当前公立医院改革试点几个问题的分析

公立医院改革试点对于卫生资源的合理配置,探索管办分开等具有重要的借鉴意义.分析了当前公立医院改革试点存在技术性措施易推行、管办模式众多、药事服务费标准难定、法人治理结构不完善等问题;并提出公立医院改革需因地制宜以探索适合当地的改革模式、加大财政投入以健全和完善公立医院补偿机制、理顺公立医院管理体制以实现管办分开、完善法人治理结构以确保公立医院的公益性等建议.

Abstract：

Trials in public hospital reforms bear special significance for rational deployment of health resources and exploring the separation of hospital management from routine operations. The paper identified such setbacks in the present trials as easy technology measures, numerous models of separations, difficulty in setting pharmaceutical service fees, and inadequate governance. Authors also recommended such measures as searching for appropriate reforms for public hospitals locally, greater financial resources for completing the compensation mechanism of public hospitals, streamlining their management system for separation of management from operations, and improving governance. All these efforts are designed to enhance the public benefit nature of public hospitals.     

深圳市公立医院法人治理改革探索

分析了目前公立医院体制机制方面存在的问题,按照"政事分开、管办分开、医药分开、营利性与非营利性分开"的改革原则,制定了公立医院法人治理改革实施路径.一是建立公立医院管理委员会,统筹政府办医保障职能;建立公立医院管理机构,提高举办医院的行政管理水平;转变卫生行政部门职能,形成多元化办医格局.二是建立分级决策机制、自主经营制度及多元监管制度,解决政事分开问题.三是研究制定公立医院章程,促进公立医院向法定机构转变,通过法制化巩固法人治理改革成果.

Abstract：

Analysis of setbacks found in the existing system and mechanism of public hospitals. Based on the health reform principles of "Separation of administration and management, Separation of administration and operation, Separation of prescribing and dispensing, and Separation of for-profit hospitals and nonprofit hospitals", the authors named the following roadmap for public hospital governance reform. First, set up a management committee for each public hospital to coordinate the government function for medical service; set up a public hospital authority to upgrade the management level of these hospitals; transform functionality of health authorities to encourage diversity in medical service providers. Second, establish the tiered decision making mechanism, autonomous operation system and diversified supervision system, to separate administration and management. Third, formulate articles of association for hospitals to encourage their evolution to legal entities, consolidating the government reforms by legal means.     

公立医院筹资补偿机制的探讨

"为群众提供安全、有效、方便、价廉的医疗卫生服务"是<公立医院改革试点指导意见>提出的公立医院医疗卫生服务的总体目标,这一目标的实现仅靠改革公立医院内部运行机制是很难奏效的.公立医院的投入机制、区域医疗卫生服务体系的布局、医院所在地的经济与产业状况、医疗保障(险)的支付额度与支付审批程序等众多因素直接影响医院的投入与产出.本文从我国医院的投入补偿机制入手,分析了医院投入与产出的特征,提出建立基于公益性绩效的公立医院投入补偿的观点,为进一步完善公立医院的管理体制、形成以公益性为导向的公立医院运行机制提供参考依据.

Abstract：

Access of safe, effective, convenient and affordable medical and health care services to the people is set as the goal of public hospitals health services as stated in the "Guidelines for Public Hospitals Pilot Reform". Such a goal, however, can hardly be achieved by mechanism changes within the public hospitals. The input and output of public hospitals rely critically on such factors as the input mechanism, regional pattern of healthcare system, the economic and industrial conditions of the region,payment quota and payment approval procedures of medical insurance. This paper set off from the input compensation mechanism of public hospitals in China and analyzed the input and output characteristics of the hospitals. Furthermore, the paper proposed to establish an input compensation mechanism based on public welfare performance for such hospitals. This provided further reference for improving the management of public hospitals and building a public welfare-oriented operation mechanism of public hospitals.     

基于社会治理视角的公立医院社会评价策略及研究框架构建

社会治理是基于对社会管理过程中权力格局分析与判断,在政府、市场、社会与公民基本关系明确定位的前提下倡导的新型公共管理模式.社会评价是基于社会治理理论的一种有效实现载体和手段,由于其对公众利益和责任表达、解决突出社会矛盾问题具针对性和优越性,已得到普遍促进和应用.在基于社会治理理论开展公立医院管理改革情景分析的基础上,阐述了国内外社会治理及社会评价理论、内涵与进展,以及对相关社会领域社会评价治理路径及实践探索进行梳理分析,提出了在医疗服务管理领域探讨和开发其公立医院社会评价策略及研究框架构建,为探索建立公立医院社会管理制度以及政策制定提供依据.

Abstract：

Social governance is a novel form of public administration made based on the analysis and judgment for the power pattern in the course of social administration, a model advocated in the premise of a clearly positioned relationship among the government, marketplace, society and citizens.Social evaluation is an effective carrier and means leveraging the social governance theory, which has found extensive and outstanding use in such issues as expression of public interests and responsibilities,and in tackling sharp social problems. The authors called into play the scenario analysis based on public hospital management reforms with the social governance theory. In addition, they explored social governance at home and abroad as well as the theories, meaning and progress of social evaluation, and analyzed the pathways and probes in social evaluation and governance in the fields in question. On such basis, the paper proposed to explore and develop the social evaluation strategies and study framework for public hospitals in terms of healthcare management, aiming at building the social governance system and policies for public hospitals.     

湖北省6家公立医院的经济运行现状分析

目的 了解湖北省公立医院的经济运行现状,分析其对公立医院公益性的影响.方法 采用现场调查的方法收集数据,结合相关统计资料对湖北省公立医院的经济运行现状进行分析.结果 湖北省公立医院的财务收支不断增加并趋于平衡;政府财政补助有限,90%以上的公立医院收入来源于医疗收入和药品收入;公立医院人均业务收入呈逐年增长的趋势;湖北省公立医院的资产负债率相对较高.结论 宏观经济体制和卫生政策的变革、经济利益的诱导阻碍了公立医院公益性的实现.完善公立医院的财政补偿机制,规范公立医院的财务管理机制.

Abstract：

Objective To understand the current economical operation of public hospitals in Hubei province and its effect on their public welfare performance. Methods To collect data in field survey and to analyze the current economic situation of such hospitals in the province based on relevant statistics.Results Financial revenue and expenditure of these hospitals keep rising and achieving a balance in general; for the insufficient government financial subsidy, 90% of the revenue of such hospitals come from their medical services and drugs sold; the per capita revenue of these public hospitals maintains a yearly rising trend; their asset-liability ratio was relatively high. Conclusions The public welfare performance of these hospitals tends to be impeded by the reform on the macro economic system and health policy changes, on top of the attraction of economic interests. Improving the government subsidy mechanism for public hospitals and standardizing the financial management mechanism of public hospitals.     

我国医院失信惩戒机制构建研究

依据失信惩戒机制的基本原理,开展医院失信惩戒机制的基本内涵与理念的探讨,提出了我国构建医院失信惩戒机制的必要性和医院失信惩戒机制构建的基本理念.重点论述了我国构建医院失信惩戒机制的基本途径,包括确立政府主导地位、制定医院失信监管主体、制定医院失信行为的认定与责任制度、医院失信行为的处罚制度、医院失信行为的信息披露制度及医院信用的奖励与教育制度以及加强建立医院失信惩戒机制的配套建设.

Abstract：

The basic principles of dishonesty disciplinary mechanism are called into play tO probe into such issues as the necessity and key points of building such a mechanism in China's hospitals.The paper focused on ascertaining government leadership,designating key regulators of hospital dishonesty,formulating the regulations for hospital dishonesty recognition and accountability,penalty system for hospital dishonesty,information disclosure system for hospital dishonesty behavior.In addition,it covered such aspects as the incentives and education measures for hospital credit,and building supportive measures for hospitals dishonesty disciplinary mechanism.     

公立医院组织文化测评量表研究

目的借鉴Denison组织文化模型,结合我国公立综合性医院特点,科学测评医院文化.方法 运用我国东、中、西3省/直辖市的87所医院的调查数据,研究设计了医院文化测评量表.结果 医院文化测评量表包括方向性、一致性、参与性、适应性4大文化特性以及社会责任、竞争意识在内的13个文化维度,经检验,量表具有良好的内部信度和效度.结论 医院文化测评量表为医院管理者进行医院文化测评、诊断和改善提供了测评工具.

Abstract：

Objective A scientific evaluation of hospital culture with the Dimension organizational culture model, in view of features of China's general public hospitals.Methods Based on Denison model, according to the characteristics of the public general hospitals in China, the authors developed a tool for organizational culture assessment (TOCA) by using the survey data from 87 hospitals in three provinces from the East, Central, and West areas in China.Results This tool, an evaluation scale, comprises the four cultural characteristics of direction, consistency, participation, and adaptability, as well as 13 cultural dimensions of social responsibility and competitive consciousness. The tool is tested as having good internal reliability and validity.Conclusion The TOCA provides hospital administrators with a tool for hospital culture evaluation, diagnosis and improvement.     

杭州地区大型公立医院涉外医疗现状调查

以杭州市三级公立医院为典型调查对象,通过对医院工作者和在杭外籍人士的双重视角的问卷调查,结合文献研究,发现和总结杭州市公立医院涉外医疗服务方面存在以下4个普遍性问题:医生与外籍患者存在沟通障碍,医疗服务信息沟通不到位,服务环境和服务态度还不尽人意,医疗保险及收费体制问题.据此提出了政府完善涉外医疗服务体系的政策建议,包括要创建与国际接轨的医疗服务质量管理规范、收费体制改革及医保管理和涉外医疗服务机构的规划和宣传,以及医院内部关键要素的管理对策.

Abstract：

The study focused on tertiary public hospitals in Hangzhou,investigating the comments of both hospitals workers and foreigners in the city with questionnaires and literature search.The foilowing four problems were identified in the study in the foreigner medical services in Hangzhou:Communication barriers between doctors and foreign patients,insufficient communication of medical service information,poor service environment and service attitude,and payment mechanism for medical insurance and charges.On such basis,the authors recommended policy changes for the government to improve foreigner-oriented medical services,including building the regulations up to intemational customs for medical services,reforms in the payment system,medical insurance management,as well as planning and promotions of foreigner-related service institutions,and management strategies for key elements within the hospital     

安徽省8所公立医院医务人员对改革的认知分析

通过对安徽省8所二三级公立医院进行专题问卷调查,分析了不同级别医院、不同岗位、不同职务、不同职称、不同年龄的1140名医务人员对医药卫生体制改革政策知晓情况、对公立医院改革重点问题的赞同情况、参与改革的意愿情况以及影响其改革意愿的相关因素,提出对公立医院改革宣传仍需加强、改革补偿机制以明确政府职责、探索注册医师多点执业的合理模式、鼓励社会资本办医并保证其"非营利性"、完善绩效考核制度以提高医务人员改革积极性等建议,旨在为卫生行政主管部门决策提供依据和参考.

Abstract：

A total of 1140 medical workers from 8 public hospitals of secondary and tertiary levels in Anhui were surveyed with questionnaire. Their knowledge of the reform, acknowledgement of key points of the reform, desire of participating in the reform and other factors that may influence the reform were investigated as categorized by their hospital, position, title and age. This study comes up with such recommendations as reinforcing communications on public hospital reform, reforming the compensation mechanism to clarify government responsibilities, probing into a better model for multi-institution practice of certified physicians, and encouraging private capital to participate in medical service while ensuring its "non-profit" nature, and improving the performance appraisal mechanism to ensure incentives of medical workers. These recommendations aim to enable the health administrators in their decision making.     

民营医院履行社会责任的实践探索

介绍了我院作为改制后的民营医院,在医院文化建设方面,通过创建爱康医院家的文化,树立爱康价值观,构建和谐的医院工作环境;在管理体制改革方面,实施管办分离,成立了支持系统和运营系统,通过先进的管理方法改进医疗服务质量;在回报社会方面,通过积极救助弱势群体、积极承担公共卫生服务、热心慈善等,付出真诚的爱心,切实履行社会责任.

Abstract：

The paper introduced the organization culture building of a private hospital, in creating the Aikang hospital as your home culture and Aikang values for building a harmonious workplace for the hospital. The management system reform features the separation between regulations and management,building of the supporting system and operating system, for better quality of care with advanced management practice. The social rewards feature great efforts in supporting the disadvantageous population, and undertaking public health service and charity activities. These care and love to the community help the hospital to fulfill its social responsibilities.     

公立医院内部治理体系和治理能力现代化的实践探索

现代医院要求治理体系上权责清晰、管理科学、治理完善、运行高效、监督有力,建立现代医院管理制度就是要实现医院治理体系和管理能力现代化。以试点医院为出发点探讨了公立医院治理结构和治理制度体系的构建,并分析了取得的社会效应和实践绩效,以期为我国公立医院建立健全现代医院管理制度提供借鉴意义。     

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.     

公立医院治理结构变革对战略绩效管理的影响研究

公立医院治理结构是实施战略绩效管理的前提和基础。当前公立医院治理的困境是导致绩效管理体系不健全的根本原因。公立医院法人治理结构的变革将理顺战略绩效管理体系,赋予其明确的战略目标和绩效管理责任。     

关于公立医院实施总会计师制度的若干问题思考

从政策研究视角,对公立医院推行总会计师制度实践的背景、政策法规现状、体制机制环境和不同治理框架下的模式选择进行分析,提出合理设计总会计师的定位和职责以及与公立医院体制机制环境相衔接的具体建议.     

落实党委领导下的院长负责制的实践与思考

党委领导下的院长负责制是国家建立现代医院管理制度、深化公立医院改革的重大举措。文章总结归纳了复旦大学附属华山医院运用组织行为学理论,从管理层次和管理幅度两个维度对管理体制进行重构的实践经验,探讨了如何充分发挥党委领导的核心和引领作用,将党的领导融入医院治理各环节,为其他公立医院开展相关工作提供了参考。     

法国、澳大利亚公立医院治理分析与启示

本文通过理论探讨以及法国、澳大利亚两国的案例分析,提出我国建设现代医院管理制度的核心是医院治理,而医院治理应包含治理结构与治理机制两个部分,通过这两个机制形成医院各利益相关方的共同决策机制,通过有效协商达成权力平衡,把医院运行的外部压力转化为协调内部管理的动力,从而提高公立医院治理的效率。并由此提出完善我国公立医院治理的政策建议。     

现代医院管理制度视域下公立医院决策机制的重构与优化研究

根据《关于加强公立医院党的建设工作的意见》要求,我国公立医院的内部领导体制由院长负责制改为党委领导下的院长负责制,公立医院的决策机制必将随之发生深刻变革。本文分析院长负责制下公立医院决策机制的内涵及其存在的问题,提出在现代医院管理制度视域下重构与优化公立医院决策机制的建议。     

建立法人治理结构的实践与探索

对东阳市人民医院建立法人治理结构、实施董事会领导下的院长负责制、落实医院独立法人地位的16年改革经历进行了回顾性综述.实践表明,建立和完善法人治理结构是推行政事分开、管办分开、经营权与所有权分离的有效形式,是落实公立医院独立法人地位、推进医院可持续发展的重要保证,是当前推进公立医院改革的一个可以借鉴的模式.     

以“管办分开”理顺公立医院治理结构——上海申康医院发展中心公立医院治理改革剖析

上海市公立医院管理体制改革通过政府相关部门参与＂申康＂董事会,形成了多部门的联合治理,实质是对公立医院决策权、执行权和监管权的重新构建。＂申康＂作为非营利性事业法人,体现了公共部门治理的特征,规范了公立医院所有者和经营者的职能和权限。＂申康＂与市级医院的分权仍是在所有权和经营权分离范围内的公立医院自主化改革,＂申康＂和政府部门的分权则是法人化改革的探索。＂申康＂的设立,为厘清管办分开和政事分开的思路提供了一个鲜活的案例。