公立医院固定资产投资行为及其优化策略研究

固定资产是公立医院的主要物质基础,标志着医院的规模和医疗水平。近几年公立医院的固定资产投资稳步增加,笔者从理论角度阐述公立医院固定资产投资的基本特征,从投资规模、投资来源、投资结构和投资效益角度分析公立医院固定资产投资现状,从健全相关法律法规、完善投资项目决策、加强项目成本管理、建立绩效评价指标体系等角度,提出优化当前公立医院固定资产投资行为的对策建议。     

公立医院固定资产非效率投资内涵及度量模型研究

借鉴企业非效率投资内涵界定思路．基于公立医院新医改后的财务目标定位，采用经济学成本效益分析法对公立医院非效率投资内涵进行了界定，从而确定公立医院非效率度量方法：基于资源依赖理论，构建了公立医院非效率投资的度量理论模型，并确定了模型主要变量的选取。     

公立医院非效率性投资行为探析

投资行为是公立医院发展和资金积累的重要基础,然而由于委托代理和信息不对称等原因,公立医院的发展过程却存在着投资不足和投资过度等非效率投资的行为。对公立医院非效率投资行为的产生机理进行理论阐述,对当前公立医院非效率投资的具体表现形式进行分析,并在此基础上提出优化公立医院投资行为的对策建议。     

固定资产投资理论在医院投资决策中的应用

医院财务管理不能以利润最大化,或者说以结余最大化为目标,并不意味着医院不需要加强财务管理。资本投资理论,尤其是固定资产投资理论不但在企业投资中具有重要意义,在当前激烈的医院竞争中对怎样使固定资产投资发挥最大效益,怎样在固定资产投资、设备购置中为领导提供切实、可靠、有用的决策信息,提高医院固定资产的创收效益也有其重要的应用价值。本文着重讨论固定资产投资理论在医院固定资产更新改造中的应用。     

杭州市公立医院财政投入分析

本文以市属公立医院财政投入为例,根据政府对医疗卫生财政投入、对公立医院投入、固定资产投资、经济运行补偿结构和成本费用数据进行分析,认为政府财政投入依据相对简单,提出政府应综合考虑医院成本核算、医疗服务价格和补偿机制等问题,有计划、科学地进行财政投入,并与医院综合考核结果相结合。     

公立医院公私合作面临的投融资政策困境及其出路

本文回顾了公立医院PPP适用的投融资政策和主要实践模式,分析了公立医院PPP面临的如何合理确定PPP设备设施项目,评估公立医院投资资产价值,让合作双方获得合理回报等投融资政策困境,在此基础上提出了公立医院摆脱困境的出路,包括加强合作项目前期可行性论证,贯彻区域卫生规划和医疗机构设置规划要求;加强公立医院PPP项目有形资产和无形资产的评估,防止国有资产流失;加强公立医院PPP财务信息披露,维护公立医院公益性和职工合法权益。     

人才风险投资与欠发达地区医院人力资源建设

制约欠发达地区公立医院发展的关键因素是人力资源,而医院人力资源建设发展需要长期大量的资金投入,通过对两个案例的描述分析,对人才风险投资理论在医院应用前景予以展望,使欠发达地区公立医院能找到一条符合实际的人才投资和培养思路,从而推动医院人力资源建设发展。     

卫生部57家成本监测医院的DEA效率分析

目的:对57家医院进行数据包络分析,量化相对非有效医院投入的不足,为医院改革提供一定的参考依据。方法:分地域、分级别对医院效率进行分析和比较。结果:在57家医院中,数据包络分析有效的医院为21家,占全部医院的37%;非数据包络分析有效得分的单元为36家,占全部医院为63%;西部医院的总体效率最高,特别是四川省和云南省,东南沿海地区医院的总体效率偏高于中部地区的医院。结论:通过对不同地域、不同级别医院的分析与比较,在全国范围内,市级医院的总体效率都需要提高,各级卫生部门需要重点加大对市级医院的投入和管理。     

Improving financial performance: a study of 50 hospitals

This article provides an analysis of key differences between a small sample of high-performing and low-performing hospitals where performance was defined as return on equity. Some of the more significant findings were: (1) high-performing hospitals achieve their superior performance through cost control rather than higher prices; (2) high-performing hospitals minimize their investment in plant assets and accounts receivable. They are also likely to have a newer plant than low-performing hospitals; (3) high-performing hospitals are not afraid to use debt in their capital structure, but they use significantly less debt than low-performing hospitals; (4) high-performing hospitals have set aside greater reserves for future plant replacement, which helps them to keep their level of debt reasonable and generates significant amounts of investment income; and (5) high-performing hospitals have greater market share than low-performing hospitals.     

四川省X线电子计算机断层扫描装置成本效益分析

目的对2007年四川省各市州X线电子计算机断层扫描装置(CT)的成本效益情况进行分析,为卫生行政部门科学管理和合理配置该设备提供依据。方法通过计算现有CT的年利润率、净现值及设备的投资回收期,分析全省不同等级医疗机构CT的使用绩效。结果全省共有CT397台,每台设备年运营成本中位数为94.7万元,年业务收入中位数为100.0万元,纯收入中位数为10.4万元,利润率的中位数为14.6%,净现值中位数为66.7万元,回收年限中位数为2.8年。全省有39台(9.8%)设备无法在规定期限内收回投资,主要集中在二级医院和无等级医院。结论全省CT总体运营情况较好,但是部分二级医院和无等级医院成本回收较差,配置与医院现状和发展相适应规格的设备,采取措施降低CT运营成本和提高效益。     

Debt,investment and endowment accumulation: the case of not-for-profit hospitals

Not-for-profit hospitals benefit from special tax rules that allow state authorities to issue tax-exempt bonds on their behalf, which may affect their investment and financing choices. Hospitals may respond by increasing their investment in physical assets; however, they may also engage in tax arbitrage by using the tax-exempt debt while maintaining endowment assets. The paper combines data from tax (information) returns and the annual survey of hospitals by the American Hospital Association for 1993-1996. Overall, the results are consistent with substantial tax planning by not-for-profit hospitals. Of the US$ 55.9 billion in tax-exempt liabilities of hospitals in 1996, as much as US$ 32.6 billion could have been eliminated if hospitals spent their endowments instead of borrowing. Furthermore, controlling for hospital size (in terms of revenues and operating assets), endowment assets are associated with a higher ratio of tax-exempt (or total) debt to operating assets. In contrast, endowment assets are not related to taxable debt suggesting that the effects of the endowment on borrowing are motivated by tax incentives. Investment and endowment accumulation regressions suggest that increases in debt increase both physical investment and endowment accumulation but these effects are concentrated among cash-rich hospitals for which the effects on endowment accumulation effects are larger than the effects on physical investment.     

医院新建信息系统投资模型的研究

本研究成果旨在为国内新建医院的信息化建设投资测算提供参考模型,即以浦东新区各二三级综合性医院为研究对象,通过剖析医院信息化建设相关因素,并通过成本分摊法计算出各相关因素的软硬件投资单价,从而建立起医院信息化建设投资模型。最后,通过医院的实际投资对模型进行验证,效果良好,具有一定的应用价值。     

四川省少数民族地区乡镇卫生院服务能力现状研究

目的:了解四川省民族地区乡镇卫生院数量、设备拥有情况、人员及卫生服务能力等情况。方法:采用自制调查问卷对2008年四川省60个民族及民族待遇县乡镇卫生院进行调查。结果:收回数据的52个民族及民族待遇县共有乡镇卫生院1180.00所,其中,中心卫生院208.00所,一般乡镇卫生院972.00所,卫生技术人员职称以初级为主占56.69%,卫生院设备短缺,业务开展情况不理想,手术类的医疗服务项目开展情况最差,各地区机构业务收入均低于业务支出,收不抵支。结论:政府加大对乡镇卫生院的投入,同时注意投入结构和投入方向的调整;建立稳定的双向流动对口支援机制,提高卫生技术人员业务素质;建立"县医院—乡镇卫生院"服务延伸网络,提高乡镇卫生院的技术水平和服务能力。     

加强政府对基层公益性医院财政投入的探讨

加强区县政府对基层公益性医院的财政投入是医药体制改革的重要内容,在改善人民健康状况、提高人力资本素质和促进社会公平等方面的作用举足轻重。本文分析区县政府在卫生资源方面存在的问题,并提出相应对策。加强区县政府对确保人民身体健康投资的主导地位,明确区县政府对基层公益性医院的责任,加大区县政府对卫生事业经费的投入力度,逐步满足广大人民群众基本医疗需求。     

公私合作模式在我国公立医院投资建设领域中应用的探讨

作者介绍了公私合作（PPP）模式的概念和国外应用的情况。对我国引入公私合作模式投资公立医院的可行性进行了探讨，详细分析并提出了该模式与传统政府投资模式相比，具有提高投资效率和质量、转移风险、降低建造成本、避免短期投资决策、弥补公共财力不足、促进革新、提高建筑质量和维护保养水平的优势，将使政府部门、公立医院、病人及私立投资部门四方共同受益。     

Valuing hospital investment in information technology: does governance make a difference?

This article examines the investment of patient care information technology (IT) systems by a nationwide sample of U.S. short-term acute care hospitals and the resulting impact these systems have in the productivity of institutions from 1990-1998. Of particular interest is the extent to which for-profit and not-for-profit hospitals obtain different results from the adoption of lT systems. We find that the marginal effect of IT on for-profit hospital productivity is to reduce the number of days supplied, while in not-for-profit hospitals the marginal effect of IT is to increase the quantity of services supplied. This resulting effect is consistent with the differing objectives of not-for-profit and for-profit hospitals and demonstrates the positive marginal value of IT as a sustainable and prudent investment.     

Investitionstätigkeit und Investitionsrückstand als Risikofaktoren für die Hochschulmedizin?

University medicine in Germany requires significantly higher funding and investment because its tasks not only include health care but also research and teaching. However, over recent decades less and less funding compared to the development of the turnover has been available. This trend is due to decreasing public funding. The diminishing funding has caused a major backlog of investment at German university hospitals. The first part of the article summarizes the investments policies at university hospitals and other hospitals. The second part describes the investment needs in university medicine and exposes risk factors for research, education and health care due to the process of investment planning and realization. Goal-oriented solutions are shown to facilitate investments. The third part discusses several risks caused by insufficient investments in university medicine. There are special risks for research, teaching, and the capacity for innovation in university medicine besides economical and medical risks. Some policies and financial strategies to overcome the backlog in investments are presented. After a summary, the article concludes with some practical examples of further measures to ensure sustainable funding.     

湖北省县级公立医院改革试点医院经济运行状况分析

目的:了解湖北省县级公立医院改革试点医院2009—2011年经济运行状况及其中存在的问题。方法:通过定性与定量﹑描述分析与对比分析等方法,研究经济运行现状及其变化发展趋势。结果:湖北省县级公立医院改革试点医院总体经济运行基本平稳,创收能力增强,偿债能力﹑运营能力和经营效率较低。结论:湖北省县级公立医院存在债务负担较重﹑政府投入不足﹑经营效率低下等问题,提出了控制负债规模﹑限制县级医院规模﹑增加政府投入等政策建议。     

天津市公立医院现状分析及对策研究

摘要 目的：对天津市公立医院现状进行系统调查分析,探索天津市公立医院改革在新一轮医药卫生体制改革当中的难点问题,并提出相应的建议,为有关部门制定医疗卫生政策提供依据。方法：通过分层抽样的方法,分类分级别抽取天津市各级公立医院共计22所,并结合《天津市卫生统计年鉴（2009年版）》相关数据,进行统计分析。结果：天津市公立医院资源区域发展不平衡,卫生服务公平性较差;公立医院资源利用不均衡,基层医疗卫生资源利用率不足;公立医院投入不足、补偿机制不健全,致使公益性弱化。结论：启动新一轮的区域性卫生规划,开展多种模式的改革试点工作;调整公立医院布局和功能;完善公立医院政府投入机制,完善公立医院卫生补偿机制;建立公立医院管理运营模式。     

The role of financial market performance in hospital capital investment

Many not-for-profit hospitals hold large portfolios of financial investments, making them vulnerable to fluctuations in market performance. This article examines the association of bond and equity market performance with investment in property, plant, and equipment by 194 not-for-profit general hospitals in California over the period 1997 to 2006. The study combines retrospective panel data from the California Office of Statewide Health Planning and Development with year-end returns on the S&P 500 and ten-year US Treasury bonds. Using fixed-effects regression, we find a significant positive association between S&P 500 performance and hospitals' capital investment; investment is not correlated with ten-year Treasury bond performance.