我国公立医院利益相关者治理模式构建研究
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摘要
医疗卫生服务是关系每个公民切身利益的重大问题。我国的医药卫生保障体系无论从结构、功能与管理模式上看,在全球都有着自身显著的特色。随着我国国民经济发展与社会进步,既有的医疗卫生体系的服务质量与运行效率日益不能满足公民的健康保障需求,因此医药卫生体制改革一直伴随着经济体制的改革而不断推进。公立医院的资源占有、技术能力、服务总量在我国医疗服务供给体系中占有绝对优势,是公民直接感受医疗卫生服务的主要平台,是其他相关体系作用机制的交汇点,因此公立医院改革是国家医药卫生体制改革的枢纽环节之一。
目前我国尚未建立起公立医院改革的完整理论框架,具体改革措施的设计缺乏系统性,已有的试点探索比较局限和零散。公立医院改革的经济学本质,是要建立针对这种特殊服务性质的卫生组织的良好治理模式。因此在充分考虑医疗卫生服务以及公立医院体制的特殊性的基础上,公司治理的基本理论特别是其基本分析思路、委托—代理模型等重要分析工具完全可以应用于公立医院治理模式的设计构建。
本研究依照公司治理理论框架,基于医疗消费的特殊属性,对我国公立医院体系的现状和问题进行了系统的剖析;对公立医院的改革历程进行了全面的梳理,对国外公立医院改革经验进行了参照和比对;引入利益相关者治理理论,在充分考察和考虑各主要利益相关者行为模式的基础上,建立了利益相关者治理分析模型,提出了新型的公立医院治理模式。研究的主要创新点如下:
①突破既有研究框架,对医疗消费的特殊属性进行了更为深入、全面的剖析,
首次提出了包括“契约、资产、信息、行为、心理”五个维度的医疗消费属性特征,作为医院区别于其他行业产业组织的基本立足点,为公立医院治理模式设计奠定了基础。
②对公立医院体系中的利益相关者及其行为模式进行了全面分析,首次将公立医院体系的利益相关者分为三级进行描述,特别是对医生和病人的特殊利益相关者属性进行了深度刻画。在此基础上,建立了公立医院体系“利益相关者治理模式”的全面数学模型,更深刻的解释了公立医院体系的矛盾、问题和交换与协作机制,指出医生及其医疗决策是公立医院治理的核心着力点。
③打破公司治理理论中的传统治理结构和内外部治理界限,首次建立了以“治理功能模组”和“治理功能链路”为主体的公立医院“利益相关者治理模式”,阐明了其治理结构和治理机制,为指导我国正在推进的公立医院改革建立了一个完整的理论框架和实践模型。同时对公立医院利益相关者治理模式下的若干关键实践环节进行了设计,提出了具体政策建议。
Health service is very important to the benefit of every citizen. The medical and health service system of China has its own significant features on structure, function and management in the worldwide. As the development of economic and social progress in China, the existing medical and health service system can not meet the growing needs of citizens in health-care, so that the reform of medical and health service system has been carried forward with the reform of economic system. Public hospitals have their own utter advantages on the following aspects: the possession of resources, the technical capability and the services; Public hospitals are the main platform that citizens receive the medical service directly, and that public hospitals are the intersection of related system mechanism. So the reform of public hospitals is one of the pivots for the reform of medical and health system.
Yet China has not established a complete theoretical framework of public hospital-reform:the design of specific reform measures is lack of systematic; the comparative exploration of pilot is limited and fragmented now. The economical essence of public hospital-reform is to establish the governance which fit the organization that provides special service. Therefore, in considering of the specificity of the public hospitals and medical service, the basic theory of company governance can be applied to the design of public hospital governance model, especially the analysis ideas and the Principal-agent model.
In this article, we studied the following aspects according to the theoretical framework of corporate governance and the specificity of medical consumption: the status and problems of public hospitals, the process of public hospital-reform, and the comparison on the experience of public hospital-reform abroad. We proposed the stakeholder governance analysis model and the new model of public hospital governance, in considering of the behavior of all major stakeholders and the stakeholder governance theory.
Innovational ideas of this Paper are as follows:
①For the first time , the author descriped the characteristics of medical consumption as five aspects, including "Contract", "Assets", "Information", "Behavior" and "Psychology", which are the main points that hospitals different from other organizations,and then provided a precondition for the design of the public hospital`s governance model.
②Analyzed the behavior of stakeholders in the public hospital system, and for the first time divides the stakeholders into three levels. Profound described the special attributes of doctors and patients. Established a mathematical model for stakeholders governance model of public hospital, further revealed the problems and exchange-cooperation mechanism. And pointed out that "Doctors and their medical decision-making " is the focus of hospital governance.
③Broke the limits of traditional governance structure and internal/external governance in general company governance theory, for the first time established a "governance function module" and "governance features links" as the main body of public hospital "stakeholder governance model," stated its governance structure and governance mechanisms. And provided a complete theoretical framework and practical model for reform of the public hospitals. Meanwhile, designed a number of key aspects of the reform practice and put forward specific policy recommendations.
目前我国尚未建立起公立医院改革的完整理论框架,具体改革措施的设计缺乏系统性,已有的试点探索比较局限和零散。公立医院改革的经济学本质,是要建立针对这种特殊服务性质的卫生组织的良好治理模式。因此在充分考虑医疗卫生服务以及公立医院体制的特殊性的基础上,公司治理的基本理论特别是其基本分析思路、委托—代理模型等重要分析工具完全可以应用于公立医院治理模式的设计构建。
本研究依照公司治理理论框架,基于医疗消费的特殊属性,对我国公立医院体系的现状和问题进行了系统的剖析;对公立医院的改革历程进行了全面的梳理,对国外公立医院改革经验进行了参照和比对;引入利益相关者治理理论,在充分考察和考虑各主要利益相关者行为模式的基础上,建立了利益相关者治理分析模型,提出了新型的公立医院治理模式。研究的主要创新点如下:
①突破既有研究框架,对医疗消费的特殊属性进行了更为深入、全面的剖析,
首次提出了包括“契约、资产、信息、行为、心理”五个维度的医疗消费属性特征,作为医院区别于其他行业产业组织的基本立足点,为公立医院治理模式设计奠定了基础。
②对公立医院体系中的利益相关者及其行为模式进行了全面分析,首次将公立医院体系的利益相关者分为三级进行描述,特别是对医生和病人的特殊利益相关者属性进行了深度刻画。在此基础上,建立了公立医院体系“利益相关者治理模式”的全面数学模型,更深刻的解释了公立医院体系的矛盾、问题和交换与协作机制,指出医生及其医疗决策是公立医院治理的核心着力点。
③打破公司治理理论中的传统治理结构和内外部治理界限,首次建立了以“治理功能模组”和“治理功能链路”为主体的公立医院“利益相关者治理模式”,阐明了其治理结构和治理机制,为指导我国正在推进的公立医院改革建立了一个完整的理论框架和实践模型。同时对公立医院利益相关者治理模式下的若干关键实践环节进行了设计,提出了具体政策建议。
Health service is very important to the benefit of every citizen. The medical and health service system of China has its own significant features on structure, function and management in the worldwide. As the development of economic and social progress in China, the existing medical and health service system can not meet the growing needs of citizens in health-care, so that the reform of medical and health service system has been carried forward with the reform of economic system. Public hospitals have their own utter advantages on the following aspects: the possession of resources, the technical capability and the services; Public hospitals are the main platform that citizens receive the medical service directly, and that public hospitals are the intersection of related system mechanism. So the reform of public hospitals is one of the pivots for the reform of medical and health system.
Yet China has not established a complete theoretical framework of public hospital-reform:the design of specific reform measures is lack of systematic; the comparative exploration of pilot is limited and fragmented now. The economical essence of public hospital-reform is to establish the governance which fit the organization that provides special service. Therefore, in considering of the specificity of the public hospitals and medical service, the basic theory of company governance can be applied to the design of public hospital governance model, especially the analysis ideas and the Principal-agent model.
In this article, we studied the following aspects according to the theoretical framework of corporate governance and the specificity of medical consumption: the status and problems of public hospitals, the process of public hospital-reform, and the comparison on the experience of public hospital-reform abroad. We proposed the stakeholder governance analysis model and the new model of public hospital governance, in considering of the behavior of all major stakeholders and the stakeholder governance theory.
Innovational ideas of this Paper are as follows:
①For the first time , the author descriped the characteristics of medical consumption as five aspects, including "Contract", "Assets", "Information", "Behavior" and "Psychology", which are the main points that hospitals different from other organizations,and then provided a precondition for the design of the public hospital`s governance model.
②Analyzed the behavior of stakeholders in the public hospital system, and for the first time divides the stakeholders into three levels. Profound described the special attributes of doctors and patients. Established a mathematical model for stakeholders governance model of public hospital, further revealed the problems and exchange-cooperation mechanism. And pointed out that "Doctors and their medical decision-making " is the focus of hospital governance.
③Broke the limits of traditional governance structure and internal/external governance in general company governance theory, for the first time established a "governance function module" and "governance features links" as the main body of public hospital "stakeholder governance model," stated its governance structure and governance mechanisms. And provided a complete theoretical framework and practical model for reform of the public hospitals. Meanwhile, designed a number of key aspects of the reform practice and put forward specific policy recommendations.
引文
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