulators in the game theory and other aspects of the necessity of the government to change the nature of the private medical institutions supervision and attention points.
Summarize the contents and methods of American private medical institutions change the nature of regulation. The United States mainly from the common law, statute, federal and state law, regulations on the nature of private medical institutions to change legislation and regulations; provisions of state attorney general, Department of health, Department of insurance, tax bureau and other government departments, courts, and hospital board etc. the responsibilities of departments; specification of a change in the nature of private medical institutions procedures, specific application materials submitted by the hospital, government departments approved changing standards; approved tax exemption qualification accept the tax department in accordance with the "community interest standard" private nonprofit hospitals, and from non-profit to for-profit medical institutions take different forms according to the disposal of assets change in different ways.
The transformation of Chinese private medical institutions and existing problems are analyzed. There are many reasons for the transformation of China's nature. The transformation process is not standardized. Investors' perceptions of net assets disposal are quite different. The government's supervision on the transformation of private medical institutions is not perfect.
Comparative analysis of change of China and private medical institutions in the United States. The main causes of differences in nature and regulation from the nature of private medical institutions change, access and change the nature of supervision, supervision, transparency of supervision, compare the level of public participation and other aspects, which together from the contents and methods of American private medical institutions change the nature of regulation theory.
discuss
Reasonable definition of a change in the nature of private medical institutions to clear the government regulatory discretion, protect the legitimate rights and interests of the public and change; changes in the nature of private medical institutions lack of regulation system, external supervision and internal institutional constraints have defects, can not guarantee the private medical institutions to adhere to the "non-profit" principle of operation, and discusses the deep-seated because of the governance structure of the imperfect supervision system; through case studies and literature research, this paper thinks that China lack of specific legal regulations, changing the nature of private medical institutions, change the disposal of funds exit and net assets is not clear, the transformation process is still a lack of transparency. The paper defines the research object and scope, clear regulatory body the need to improve the governance structure of private medical institutions, is changing the nature of private medical institutions a pressing matter of the moment to establish the regulation system of private medicine The change in the nature of the medical institution needs legislative and policy support, and transparency is the objective requirement of supervision.
There are still some bias in the research. The research contents are extensive, but the research is not deep enough to be further improved. There are many transformation forms of the transformation of the nature of the private medical institutions.
proposal
Many departments of the division of supervision, and implement a clear regulatory authorities and responsibilities; perfecting private medical institutions "non-profit" supervision system; regulate the process of changing the nature of private medical institutions; clear net assets attributable to non-profit organizations; focus on supervision of transparency of information.

【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.3

【参考文献】