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本文通过回顾中国公立医院改革历程和分析其改革政策,认为政府财政补助不足、不规范的市场、扭曲的医院服务定价政策以及政府管制和公共治理能力不足是造成目前医疗费用上涨、资源缺乏配置效率的深层次原因;现行的治理结构是导致公立医院费用上涨、效率低下的重要原因。公立医院所有者职能不统一、缺乏评估公立医院组织绩效的手段、对公立医院院长缺少有效的激励约束机制等原因导致公立医院内部治理失效;社会医疗保险覆盖面小、社区卫生服务发展缓慢无法形成资源有效配置的市场结构等原因导致外部治理失效。公立医院改革是一个艰难的过程,而目前我们尚不具备法人化改革的条件,只有全面规范公立医院自主化改革。
By reviewing the reform process of Chinese public hospitals and analyzing their reform policies, this paper argues that inadequate government subsidies, unregulated markets, distorted hospital service pricing policies, and inadequate government control and public governance are the reasons for the current medical costs rising, the lack of efficient allocation of resources The underlying reason; the current governance structure is an important reason for the rising cost and inefficiency of public hospitals. Public hospital owners do not have the same function, lack of means to assess the performance of public hospital organizations, lack of effective incentive and restraint mechanisms for public hospital directors and other reasons leading to the failure of internal public hospital governance; small social health insurance coverage and slow development of community health services The effective allocation of resources, market structure and other reasons led to the failure of external governance. Public hospital reform is a difficult process, and at present we do not yet have the conditions for legal person reform, only to fully regulate the reform of public hospital autonomy.