我国医疗服务竞争机制的优化策略——建立纵向整合的医疗服务体系

新医改时期,我国医疗服务提供引入市场机制已成必然选择,但如何完善当前的竞争机制需要进一步深入研究。本研究首先给出了衡量竞争机制有效性的评价标准;辨析了我国目前的竞争机制是医疗服务机构间在＂机构水平＂上相互竞争、以机构完成医疗服务量作为激励机制,并结合医疗服务特征,阐述了这是一种低效的竞争机制。提出＂系统水平＂上的竞争是今后我国新医改医疗服务竞争机制的选择,即在区域内构建多个纵向整合的医疗服务体系,竞争在系统与系统之间进行、以服务人群的健康改善作为激励机制。最后,对全球医疗服务竞争机制的演变进行了回顾,从经验上验证了上述理论分析的结论。

Strategy for optimizing the mechanism of healthcare competition:Establishing the vertical integrated healthcare delivery systems

It is an essential choice to introduce market mechanism into health care delivery system for the New Health Reform in China and improving the current competition mechanism urgently calls for further research. This paper firstly set up standards of evaluating effectiveness of competition mechanism and then to clarify the current competition mechanism as "organizational-level" competition together with a fee-for-service incentives. Based on the standards and the characteristics of health care service, the paper conducts a deep-analysis with a conclusion that the organizational-level competition mechanism is inefficient. Secondly, the paper fourthly expounds the advantages hold by vertically integrated delivery systems (IDSs) and propose that the "system level" competition mechanism maybe is a future choice for New Health Reform of China, namely establishing several IDSs in a region, the systems compete with each other and use the health improvement of population as incentive. Finally, the paper makes a review of evolution of global health care competition mechanism and empirically proves the conclusion of what has been discussed above.