减负的根本是消除垄断

目前,为控制医疗费用,降低患者医疗负担,政府引入了一系列的管制措施,管制医院医生行为,管制医疗服务及药品价格,结果却事与愿违。应该说,在政府管制和医生应对的博弈中,政府压根儿就是帮倒忙。降低患者医疗负担的根本措施是消除公立医院在医疗服务和药品零售市场上的垄断地位。     

社会资本投资于医疗服务领域的相关政策

目前,我国开放医疗服务市场,鼓励社会资本投资于卫生领域,需要明确几个重要的相关政策:打破行政垄断,放宽市场准入;平衡卫生服务的规划指导与市场竞争的关系;在市场开放的同时,必须保证基本医疗服务需求;明确社会资本投资与卫生的重点和途径;完善分类管理政策和公立医院向民办营利性医院和非营利性医院转制的政策;鼓励公立医院的管理体制和治理结构创新;加强对医疗服务市场的监管,克服市场失灵.     

从捆绑销售的视角探讨药价虚高问题

药品价格虚高已经成为严重的社会问题,本文认为医疗机构基于医患之间的信息不对称和医疗服务的价格管制而对医疗服务与药品进行捆绑销售,这是导致药价虚高的主要原因。因此,必须建立公开的信息制度、改革医疗服务价格管制制度、打破公立医院的垄断格局,强化医疗服务提供者之间的竞争。     

试论医疗服务市场失灵、信息披露及其管制

在现代经济学的框架中，公共产品、外部性、自然垄断和信息不对称的存在会导致市场失灵。我国医疗服务市场因其特殊的技术与经济特点也存在一般意义上的市场失灵，从而使市场机制对卫生资源的配置偏离了最优状态，也使政府管制这一非市场治理机制的产生与存在成为必要，以弥补与矫正市场失灵，保证医疗服务信息的充分、及时、完整披露，医疗服务市场的规范运行。     

浙江省公立医院医疗服务价格改革的探索与实践

浙江省公立医院综合改革以来,通过调整医疗服务价格,完善医疗服务收费结构,同步完善医保政策,采取先放后限价格调整策略等措施,一定程度上体现了医务人员劳务价值,保持了公立医疗机构的平稳运行,引导了医疗资源的优化配置。本文通过分析浙江省医疗服务价格调整的各项举措,评判成效与不足,建议从推进医疗、医保、医药三医联动,探索药械采购新机制,建立医疗服务价格动态调整机制,探索医疗服务价格管理新机制,加强医疗服务监管等方面进一步深化公立医院综合改革。     

医疗服务特殊性假设与行政管制推论的逻辑关系分析

信息不对称和价格低弹性作为医疗服务的两大特性,是政府对公立医院行政管制的两大依据.文章重点分析信息不对称和价格低弹性两个假设的真实性,并探讨举办服务和行政管制推论的合理性,然后提出治理信息不对称和价格低弹性及医疗服务市场失灵的可行路径.     

北京市公立医院法人治理结构改革的外部环境分析

从公立医院法人治理结构改革的市场环境、筹资支付系统和政府监管三方面探讨改革的动力和阻力。动力来自社会需求、医药卫生体制改革的目标和发展方向及医疗服务市场的完善,阻力来自于公立医院所处的市场地位,优质资源的不足和尚未理顺的管理体制和机制。     

基于垄断分析的医疗机构管理体制改革

我国医疗服务垄断包括市场垄断和医疗服务产品垄断两种形式。医疗服务垄断带来医疗资源利用效率下降和医疗费用上升,导致“看病难、看病贵”。打破医疗服务市场主体垄断的方法是引入竞争,对处于垄断地位的大型国有医院进行管理体制改革;而解决医疗服务产品垄断问题,则要完善医药流通体制,以降低药品价格、改变“以药养医”的局面。     

公立医院国际医疗服务价格行为管理政策分析

为改善本地高层次引才引智、营商和生活环境,多个省份的公立医院成立国际医疗部。本文在梳理国家层面国际医疗及其价格行为管理政策、典型地区公立医院国际医疗服务对象定位与价格政策的基础上,对部分公立医院国际医疗服务自主定价项目与收费标准进行了调查,获得了加强公立医院国际医疗服务价格管理的启示：公立医院按所属医疗保障行政部门批复价格项目提供国际医疗服务,国际医疗部医疗服务价格项目执行自主定价,公示并备案。     

利用竞争作为政策工具推进公立医院改革

市场配置医疗卫生资源不等同医疗市场私有化,其核心是引入竞争机制。医院竞争不仅存在于不同产权医院间,公立医院内部也可引入竞争。促进公立医院＂内部竞争＂的公共政策可充分发挥市场机制作用。由于医疗市场存在特殊性,竞争可能产生正面或负面影响。为取得预期效果,在促进竞争的同时,决策者需要科学设计政策环境,对公立医院竞争进行驾驭。加强管制、权利下放和信息发布三者并重将是现阶段利用竞争作为政策工具推进中国公立医院改革的关键。     

Privatization of local public hospitals: effect on budget,medical service quality,and social welfare

We analyze a duopolistic health care market in which a rural public hospital competes against an urban public hospital on medical quality, by using a Hotelling-type spatial competition model extended into a two-region model. We show that the rural public hospital provides excess quality for each unit of medical service as compared to the first-best quality, and the profits of the rural public hospital are lower than those of the urban public hospital because the provision of excess quality requires larger expenditure. In addition, we investigate the impact of the partial (or full) privatization of local public hospitals.     

科学配置医疗资源 提升卫生服务能力

在分析了南京市科学配置医疗资源的现状与实践的基础上,总结了提升卫生服务能力所面临的困难和挑战。在推进改革的进程中,南京市从修订医疗机构设置规划入手,优化卫生资源配置,引入竞争机制,推动城区二级医院转型;通过创新驱动,实施"三名战略",提高医疗卫生整体服务水平;通过加强基层医疗卫生服务、公共卫生和应急能力建设,关口前移,重心下沉,打造"十五分钟健康服务圈",探索公立医院运行机制改革的新思路。     

基于健康保障责任的县级医院综合改革思路探讨

从健康保障出发,县域的医疗服务需要由县域医疗服务体系承担,其中,县城医疗服务体系主要由公立医院组成.县政府通过县域医疗服务体系管理公立医院,由此确定相应的投入责任和管理体制.在医疗服务体系的管理下,外加医疗保险及新农合对医院医疗费用的管理,县级医院依据外部环境和条件,构造内部管理体制.当前县级医院管理体制改革中存在两个关键问题:一个是农村基层医疗卫生机构(乡镇卫生院和村卫生室)在医疗服务和预防保健服务上的连体问题:另一个是在经济上调整医患双方利益问题,解决这两个问题将有利于推进县公立医院综合改革.     

Re-forming medical delivery systems: economic organization and dynamics of regional planning and managed competition

This paper compares structural components of medical delivery in two major systemwide reform strategies in the United States. Commonly portrayed in terms of opposing ideologies of planning vs. market reform, regional organization and managed competition have promoted similar structural elements and geographic configurations. They both support growth of institution-based specialized teams and hospital consolidation. They both differentiate hospital care into vertically integrated levels, and develop regions as the key production and market area for organized delivery systems. System-wide management or regulation in each has tried to control allocation of resources, capital investment, and competition. Developed in the context of large-scale industrial production, these components have inherent economic dynamics and together they shape the market structure of medical care. The final section briefly considers the locus of power in the two reform approaches and the implication for choosing mechanisms of reform. It also notes that despite their rhetoric, the two strategies do not shape their services according to information about population benefit. The conclusion points out that the commonalities in structure and power demonstrate the dominance of economic organization in medical reform and contribute to the wide acceptance of this business form of organization as an international model.     

树立全新经营理念实现县级医院可持续发展

建平县医院地处辽西山区,医院的生存环境非常艰难.通过几年的大胆改革和不断创新,笔者深刻地体会到：随着我国医疗卫生体制改革的不断深化,医疗机构形式的多元化导致医疗市场竞争更加激烈,由于市场经济观念的深入,各行各界对经济利益追求达到最大化以及人们对医疗机构片面、过高的期望,使目前存在的患者＂看病难、看病贵＂与县级医院生存艰难的矛盾更加突出.在现有政策环境条件下,树立全新的经营理念,坚持科技兴院的发展原则,实行科学的分配制度,创建人性化的服务模式,是县级医院可持续发展的必然要求.     

Competition's flawed perspective on the health care market and an alternative approach

This article contends that competition advocates have treated the public market as peripheral to the development of a private allocative efficient market based on price determinations. A system which omits 40% of distributive resources, 30% of its users and over 50% of hospital revenues sets the stage for cost/charge spirals that promote greater inefficiencies than those which presently exist. The government in the sixties set a goal of universal quality service for medical care. However, this goal has not been achieved and the sky-rocketing cost for medical care is putting an increasing burden on the government. The authors attempt to provide a basis for the incorporation of the concept of the mixed market through a definition of public and private reimbursement systems. The public sector, rather than paying directly for care, purchases it in an efficient market which it helps to form. The government working with other health insurance companies in the private market attempts to set reasonable charges for reimbursement for medical services. Any price above the competitive level will be paid directly by the consumer. However, quality care is guaranteed to the consumer at the reasonable charge by insurance company referred physicians.     

基于患者群市场细分的医疗市场营销策略

随着医疗市场竞争日益剧烈,医疗服务需求日趋多样化,越来越多的市场营销理念和策略被引入到医疗行业。笔者以患者到医院就诊的状态为标准对医院患者群进行细分,并针对各细分市场,采取不同的营销策略。     

社区卫生服务的营销组合及其策略

社区卫生服务是由政府主导兴办、其它力量参与的一种基层卫生保健服务，具有较强的公益性，但是也需要参与日益激烈的医疗市场竞争。因此，要想获得一席之地并得到持续发展，就必须逐步提高市场和服务意识，通过进行营销组合及其实施策略，最终赢得患者的青睐和再次消费。     

Hospital Health Care: Pricing and Quality Control in a Spatial Model with Asymmetry of Information

The cost of hospital care depends on the quality of the service, on the personal characteristics of the patient, on the effort of the medical staff and on information asymmetry. In this article the cost minimizing properties of alternative payment systems will be discussed in a context where hospitals can observe patient severity and compete according to the rules of Hotelling's spatial competition. The scheme is designed from the standpoint of a purchaser that sets up a contract with several providers for services of a given quality at the least possible cost. Patients' severity cannot be observed and quality cannot be verified, but the latter can be inferred through the choice of patients. The model shows that in the health care market, prospective payments and yardstick competition are weak instruments for cost containment; incentive compatible schemes are, at least from a theoretical point of view, better instruments especially in a context where the purchaser can use signals relating to the variables it cannot observe. Cost inflation has two components: the information rent paid to the provider and inefficiency. In our model the information rent is used by the provider to get more patients to his hospital; spatial competition can then be used to curb the cost of providing hospital care. JEL classification: I110, I180, D820     

我国港澳地区医疗券制度及其对内地的启示

引入市场竞争机制是医疗体制改革的重点和难点。我国港澳地区的医疗券制度能够为内地推进医改体制创新、倒逼公立医院改革和合理配置医疗卫生资源提供借鉴。本文首先介绍了医疗券制度的起源和发展。然后详细阐述了港澳地区医疗券制度的实施背景、异同与政策效果,发现医疗券制度在引导需方更多使用私立医疗服务、提高居民预防保健意识、推广家庭医生制度等方面起到了积极作用。最后对医疗券制度在内地的适用性进行了分析,指出其与内地医改导向相契合,并可作为内地医保制度的有益补充和推动社会办医的有效措施,在完善内地医疗保险、医疗救助制度和发展私立医疗机构等方面具有一定的可行性。