公立非营利医院补偿方对医院的内外部治理研究

本文首先研究了公立非营利医院补偿体系和治理结构之间的相互关系,然后根据利益相关者理论,深入分析了医院补偿方的属性、利益诉求、实现途径,并提出在公立医院法人治理结构中物格与人格的映射关系。接着阐述了补偿体系外部治理的机制。文章最后指出,补偿方需要从内部治理和外部治理两方面对公立医院共同治理,从而提高公立非营利医院的运行效率和资金补偿的效率。     

基于利益相关者理论视角分析我国实行公立医院法人治理结构的可行性

随着我国公立医院改革的日渐深入,探索建立医院法人治理结构被提上议事日程。文章基于利益相关者理论,对我国实行公立医院法人治理结构的动力和阻力进行深入分析,并有针对性地提出政策建议,以消除相关利益者的阻力,加速公立医院改革进程。     

美国非营利医院社会责任报告制度及管理机制研究

通过非营利医院社会责任报告与免税或财政支持衔接的管理制度设计,政府机构与行业协会引导非营利医院承担社会责任,提升美国非营利医院履行社会责任的积极性。我国有必要建立利益相关者参与的公立医院社会责任报告制度,并设计适合国情的报告管理机制。     

公立医院数字化管理模式创新与路径选择

公立医院承担了诸多社会责任,医院管理模式也应从注重内部管理转向内外部利益相关者协调治理。文章以“以人文本”和“可持续发展理念”为指导,基于利益相关者理论和公众参与理论,对公立医院的利益相关者进行定性分类,并提出构建公立医院数字化管理的“3P”模式框架、运行机制以及路径选择。     

治理视角下公立医院审计需求与服务模式完善路径

目的:分析治理视角下公立医院审计需求及服务完善路径。方法:运用委托代理理论、利益相关者等理论,分析法人治理改革中的公立医院监管问题及相应的审计服务需求以及目前审计服务模式存在的问题。结果:现有审计模式忽视了外部治理层的审计需求,重合规审计、轻绩效审计。结论:建议构建基于利益相关者参与,以决策有用为目标导向的审计服务模式,以服务于医院治理需求。     

法人治理结构:公立医院制度安排的途径及对策

"法人治理结构"是通过制度安排所有者对经营者的一种监督与制衡机制,合理地配置所有者与经营者之间的权利与责任关系,以保证所有者利益的最大化。公立医院法人治理结构研究的是各国经济中的医院制度安排问题。随着公立医院自主权不断扩大,政府在公立医院外部治理中的作用越来越向日常程序管理和监督管理角色转变,建立和完善公立医院内部治理结构很必要。提出以法人治理结构为核心的公立医院制度安排的途径和对策有重要的现实和理论意义。     

以法人治理推进公立医院管理自主化

公立医院法人治理是指在所有权和经营权分离的情况下,为实现公立医院出资者目的,平衡所有者、经营者以及利益相关者利益而进行的若干制度化安排。＂探索建立以理事会等为核心的多种形式的公立医院法人治理结构＂作为一项重要内容在2010年2月由国家卫生部等5部门联合公布的《关于公立医院改革试点的指导意见》中被提出。     

基于法人治理的我国公立医院道德风险控制

＂新医改方案＂明确提出＂建立和完善医院法人治理结构,明确所有者和管理者的责权＂,为我国公立医院的深入改革指明了方向。公立医院日益追逐商业化的行为与其承担的社会公共服务功能日渐背离,其公益性目标受到道德风险的挑战。在对公立医院的道德风险进行经济学分析的基础上,剖析了公立医院道德风险产生的现实原因,提出建立和完善法人治理结构,才能够有效地制衡公立医院道德风险行为。     

公立医院治理结构变革引入利益相关者理论的必要性分析

归纳总结了利益相关者理论的核心内容，分析了我国公立医院治理结构变革引入利益相关者理论的必要性：有利于公立医院内外部制衡的实现，对公立医院经营管理形成有效的监督：有利于保护利益相关者的利益．促进医院长远绩效的提高；有利于委托人职能统一，保障医院社会责任的实现。明确了将利益相关者理论引入公立医院治理结构变革中所需解决的一些问题。     

公立医院治理制度改革的利益相关者识别分析

目的准确识别公立医院治理制度变革涉及的各利益相关者,厘清各方之间的关系和地位,推进公立医院治理制度改革。方法采用文献综述法、政策法规分析法和专家访谈法,采访地方行政官员、医院管理者和临床医生等共I5人,列举分析各个利益相关者的类型和改革中的职权变化。结果公立医院治理制度改革涉及14个利益相关者,改革的推进会导致各利益相关方工作量的增加或权益的减少,改革比较复杂,难度较大。结论利益相关者在公立医院治理制度改革中的力量不容小觑,行政决策首脑必须明确改革的方向,描绘清晰的愿景,设立权威联系人,建立联动机制．设立改革专项经费,补偿各利益相关者的额外劳务,才能保证改革的可行性。     

对我国现代医院管理制度中公益性与生产性的分析

医药卫生体制改革已进入攻坚阶段。我国卫生事业的性质及国情决定现代医院管理制度必须兼顾公益性与生产性。面对目前医院公益性与生产性不协调的困境,在建立现代化医院管理制度中,要通过明确政府与医院的责任边界、规范监管和补偿机制、实现医院法人治理、改进人力资源管理等,实现医院公益性与生产性的和谐共赢。     

我国公立医院政事分开协同机制研究

协同学是一门研究开放系统从无序到有序的演化规律的新兴综合性理论,被广泛应用到自然科学与社会科学的各个领域。公立医院符合协同学研究对象的要求,在政事分开中运用协同学,丰富了政事分开的理论内涵。推进政事分开应首先构建公立医院监管的协同机制,继而完善公立医院法人治理的协同模式,最终建立政事分开协同机制。     

On a hiding to nothing? assessing the corporate governance of hospital and health services in New Zealand 1993–1998

In New Zealand the governance of public sector hospital and health services has changed significantly over the past decade. For most of the century hospitals had been funded by central government grants but run by locally elected boards. In 1989 a reforming Labour government restructured health services along managerialist lines, including changing governance structures so that some area health board members were government appointments, with the balance elected by the community. More market oriented reform under a new National government abolished this arrangement and introduced (1993) a corporate approach to the management of hospitals and related services. The hospitals were established as limited liability companies under the Companies Act. This was an explicitly corporate model and, although there was some modification of arrangements following the election of a more politically moderate centre-right coalition government in 1996, the corporate model was largely retained. Although significant changes occurred again after the election of a Labour government in 1999, the corporate governance experience in New Zealand health services is one from which lessons can, nevertheless, be learnt. This paper examines aspects of the performance and process of corporate governance arrangements for public sector health services in New Zealand, 1993-1998.     

Social Responsibility: A New Paradigm of Hospital Governance?

Changes in modern societies originate the perception that ethical behaviour is essential in organization’s practices especially in the way they deal with aspects such as human rights. These issues are usually under the umbrella of the concept of social responsibility. Recently the Report of the International Bioethics Committee of UNESCO on Social Responsibility and Health has addressed this concept of social responsibility in the context of health care delivery suggesting a new paradigm in hospital governance. The objective of this paper is to address the issue of corporate social responsibility in health care, namely in the hospital setting, emphasising the special governance arrangements of such complex organisations and to evaluate if new models of hospital management (entrepreneurism) will need robust mechanisms of corporate governance to fulfil its social responsiveness. The scope of this responsible behaviour requires hospitals to fulfil its social and market objectives, in accordance to the law and general ethical standards. Social responsibility includes aspects like abstention of harm to the environment or the protection of the interests of all the stakeholders enrolled in the deliverance of health care. In conclusion, adequate corporate governance and corporate strategy are the gold standard of social responsibility. In a competitive market hospital governance will be optimised if the organization culture is reframed to meet stakeholders’ demands for unequivocal assurances on ethical behaviour. Health care organizations should abide to this new governance approach that is to create organisation value through performance, conformance and responsibility.     

Preparing for the introduction of hospital autonomy in Laos: an assessment of current situation and suggestions for policy‐making

The National Assembly of Lao People's Democratic Republic (Laos) approved the Health Sector Reform Strategy in 2012, which called for an assessment as to whether Laos should introduce hospital autonomy, and if so, in which ways. The purpose of this study is to assess the status quo of hospital governance in Laos and propose policy suggestions for hospital autonomy in the country. We formulated an analytic framework for hospital autonomy based on previous work by other researchers, collected qualitative data through key informant interviews and focus group discussions, and also performed secondary data analysis. Public hospitals in Laos enjoyed some informal autonomy with little accountability and Laos is facing key challenges of hospital governance. As a result, introducing hospital autonomy in Laos could bring risks, benefits and debates. Before Laos decides on granting autonomy to its public hospitals, we strongly suggest that the government do pilot in selected public hospitals with well‐regulated governance framework first and conduct rigorous evaluations to examine whether the granted autonomy leads to the intended social goals of equity, quality, efficiency and sustainability. We recommend residual claimants should be monitored by the government and by the society with open and transparent approach, and active measures should be taken to improve performance and ensure social functions. The study findings may also provide some suggestions for low‐ and middle‐income countries, which are contemplating the introduction of hospital autonomy in the public sector. Copyright © 2015 John Wiley & Sons, Ltd.     

深圳市构建现代医院管理制度的基本路径与进展分析

深圳市按照现代医院管理制度建设要求，着力转变政府职能，厘清政府与医院、医院与市场、医院与医务人员、医院与患者之间的关系，通过改革公立医院管理体制、治理机制、补偿机制，推动三医联动、人事薪酬制度改革，完善医院内部制度规范，推进智慧医院建设，初步建立起权责清晰、管理科学、治理完善、运行高效、监督有力的现代医院管理制度。2010-2018年，深圳市公立医院收支结构趋于合理，公益性得到良好体现，医务人员薪酬得到合理提高。目前改革中依然存在若干挑战，权责清晰的公立医院治理体系还不完善，医院核心管理制度还不健全，人事薪酬等关键环节改革尚未全面开展；建议以法治强化全行业管理，以章程为总纲强化医院制度建设，以人事薪酬制度改革为核心推动医院高质量发展。     

我国公立医院法人治理结构研究综述

我国学术界和实务界对公立医院法人治理问题已经进行了较有价值的研究和探讨。文章从公立医院法人治理结构的界定、对国外公立医院法人治理结构的研究、国内试点公立医院法人治理结构研究及建议等方面对我国相关研究文献进行了系统的梳理,指出了我国当前公立医院法人治理结构研究的问题,提出了有关研究应完善的方面。     

潍坊市公立医院法人治理结构改革总体思路与探索

介绍了潍坊市实施公立医院法人治理结构改革的总体思路和具体做法,包括:组建政府办医机构,明确公立医院所有者的责权;落实独立法人地位,激发公立医院内在活力;完善监督制约机制,确保公立医院有序有效运行.通过实施公立医院法人治理结构改革,理顺了公立医院管理体制,调动了医院院长及医务人员的积极性,公立医院公益性得到进一步发挥,群众看病就医满意度显著提高.     

Corporate and philanthropic models of hospital governance: a taxonomic evaluation.

OBJECTIVE. We assess the theoretical integrity and practical utility of the corporate-philanthropic governance typology frequently invoked in debates about the appropriate form of governance for nonprofit hospitals operating in increasingly competitive health care environments. DATA SOURCES. Data were obtained from a 1985 national mailed survey of nonprofit hospitals conducted by the American Hospital Association (AHA) and the Hospital Research and Educational Trust (HRET). STUDY DESIGN. A sample 1,577 nonprofit community hospitals were selected for study. Representativeness was assessed by comparing the sample with the population of non-profit community hospitals on the dimensions of bed size, ownership type, urban-rural location, multihospital system membership, and census region. DATA COLLECTION. Measurement of governance types was based on hospital governance attributes conforming to those cited in the literature as distinguishing corporate from philanthropic models and classified into six central dimensions of governance: (1) size, (2) committee structure and activity, (3) board member selection, (4) board composition, (5) CEO power and influence, and (6) bylaws and activities. PRINCIPAL FINDINGS. Cluster analysis and ANCOVA indicated that hospital board forms adhered only partially to corporate and philanthropic governance models. Further, board forms varied systematically by specific organizational and environmental conditions. Boards exhibiting more corporate governance forms were more likely to be large, privately owned, urban, and operating in competitive markets than were hospitals showing more philanthropic governance forms. CONCLUSIONS. Findings suggest that the corporate-philanthropic governance distinction must be seen as an ideal rather than an actual depiction of hospital governance forms. Implications for health care governance are discussed.     

From corporate governance to hospital governance. Authority, transparency and accountability of Belgian non-profit hospitals' board and management

As a result of multiple developments in health care and health care policy, hospital administrators, policy makers and researchers are increasingly challenged to reflect on the meaning of good hospital governance and how they can implement it in the hospital organisations. The question arises whether and to what extent governance models that have been developed within the corporate world can be valuable for these reflections. Due to the unique societal position of hospitals--which involves a large diversity of stakeholders--the claim for autonomy of various highly professional groups and the lack of clear business objectives, principles of corporate governance cannot be translated into the hospital sector without specific adjustments. However, irrespective of these contextual differences, corporate governance can provide for a comprehensive 'frame of reference', to which the hospital sector will have to give its own interpretation. A multidisciplinary research unit of the university of Leuven has taken the initiative to develop a governance model for Belgian hospitals. As part of the preliminary research work a survey has been performed among 82 hospitals of the Flemish Community on their governance structure, the composition of the governance entities, the partition of competencies and the relationship between management and medical staff.