法国公立医院改革的主要做法与启示

为了应对经济危机和人口老龄化,法国公立医院开始了以成本控制为主要目标的改革。改革的重点在于服务体系、管理体制和补偿机制,具体措施包括成立区域卫生管理局,制定区域卫生规划,为公立医院发展设定目标和明确功能定位;通过构建权责明晰的治理结构和签订绩效管理合同,公立医院院长在政府宏观管理下拥有较大的经营自主权;通过加强预算管理和支付方式改革等多种方式控制医疗服务成本;加强对公立医院的认证和评价。改革主要特点是加强医疗资源规划与整合,促进公立医院与区域卫生管理局的契约化,明确公立医院治理的各方权责,通过控制医疗费用提高资源利用效率,对我国公立医院改革具有一定借鉴。

The main practices and implications of public hospital reform in France

In response to economic crisis and population aging, French public hospitals lunched a reform targeted mainly on cost control. The reform focuses on service system, management system and compensation mechanism for public hospitals. Specific measures include: i) establishing regional health administration bureaus; formulating regional health plans; setting objectives and clarifying functional orientation of development of public hospitals; ii) through building governance structure with clear authorities and responsibilities as well as signing performance management contracts, presidents of public hospitals own greater independent rights of management and operation under governmental macro administration; iii) the government controls medical service costs through multiple approaches such as strengthening budget management and reform of payment method; and iv) enhancing certification and evaluation of public hospitals. The reform is characterized mainly by: strengthening the planning and integration of medical resources; promoting contract system between public hospitals and regional health administration bureaus; clarifying the authorities and responsibilities of all parties involved in governance of public hospitals; and improving resource utilization efficiency through controlling medical expenses. It also provides a sound reference for the reform of public hospitals in China