我国医疗卫生行业政府投入管理制度研究

发布时间：2018-04-13 23:22

本文选题：医疗卫生行业 + 政府投入规模　；参考：《财政部财政科学研究所》2014年博士论文

【摘要】：经过三十多年的改革发展,我国已经建立起较为完善的公共卫生服务体系、基本医疗服务体系、基本医疗保障体系和药品供应保障体系,医疗卫生行业迎来了崭新的发展阶段。但是随着人口老龄化的发展,应用新药械技术的迅速提高和我国医疗卫生服务需求多样化及快速增长态势,我国医疗卫生行业健康发展面临众多考验。从全球看,没有一个国家的医疗卫生体制是完美的,也没有一个国家的医疗卫生改革是一劳永逸的。世界各个国家总是持续不断地对本国的医疗卫生行业进行改革,其中对政府投入管理制度的改革和调整是其中的重要一环。科学的政府投入管理制度,是医疗卫生行业健康发展的重要途径。本文通过对医疗卫生行业政府投入管理制度的研究,探求如何通过对政府投入的有效管理,在医疗卫生服务资源不足的情况下,保证医疗卫生服务资源分配的公平与可及性,提高医疗卫生服务资源的使用效率和效果,进而促进整个医疗卫生行业的健康可持续发展。在第一部分导言的基础上,第二部分介绍了国内外文献资料情况。包括医疗卫生行业投入主体研究、医疗保险保障筹资问题研究、医改投入方向研究、医疗卫生行业资源分布问题研究和医疗卫生行业管理机制研究五个方面,为研究我国医疗卫生行业政府投入管理问题奠定了良好的基础。第三部分以医疗卫生行业的相关理论基础为切入点,通过对公共产品理论、卫生经济学理论的研究指出政府主导医疗卫生行业发展的必然性。通过对制度与行为经济学理论、信息不对称与代理人理论的研究指出,政府不仅负有对医疗卫生行业投入的责任,同时必须注意政府责任的有限性；医疗卫生行业的信息不对称特征要求政府采取措施避免行业垄断的发生和供给诱导需求的存在；对机制设计理论的研究表明医疗卫生行业的内在特点决定我们只有通过运用正确的机制协调各方利益,才能实现行业的健康发展目标。第四部分以发达国家、发展中国家包括转型国家医疗卫生改革为背景,对各类国家医疗卫生行业的政府投入管理进行了深入的研究和比较,一方面选取具有代表性的国家进行横向对比,考察不同国家医疗体系对政府投入管理的理念、规模、效率、效果的影响；另一方面对各国医疗卫生行业政府投入管理的经验进行归纳总结,指出医疗卫生行业政府投入管理中的共性和特性,找出对我国医疗卫生行业政府投入管理制度设计的启不。第五部分介绍了我国医疗卫生行业投入管理状况。本部分分别从发展历程、数据分析、成绩问题三个维度对我国医疗卫生行业状况进行描述和分析,深入剖析了我国医疗卫生行业原有政府投入管理制度形成的背景、存在的合理性、改革的动因和目前的问题所在,找出政府投入管理制度设计必须考虑的诸多问题,为下一步问题解决奠定了基础。第六部分至第九部分是论文的重点,是前五部分论证的延续、扩展和总结。第六部分在上文研究论证的基础上,提出我国医疗卫生行业政府投入管理制度设计需要考虑的问题、行业发展的基本原则和下一步改革思路。第七部分至第九部分是在第六部分基础上提出了改革的具体建议：第七部分和第八部分分别对政府在建立健全医疗服务体系和医疗保障体系中的职责进行了明确。第九部分针对目前政府投入的存量管理问题,建议以医疗国资委为主其他形式为辅的多种形式做实公立医院国有资本的出资人,把公立医院的资产管理向资本管理转变。本文的创新之处与主要贡献有四：首先,以政府投入管理制度设计为视角,通过分析医疗卫生行业中市场、产品、各参与方诉求的特点入手,确定政府的角色定位,以此为基点确定政府投入医疗卫生行业的责任以及政府筹资管理制度、投入管理制度对医疗卫生行业发展的影响,奠定了政府主导医疗卫生行业建立和运行的理论基础,提出政府投入责任的有限性的理论依据。第二,本文认为政府投入规模的国际间比较如果只是单纯的总量对比,是缺乏科学性的。只有在同一模式和相似经济发展水平下的政府卫生支出才可以进行有效比较,得出建设性的结论。本文在把三种医疗保障模式的国家细分的基础上通过对各组数据进行比较分析得出,我国医疗卫生行业政府投入规模基本适当。第三,通过回归分析模型对未来影响我国政府医疗卫生投入的因素进行研究。本文选择了五个自变量,通过回归模型得出人口老龄化和经济发展水平是对各国卫生支出最具影响的指标。由此认为,随着经济发展水平提高和我国老龄化社会的到来,预计我国政府卫生投入比例也将随之上升。第四,提出以医院国资委为主其他形式为辅对政府投入存量进行管理。目前公立医院政事不分,政府对公立医院投入存在出资人缺位的问题。本文认为,只有在公立医院实现资产管理向资本管理转变的情况下,切实完善公立医院法人治理结构,完善政府对医院国有资本运行的监管机制,才能从根本上解决公立医院的发展问题,才有可能给予民营资本在医疗卫生行业的发展打开公平竞争和合作共赢的空间,加快形成多元化办医格局。
[Abstract]:After more than 30 years of reform and development , our country has set up a more perfect health service system , basic medical service system , basic medical security system and medicine supply safeguard system , and the medical and health industry is facing a lot of test .

The scientific government input management system is an important way for the health development of the medical and health industry . Through the research on the administration management system of the government of the medical and health industry , how to ensure the fairness and accessibility of the resource allocation of the medical and health services can be ensured through the effective management of the government input , and the use efficiency and the effect of the medical and health service resources are improved , and the healthy sustainable development of the whole medical and health industry is further promoted .

On the basis of the introduction of the first part , the second part introduces the domestic and foreign literature and information , including the research of the main body of the medical and health industry , the research on the financing of medical insurance , the research on the direction of medical reform input , the research on the resources distribution in the medical and health industry and the research on the management mechanism of the medical and health industry , and lays a good foundation for the study of the administration of the government in the health industry .

The third part , based on the relevant theoretical foundation of the medical and health industry , points out the necessity of the government to lead the development of the medical and health industry through the research of the theory of public goods and the theory of health economics .
The information asymmetry in the medical and health industry requires the government to take measures to avoid the occurrence of industry monopoly and the existence of supply - induced demand ;
The research on the mechanism design theory indicates that the inherent characteristics of the medical and health industry decide that we can achieve the healthy development goals of the industry only by using the correct mechanism to coordinate the interests of the parties .

In the fourth part , in the background of the reform of the developed countries and developing countries , including the reform of health and health in the countries with economies in transition , the government inputs and management of various kinds of countries ' medical and health industries are deeply studied and compared . On the one hand , the influence of different national medical systems on the concept , scale , efficiency and effect of government input management is investigated .
On the other hand , the author summarizes the experiences of government input management in the national health and health industry , points out the commonness and characteristics of the government input management in the medical and health industry , and finds out the lack of the design of the government input management system of the medical and health industry in our country .

The fifth part describes the management of the medical and health industry in our country . This part describes and analyzes the situation of the medical and health industry in our country from three dimensions of development course , data analysis and achievement problem respectively . It deeply analyses the background , the rationality , the motivation of the reform and the present problems , and finds out the many problems which must be taken into consideration in the design of the government input management system , and lays a foundation for the next issue resolution .

The sixth part to the ninth part are the focus of the thesis , which is the continuation , extension and summary of the first five parts demonstration . Part VI is based on the above research demonstration , and puts forward the basic principle and the next reform thought of the government input management system design in our country . The seventh part and the eighth part are the concrete suggestions of the reform in the sixth part . The ninth and the eighth part are the concrete suggestions for the government to establish and improve the medical service system and the medical security system respectively .

The main contributions of this paper are as follows :

First , based on the government input management system design as the visual angle , the government ' s role orientation is determined by analyzing the characteristics of the market , the product and the appeal of each participant in the medical and health industry .

Secondly , the author thinks that the international comparison of government investment scale is not scientific . Only in the same model and similar economic development level , the government health expenditure can be effectively compared , and the constructive conclusion is reached .

Thirdly , through the regression analysis model , we study the factors that affect our government ' s medical and health input . This paper selects five independent variables , and concludes that the population ' s aging and economic development level is the most influential indicator of the national health expenditure through the regression model . It is expected that the proportion of the government health input will rise with the improvement of the level of economic development and the coming of the aging society in China .

Fourthly , it is suggested that the state - owned enterprises should be divided into other forms to manage the government ' s investment . At present , the administration of public hospitals is not divided , and the government ' s input into the public hospitals is vacant . In the view of this article , only if the public hospital realizes the transformation of capital management to the capital management , it is possible to improve the government ' s supervision mechanism for the operation of the state - owned capital of the hospital , so as to fundamentally solve the problem of public hospital development , and it is possible to give the private capital the space to open fair competition and cooperation in the development of the medical and health industry , and speed up the formation of diversified medical patterns .

【学位授予单位】：财政部财政科学研究所
【学位级别】：博士
【学位授予年份】：2014
【分类号】：F812.45;R197.1

【参考文献】