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目的:探讨我国医疗市场拥堵的形成机理、效应及其主要的改革政策取向。方法:基于国际比较、制度演化和信息经济学范式进行研究。结果:我国医疗卫生资源配置总量并未偏低,拥堵是市场内部结构失衡的直接结果。在价格管制条件下,既往的医疗卫生体制改革诱导产生趋向资本密集而忽视人力资本的投资动机,“柠檬市场”式市场失灵驱动医疗从业人员和患者流向高等级医院。既有的激励结构会引致产生成本提升效应、人力资本“双退化”效应和特定要素效应。结论:不合理激励结构的解构端赖于价格体系重构和医疗人员执业自由等市场机制的运用。
Objective: To explore the formation mechanism and effect of congestion in China’s medical market and its main reform policy. Methodology: Based on international comparison, institutional evolution and paradigm of information economics. Results: The total amount of medical and health resources in China is not low, and congestion is the direct result of the internal structural imbalance in the market. Under the condition of price control, the previous medical and health system reform has induced investment motives that tend to be capital intensive and neglect human capital, and the “lemon market” market failure has driven the flow of medical practitioners and patients to higher-level hospitals. The existing incentive structure will lead to cost increase effect, human capital “double degeneration ” effect and specific factor effect. Conclusion: The deconstruction of irrational incentive structure depends on the application of market mechanisms such as price system reorganization and free medical practitioners.