从经济学角度谈医院所有制改革的难点

论述了医院所有制改革的必然性和紧迫性。分析了医院所有制改革工作的重点和难点。明确了建立适应社会主义市场经济发展要求的医药卫生体制具有重要意义的改革目标。无论是在理论上 ,还是现实中都可以总结出 :对于我国 ,至少在很长一段时间内 ,公立医院应该占主导地位 ,为广大人民提供基本的医疗保障 ;而私立医院的服务及质量优势较为突出 ,只有当人们的生活水平达到较高的程度以后才能体现出来。     

Does hospital ownership influence hospital referral region health rankings in the United States

Extensive evidence demonstrates that a hospital's organizational ownership structure impacts its overall performance, but little is known concerning the influence of hospital structure on the health of its community. This paper explores the association between US hospital referral region (HRR) health rankings and hospital ownership and performance. Data from the 2016 Commonwealth Fund Scorecard on Local Health System Performance, the American Hospital Association dataset, and the Hospital Value‐Based Purchasing dataset are utilized to conduct a cross‐sectional analysis of 36 quality measures across 306 HRRs. Multivariate regression analysis was used to estimate the association among hospital ownership, system performance measures—access and affordability, prevention and treatment, avoidable hospital use and cost, and healthy lives—and performance as measured by value‐based purchasing total performance scores. We found that indicators of access and affordability, as well as prevention and treatment, were significantly associated across all 3 hospitals' organizational structures. Hospital referral regions with a greater number of not‐for‐profit hospitals demonstrated greater indications of access and affordability, as well as better prevention and treatment rankings than for‐profit and government hospitals. Hospital referral regions with a greater number of government, nonfederal hospitals had worse scores for healthy lives. Furthermore, the greater the total performance scores score, the better the HRR score on prevention and treatment rankings. The greater the per capita income, the better the score across all 4 dimensions. As such, this inquiry supports the assertion that performance of a local health system is dependent on its community's resources of health care delivery entities and their structure.     

我国公立医院混合所有制可行性探讨

混合所有制经济"是基本经济制度的重要实现形式",但是作为向社会提供具有公益性医疗服务的公立医院,如何与社会力量合作,如何激励社会力量积极参与医疗服务,具有不同于其他行业的改革难度。本文围绕我国公立医院探索混合所有制过程中存在的问题展开讨论,认为公立医院不宜参考国有企业改革模式实施混合所有制,为解决公立医院数量过多和存在的治理及内部管理问题,可考虑社会化治理改革,将其转变为一种新型医院制度形式的特殊法人。     

探索与反思：乡镇卫生院产权制度改革研究十年回展

乡镇卫生院产权制度改革围绕拍卖转让、回购与否,引发了从产权制度到政策层面,从学术界到政府、社会的大讨论。焦点在于公共卫生服务能力是否弱化,＂看病贵＂是否解决,市场主导还是政府主导。在当下财政投入仍然有限的条件下,对卫生院改制后的取舍有必要从制度成本与组织效率的理性视角去思考。     

Profit efficiency and ownership of German hospitals

This paper investigates the cost and profit efficiency of German hospitals and their variation with ownership type. It is motivated by the empirical finding that private (for-profit) hospitals - having been shown to be less cost efficient in the past - on average earn higher profits than public hospitals. We conduct a Stochastic Frontier Analysis on a multifaceted administrative German data set combined with the balance sheets of 541 hospitals of the years 2002-2006. The results show no significant differences in cost efficiency but higher profit efficiency of private than of publicly owned hospitals.     

福利归属视角下社会医疗保险政策的纵向比较研究

为了促进基本医疗保险政策的高质量协调发展,本文从福利归属视角对我国基本医疗保险政策进行审视和分析。利用中国综合社会调查数据(CGSS)和中国家庭金融调查数据(CHFS)等多源数据库进行分析,得出如下结论:基本医疗保险的参保率实现了较高水平,但未参保群体中农村群体和低收入群体占比有提高的趋向;基本医疗保险的受益具有一定的亲富性,并具有强化趋向;而疾病负担具有一定的亲贫性,也具有强化趋向。因此,需要明确规定基本医疗保险参保的强制性,反思现行基本医疗保险的待遇支付,以及完善面向弱势群体倾斜的医保补偿政策。     

Rural hospital ownership: medical service provision, market mix, and spillover effects

Objective. To test whether nonprofit, for‐profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data Sources/Study Setting. Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. Study Design. We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Principal Findings. Rural nonprofit hospitals are more likely than for‐profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for‐profits to changes in service profitability. Nonprofits with more for‐profit competitors offer more profitable services and fewer unprofitable services than those with fewer for‐profit competitors. Conclusions. Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership.     

我国公立医院产权制度改革的战略选择

随着医疗体制改革的深化和医疗市场竞争的加剧，公立医院的产权改革势在必行。本文在结合公立医院管理经验和自身的特殊性的基础上，探讨了公立医院产权改革可能的发展战略。提出国有产权在现代医院管理制度中应该处于主导地位，产权改革的重点是减少国有资本的政策性负担和加强国有资本的影响力和控制力。     

国有医院成本核算与确定职工收入分配总量的研究

该着重研究国有医院成本核算与确定职工收入分配总量的问题。通过阐述国有医院财务管理与会计核算的目标、任务和要求，对国有医院业务经济管理现状作出性分析和客观性评价；重点介绍了有关国家和地区医院财务管理、成本控制做法和管理理念；在分析目前医院实施工资性支出管理办法的基础上，着重提出了确定国有医院职工收入分配总量的改革方案，以供探讨。     

Contribution of case‐mix classification to profiling hospital characteristics and productivity

Case‐mix classification has made it possible to analyze acute care delivery case volumes and resources. Data arising from observed differences have a role in planning health policy. Aggregated length of hospital stay (LOS) and total charges (TC) as measures of resource use were calculated from 34 case‐mix groups at 469 hospitals (1 721 274 eligible patients). The difference between mean resource use of all hospitals and the mean resource use of each hospital was subdivided into three components: amount of variation attributable to hospital practice behavior (efficiency); amount attributable to hospital case‐mix (complexity); and amount attributable to the interaction. Hospital characteristics were teaching status (academic or community), ownership, disease coverage, patients, and hospital volume. Multivariate analysis was employed to determine the impact of hospital characteristics on efficiency. Mean LOS and TC were greater for academic than community hospitals. Academic hospitals were least associated with LOS and TC efficiency. Low disease coverage was a predictor of TC efficiency while low patient volume was a predictor of unnecessarily long hospital stays. There was an inverse correlation between complexity and efficiency for both LOS and TC. Policy makers should acknowledge that differentiation of hospital function needs careful consideration when measuring efficiency. Copyright © 2010 John Wiley & Sons, Ltd.     

Expansion in markets with decreasing demand-for-profits in the German hospital industry

Over the last 20 years, acute-care hospitals in most OECD countries have built up costly overcapacities. From the perspective of economic policy, it is desirable to know how hospitals of different ownership forms respond to changes in demand and are probably best suited to deal with existing overcapacities. This article examines ownership-specific differences in the responsiveness to changes in demand for hospital services in Germany between 1996 and 2006. With respect to the speed of adaptation to increasing demand, the study finds for-profit ownership to be superior to public and nonprofit ownership. However, contrary to other ownership types, for-profits also tend to expand in markets with decreasing demand - mainly through conversions of publicly owned hospitals. Thus, in short term, the privatization of the hospital sector may slow down the reduction of excess capacities and be therefore socially wasteful.     

The transition from hospital to home: an exploratory study.

With the predominance of the elderly and chronically ill, and shorter lengths of stay, hospitals struggle with facilitating timely discharge while ensuring that the patient and family receive proper ongoing care. Subsequently, facilitating the patient's smooth transition from hospital is of primary importance at the time of discharge. Yet, little is known about the situations and difficulties patients experience during the first week after discharge. This study explored the patient's transition from hospital to home. Using a random sample of adult medical-surgical patients, data was collected during the first week at home using telephone and in-depth interviews, and participant observation. The results of this study present four major themes: the nature of the patient's continuing care needs, the importance of an available and able caregiver, the presence of caregiver uncertainty, and the need for information. In addition, it identified home care services as a vital resource to assist patients with illness management. Further research is needed to examine the patient's transition home over time, to explore the importance of caregiver networks and information seeking after discharge, and to develop discharge planning methods which integrate hospital and community services.     

Assessing performance of Taiwan hospitals using data envelopment analysis: In view of ownership

With rapid economic development in Taiwan, people have greater awareness of health care and are paying more attention to it. From the perspective of hospital management, the scale of hospitals and efficiency improvement are of concern to hospital managers. However, the extent of efficiency will differ between public and private hospitals due to their different ownership and goals. The study aims to evaluate the efficiency of public and private hospitals and to investigate the influence of ownership on efficiency of hospitals. The differences between hospitals can be understood by analyzing the features of the organization of hospitals and their geographic environment. In this way, hospitals with relatively low efficiency will be able to make improvements based on concrete evidence. By means of the two‐stage method, the efficiency scores of 182 hospitals in Taiwan are compared. In the first stage, the data envelopment analysis is applied to obtain the efficiency scores of hospitals. The results show that private hospitals are more efficient than public hospitals. In the second stage, Tobit regression is used to investigate the factors influencing efficiency obtained by the data envelopment analysis. The results indicate that there are differences between ownership in market competition and the average length of stay.     

吸纳公益资本后的公立医院治理结构实证研究

目的探索公立医院吸纳公益性社会资本后,如何建立法人治理结构的现代医院管理模式。方法通过对东阳市人民医院吸纳公益性社会资本后建立法人治理结构的10多年运行情况的调查,结合有关文献进行研究分析。结果吸纳公益性社会资本,创建多元投资主体的公立医院,建立现代法人治理结构,能够促进管办分离、资本多元化、监督多元化、院长经营管理职业化。结论提出吸纳公益性社会资本是医疗产权改革的首选。建立法人治理结构符合公立医院创建社会效益并实现持续发展的目标。     

公立医院改制的动力、特点与相关政策

该文根据现场调查,对公立医院转制为民办非营利性医院或民办营利性医院的动力和阻力进行了角色分析,揭示了目前公立医院转制的特点和问题,并对公立医院的改制提出了政策建议:建立公立医院转制的原则和程序,制定医院资产评估和拍卖的管理办法,转化医院职工的身份,减少改革成本.     

我国公立医院社会公益性缺失的根源及对策

一段时期以来,部分公立医院逐步由提供基本医疗服务、预防为主、追求社会公益等非营利性行为向提供特殊医疗服务、治疗为主、追求经济利益等营利性行为转变。这一转变带来的最大危害可能是造成我国医疗费用的过快上涨。因此,如何保证公益性就成为公立医院改革的突破口。     

医院托管个案评价研究：成员医院资源利用效率的变化

目的分析医院托管对成员医院资源利用效率的影响。方珐采用回顾性对照研究。结果（1）托管行为提高了被托管医院住院服务和手术服务的人力效率,明显提高了被托管医院的床位效率。（2）医院托管后,主体医院门急诊服务人力效率增幅明显低于同类医院．住院和手术服务人力效率与同类医院齐同,床位效率始终高于同类医院水平。结论从长期效果来看,医院托管有利于缓解主体医院的工作压力．提高被托管医院的资源利用效率,促进不同层级医院的合理分工。     

Cost efficiency of US hospitals: a stochastic frontier approach

This study examined the impact of managed care and other environmental factors on hospital inefficiency in 1631 US hospitals during the period 1990-1996. A panel, stochastic frontier regression model was used to estimate inefficiency parameters and inefficiency scores. The results suggest that mean estimated inefficiency decreased by about 28% during the study period. Inefficiency was negatively associated with health maintenance organization (HMO) penetration and industry concentration. It was positively related with Medicare share and for-profit ownership status.     

Evaluating user satisfaction in a hospital environment: an exploratory study.

This article demonstrates the usefulness of user satisfaction measurement to pinpoint potential problem areas as well as to document application areas with satisfied users in hospital information systems. It discusses the rationale of measuring user satisfaction and the instruments to carry out the measurement procedure. It, then, reports the results of implementing a previously developed, documented, and validated user satisfaction measurement instrument in a hospital environment.