部分国家政府举办公立医院的经验与启示

世界各国不论经济发达与否，均举办一定数量的公立医院。公立医院的重要地位和作用是：弥补市场缺陷、体现政府保障居民健康权益的责任，并在控制医药费用、提高卫生服务公平可及性、有效利用资源等方面发挥重要作用。不同卫生保健体制国家的公立医院功能定位具有不同特点：国民卫生服务体系国家强调政府主导卫生筹资，公立医院为人群提供免费或廉价的基本卫生服务；社会健康保险体制国家以德国为例，公立医院除承担一般性功能外主要提供住院服务；商业健康保险体制国家以市场为主导，公立医院的作用在于调节市场失灵，在医疗服务体系中发挥基础性但非主体性作用，并履行一定的社会职责。各国政府通过探索公立医院改革，如实行“管办分离”，以明确政府举办公立医院的职责。国际经验对我国的启示是：政府应举办一定数量的公立医院，为其承担大部分筹资，完善监管政策，促使其落实社会职能和责任；公立医院要通过高效率运行，为群众提供高质量的服务，并要代表国家医疗服务体系的先进水平，起到示范作用；政府进行公立医院改革要以转变政府职能为前提，并保障公立医院的社会功能；公立医院的功能应适应国家医药卫生体制的制度环境。

The experiences and inspirations of governmental responsibilities for establishing public hospitals in some countries

All the countries in the world, regardless of economic status, establish a certain number of public hospitals. The important roles of public hospitals include： remedying market flaws, safeguarding people＇s health rights on behalf of the government, controlling medical expenditures, improving accessible and equal health services and efficiently making use of health resources. However, different countries with different health care systems have distinct characteristics in terms of functional orientations of public hospitals. Countries with national health system emphasize the government playing the leading role in health financing and public hospitals providing free or inexpensive services for the population; Germany, as a typical representative with social health insurance system, focuses on providing inpatient services on top of undertaking other general functions; countries with commercial insurance system stress the market playing the dominant role, and public hospitals being accountable to adjusting market failure and fulfilling some social duties. Other countries define their responsibilities for establishing public hospitals through reform of ＂separation from decision making and monitoring functions and enforcing functions of the government＂. These international experiences reveal many inspirations, such as： （1） the government should establish some public hospitals, assume the major responsibility for health financing and improve monitoring policies to make public hospitals fulfill social functions; （2） public hospitals should deliver quality services through highly efficient operation; （3） public hospitals are manifest of advanced medical level in health system and erect a good demonstration; （4） public hospitals reform should be based on the pre-conditions of changing governmental responsibilities and ensuring social functions of public hospitals ; and （5） social functions of public hospitals should be congruent with the institutional arrangement of health care system.