上海市某区区属公立医院政府补偿方案研究

在前期调查分析基础上,提出了某区区属公立医院财政补偿的原则、机制和方案,并指出公立医院财政补偿方案应符合我国公立医院补偿机制改革的要求,发挥积极引导作用,应加强对公立专科医院学科建设的投入。     

我国公立医院政府补偿机制研究

公立医院是政府实行一定福利政策的社会公益事业,为了保证公立医院的公益性和社会福利性,就必须建立起完善的政府补偿机制.文章主要探讨的是在新医改方案下如何解决公立医院政府补偿机制的问题.首先分析了政府对公立医院进行补偿的依据,然后明确了政府对公立医院的补偿范围,最后根据现阶段我国公立医院政府补偿存在的主要问题,提出了相关建议.     

公立医院财政补偿水平的影响因素分析

目的:通过实证分析目前公立医院财政补偿水平的影响因素,发现其中存在的问题,为合理制定财政补偿方案提供依据。方法:运用综合指数法对影响因素进行分类处理,使用秩和检验和多重线性回归分别做单因素、多因素分析。结果:分析结果显示医院规模、医院运营状况是目前公立医院财政补偿水平的关键影响因素。结论:在成本核算的基础上多角度、全方面考虑财政补偿水平的影响因素,为补偿方案的完善奠定基础。     

公立医院补偿机制改革之政府补偿方式探索——按工作量法补偿医疗服务亏损

政府补偿是公立医院补偿机制改革的关键,政府对医疗服务亏损的补偿在逐步取消公立医院药品批零差价时尤显重要,需要建立科学可行的补偿方案。本文就政府对公立医院财政补偿机制进行探讨,分析政府补偿范围及方式,并在综合考虑医疗服务质量和特点的基础上,提出基于综合工作量法和单位工作量补偿额的医疗服务亏损补偿方案,试图从机制上扭转公立医院不合理的补偿结构,为决策者提供参考。     

基于博弈论分析的宁夏公立医院补偿机制研究

目的利用博弈论理论分析宁夏公立医院补偿情况,探讨更为经济合理有效的公立医院补偿模式。方法采用文献复习、定量数据收集方法、描述性分析法和博弈分析等分析方法。结果政府对公立医院补偿实际水平较高,医疗服务收费补偿并未达到补偿效果,补偿过程中政府、医院和患者均未获益。建议界定公立医院内涵,建立健全补偿标准,测算调整医疗服务成本,制定合理的医疗服务收费价格。     

我国公立医院补偿机制现状浅析

通过对不同国家、不同地区、不同级别公立医院补偿机制现状进行比较分析,探讨进一步完善公立医院补偿机制的政策和措施,为政府部门制定补偿政策提供依据。医院发展离不开资金,因此对医院资金必须集中管理、统一调配、有效监督,加强资金收支的监督管理。健全医疗服务成本及价格监测体系,加强对医疗服务价格及成本构成要素的监测,为制定合理的医疗服务指导价格、建立灵活的价格调整机制提供依据。在医疗这一重要的社会消费领域,需要给公众真实客观的信息,加强宣传和沟通也极为重要。总之,完善公立医院补偿机制,是建立规范高效公立医院运行机制的重要保证,也是充分体现公立医院公益性的必然要求。当前我们应该积极探索,加快完善公立医院补偿机制。     

基于平衡计分卡的医师薪酬分配设计

制定能够合理补偿和体现医师价值的薪酬分配体系关系到国家公立医院改革的成败。公立医院医师薪酬分配机制,既有别于非公立医院中医师薪酬的高度市场化激励政策,又有别于以往计划经济时代薪酬的高度集权化管理制度。笔者主要在医疗体制改革和事业单位绩效工资改革的背景下,分析公立医院医师薪酬分配中存在的问题,讨论变革背后公立医院医师薪酬分配机制的转变问题,介绍基于平衡计分卡的医师薪酬分配方案。     

完善公立医院补偿机制改革的难点与思考

补偿机制改革是公立医院改革的重点和难点。文章在分析当前公立医院财政补助现状以及取消药品加成的影响的基础上。指出当前补偿途径在具体实施过程中还存在相当的困难。为保障公立医院补偿机制改革的顺利推进,应从医疗服务的公平性和效益出发。明确补偿范围,制定补偿标准,并在机制体制上确保补偿到位。     

我国公立医院财政长效补偿机制实现方式探讨

通过对公立医院财政补偿方式与发展趋势的阐述,分析了公立医院补偿机制的现状及问题,并提出了完全实现社会功能的公立医院、待实现社会功能的公立医院和待转型的公立医院3种补偿机制,以期对我国公立医院财政长效补偿机制的实现提供参考依据.     

公立医院公共卫生服务补偿方式探析

梳理了上海市公立医院公共卫生服务补偿的现状:公立医院补偿方式主要有基于成本和绩效两种,这两种补偿方式有着内在联系,在实际应用中各有优缺点。由于公立医院公共卫生服务内容多样,建议基于服务内容特点分别采取按人头定额补偿、按差价补偿和基于产出购买服务等补偿方式。对公立医院公共服务的补偿,建议首先从补偿的角度对公共卫生服务项目进行分类,然后基于公共卫生服务成本核算结果制定补偿标准,最后建立以绩效为导向的投入体系。部分公共卫生服务项目可探索向社会机构购买机制。     

公立医院公益性淡化的系统动力学分析——以患者感知为视角

坚持公立医院公益性是新医改的核心原则,解决公益性淡化问题必须对其成因进行系统化分析。论文从政府补贴、居民就医选择以及患者感知的"看病难、看病贵"的成因入手构建了系统动力学模型,应用因果关系图展现各子系统之间的相互影响关系,通过综合分析提出促进公立医院公益性回归的政策着力点,最后进行总结与展望。     

公益性视角的公立医院融资困境及应对策略

医疗服务需求的持续释放激发了公立医院的发展冲动,政府财政补助和医院自有资金不足背景下部分公立医院寻求市场化融资方式的支持,但是公立医院的公益性和资本的逐利性两者之间的矛盾使得公立医院融资进程陷入进退两难困境。通过对公立医院公益性内涵和PPP项目案例的分析,发现公立医院的公益性并不完全排斥资本的逐利性,资本逐利所依托的市场竞争机制也是实现公立医院公益性的前提条件。要在坚持公立医院公益性的基础上利用好市场化融资方式必须做到:第一,坚持政府在公立医院运营方向上的主导性;第二,在引进资本的同时着眼于运营机制的改革与创新;第三,将归属于政府的分红转化为对公立医院的持续性投入以支持公益性的实现;第四,结合地方政府财力采用差异化的融资模式。     

Public hospitals find long road to autonomy

More public hospitals and systems are looking to be freed from ties to the governments that control them. They're hoping to achieve greater efficiency and more independence from governmental processes and political wrangling. But the very politics they seek to escape can play havoc with public hospitals' attempts to revamp longstanding relationships with their governmental sponsors.     

Public money, private control: a case study of hospital financing in Oakland and Berkeley, California

Government support of public and private hospitals in Oakland and Berkeley, California was investigated. The private hospitals received government subsidies amounting to at least 60 per cent of their total revenues. The dollar amount of the subsidies to private hospitals was four and one-half times greater than government expenditures on the public hospital. In Oakland and Berkeley, as in many cities, public medical services have been reduced while both government health expenditures and private hospital revenues have increased sharply. The private hospitals, although all nominally non-profit, exhibit revenue maximizing behavior which results in socially unjust and medically irrational resource allocation. Funds might be found for public hospitals and clinics, and resources allocated more justly and rationally, if government expenditures in the private sector were brought under greater public scrutiny and control.     

Population characteristics of markets of safety-net and non-safety-net hospitals

Research Objectives To compare and contrast the markets of urban safety-net (USN) hospitals with the markets of other urban hospitals. Study Design To develop profiles of the actual inpatient markets of hospitals, we linked 1994 patient-level information from hospital discharge abstracts from nine states with 1990 data at the ZIP code level from the US Census Bureau. Each hospital's market was characterized by its racial and ethnic composition, median household income, poverty rate, and educational attainment. Measures of hospital competition were also calculated for each hospital. The analysis compared the market profiles of USN hospitals to those of other urban hospitals. We also compared the level of hospital competition and financial status of USN and other urban hospitals. Principal Findings The markets of USN hospitals had higher proportions of racial and ethnic minorities and non-English-speaking residents. Adults residing in markets of USN hospitals were less educated. Families living in markets of USN hospitals had lower incomes and were more likely to be living at or below the federal poverty level. USN hospitals and other urban hospitals faced similar levels of competition and had similar margins. However, USN hospitals were more dependent on Medicare disproportionate share payments and on state and local government subsidies to remain solvent. Conclusion USN hospitals disproportionately serve vulnerable minority and low-income communities that otherwise face financial and cultural barriers to health care. USN hospitals are dependent on the public subsidies they receive from federal, state, and local governments. Public policies and market pressures that affect the viability of USN hospitals place the access to care by vulnerable populations at risk. Public policy that jeopardizes public subsidies places in peril the financial health of these institutions. As Medicare and Medicaid managed care grow, USN hospitals may lose these patient revenues and public subsidies based on their Medicaid and Medicare patient volumes. The loss of these funds would hinder the ability of USN hospitals to finance uncompensated care for uninsured and underinsured patients. An earlier draft of this paper was presented as a poster at the 14th annual meeting of the Association for Health Services Research, Chicago, IL, June 15–17, 1997. Financial support for this research was provided by the Commonwealth Fund. The opinions expressed are solely those of the authors and do not necessarily reflect the positions of Georgetown University and the Commonwealth Fund.     

我国公立医院债务融资的现状、成因和治理策略

公立医院债务融资是当前深化公立医院管理体制改革中一个迫切需要研究的问题.本文根据债务融资理论与原理,分析我国公立医院债务融资的现状,在讨论其产生原因的基础上上,从完善对公立医院的投入和监管机制、控制负债规模、保持合理的负债结构、拓宽公立医院投融资渠道、实施对外业绩信息发布制度、建立明晰的领导任期内经济责任制等方面提出了完善公立医院债务融资的政策建议.     

公立医院实现公益性的难点及其策略

随着社会主义市场经济深入发展,公立医院公益意识逐渐被淡化。新医改方案提出“公立医院要遵循公益性质和社会效益原则”。落实公益性质的突出难点是国家投入不足,政府主导和监管责任缺失。落实公立医院的公益性质,要坚持政府主导,增加政府投入,强化行业监管;坚持推进改革,完善医院运行机制。     

Explaining Differentials in Subsidy Levels Among Hospital Ownership Types in Germany

German hospitals receive subsidies for investment costs by federal states. Theoretically, these subsidies have to cover the whole investment volume, but in fact, only 50–60% are covered. Balance sheet data show that public hospitals exhibit higher levels of subsidies compared with for‐profit hospitals. In this study, I examine the sources of this disparity by decomposing the differential in a so‐called facilitation ratio, that is, the ratio of subsidies to tangible fixed assets, revealing to which extent assets are funded by subsidies. The question of interest is whether the differential can be attributed to observable hospital‐specific and federal state‐specific characteristics or to unobservable factors. Copyright © 2016 John Wiley & Sons, Ltd     

政府公立医院财政专项补助对居民医疗费用负担的影响——基于某市23家三级医疗机构的分析

以基本建设或设备购置等方式注入公立医院的财政专项补助,能够在一定程度上分担公立医院发展投入方面的资金压力,减轻患者的医疗费用负担.为验证上述假设,基于某市23家三级医疗机构的数据,建立面板数据模型.实证研究发现:财政专项补助的增加会降低患者的医疗费用负担,相比之下,门诊医疗费用负担受财政专项补助的影响更为明显.财政专项补助通过分担公立医院部分成本而影响医院提供服务的行为,进而有利于降低患者的医疗费用负担.     

南通市公立医院补偿机制的调查研究

目的了解南通市公立医院的运行机制,进一步分析财政补偿与公立医院实现公益性的联系。方法调查南通市8所市直医院和10所县级医院的年度财务报表,逐项分析指标。结果公立医院收支保持基本平衡。公立医院收入主要来自服务创收。公立医院发展资金主要靠自筹。多项因素对公立医院运营造成影响。结论南通市公立医院改革亟须加快推进,同步完善政府财政补偿机制,切实加大财政对卫生事业的投入,真正体现公立医院的公益性质。