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目的:分析我国公立医院的软预算约束现象及其对医院服务提供行为的影响。方法:利用930个综合性县级公立医院4年调查数据,通过Probit模型和多元线性回归模型分别进行实证分析。结果:无软预算约束医院的平均医疗收支结余为541.11万元,而有软预算约束的医院平均医疗收支结余亏损365.67万元;且有软预算约束医院的下一年财政补助比无软预算约束医院高约300万元,两组的差异均具有统计学意义(P<0.000 1)。Probit模型回归结果表明,前1年医疗收支亏损越多的县级公立医院在未来1年中更容易获得足以弥补亏损的财政收入(P<0.000 1)。多元线性回归表明,软预算约束与医疗服务提供数量呈负相关(P<0.000 1)。结论:我国公立医院存在软预算约束现象,医院亏损越多政府对医院亏损的补偿也越多,并且软预算约束会降低医院控制成本的动力,使其诊疗和住院服务提供量相对较低。
Objective: To analyze the soft budget constraint of public hospitals in China and its impact on the service delivery of hospitals. Methods: Based on the 4-year survey data of 930 comprehensive county-level public hospitals, the empirical analysis was carried out by Probit model and multiple linear regression model respectively. Results: No soft budget constraints hospital average medical balance was 5.4111 million yuan, while the soft budget constraints hospital average medical balance of deficits of 365.67 million yuan; and there are soft budget constraints hospital next year financial subsidies than no soft The hospital with a budget constraint of about 3000000 yuan, the differences between the two groups were statistically significant (P <0.0001). The Probit regression results show that county public hospitals with more medical expenses and losses in the previous year are more likely to have sufficient financial income to make up for losses (P <0.000 1) in the next year. Multivariate linear regression showed that the soft budget constraint was negatively correlated with the number of medical service providers (P <0.000 1). Conclusion: The soft budget constraints exist in public hospitals in our country. The more the hospitals lose, the more the government will compensate for the loss of hospitals. And the soft budget constraint will lower the driving force of hospital control costs and lower the supply of medical treatment and inpatient services.