医院公有制“国有民营”模式的可行性研究

医院实行“国有民营”的内涵是公有制医院在保持所有制不变，医院仍为国家所有的情况下，建立国有医院和政府之间的专业投股机构或医院管理公司，避免政府直接提供卫生保健服务，医院则自主经营，实现所有权与经营权分离。这种模式的特点是保持公有制不变，通过非政府组织实现国家所有权，而不是实行私有化。作者借鉴国外经验，参照企业改革走过的路。总结回顾过去医院改革的经验和教训，提出公立医院“国有民营”的模式，并进行粗浅的可行性分析，以供同行共同研究。     

WTO规则与国有医院"两权分离、国有民营"改革

长期以来，我国的国有医院实行的是国家所有、国家经营，这种办医方式使国有医院无法实行自主经营、自负盈亏、不能作为独立的法人实体和竞争主体参与市场竞争。为此，面对我国入世形势下医疗服务业的逐步开放，笔者就国有医院的产权制度改革提出以治理结构变革为主要内容的“两权分离、国有民营”这一概念。“两权分离”即指医院财产的所有权和经营权的适度分离，最终变革的思路是国家终极所有权和医院法人所有权分离，国家只对国有资产拥有终极所有权，国有医院拥有法人所有权并与经营权两权合一，成为真正的法人。“国有民营”是指在国家享有医院财产终极所有权，保持对国有医院控制力的前提下，在医院性质、职能、隶属关系和国家对非营利性医疗机构的各项优惠政策不变的基础上，国有医院通过采取民营的方式进行经营管理。“两权分离”是前提，“国有民营”是核心。“两权分离、国有民营”改革具有现代企业制度的基本特征，简而言之，就是法人财产制、法人治理结构和有限责任制。     

医院引入“国有民营”机制的思考

医院引入“国有民营”机制的思考陕西省安康地区中医院（７２５０００）李胜伦＂国有民营＂原是企业改革的一个有效措施，近年来虽未明确提出医院国有民营，但实际上已在不自觉中将这一机制引入了全民所有制医院管理之中，它主要表现在以下几个方面：①将科室承包到个人或...     

医院改制的定义与模式探讨

目前有一种说法，公立医院改制可引入社会资本，但仍维持非营利医院的性质，即所谓“国有民营”。“国有民营”是一个新名词，可以理解为不改变国有资产的属性而将医院整体或部分交由社会资本经营、管理，国有资产所属方对社会资本的保值增值有一系列的考核指标，同时社会资本对医院的经营、管理享有充分的自主权。     

对乡镇卫生院公有民营改革的探讨

1　乡镇卫生院公有民营的概念与特征1.1　概念公有民营 ,简而言之是所有权属公家 (国家和集体 ) ,营运权属个人。公有民营卫生院是将若干管理权和责任下放经营者 ,由其自主经营、自我发展、自负盈亏 ,不涉及所有制形式的改变。也有人称之为“国有民营”和“公退民进”。笔者认为 ,“公有民营”更为贴切。第一 ,“公有”的范围较“国有”大 ,既包括全民所有制卫生院 ,又包括集体所有制卫生院 ,还包括混合所有制中的国有成份和集体成份。第二 ,卫生院现有资产既有历年各级政府的投入 ,又有卫生院几代职工的劳动积累 ,特别是有的卫生院低分配、…     

口腔医疗卫生保健模式改革与发展的探讨

目前，国家允许社会和民营资本进入医疗卫生服务领域，部分地开放了境外的口腔医疗服务进入国内市场，使民营、外资医疗机构和公有制为主体的国有医疗卫生机构竞争、互补，满足人们对口腔卫生保健日益增长的需要。     

对乡镇卫生院试行国有民营几个问题的认识

为适应社会主义市场经济体制,有些地区对一些乡镇卫生院试行国有民营的经营模式,这是转换经营机制的尝试。笔者就以下几个问题提出个人管见,供同道参考。 一、国有民营的内涵界定 国有民营的基本思路是借鉴企业经验,坚持所有权与经营权分离,明晰产权关系,划分产权责任,转换经营机制的一种尝试,它能增加职工风险意识。“国有”意味有四不变:固定资产如房屋设备     

医院转制问题新思考

在我国向社会主义市场经济转型的过程中,国有医院暴露出的低效率已是不争的事实.在以产权改革为核心的医院体制改革中,我国目前主要有两种模式即国有民营和民营医院.文章探讨了所有权与经营权分离的国有民营模式,分析了转制前后政府对民营医院发展的政策导向.同时看到了在转制过程中人力资本的产权问题,并对红包、兼职现象进行了非传统意义上的解释.最后,我们还试图解释国外私立非营利性医院存在的合理性,从中给我国国有医院转制道路提供新思考.最后结合我国<关于深化城市医疗体制改革试点的指导意见(讨论稿)>进行讨论.     

破茧成蝶树丰碑--从西安唐城医院看民营医院的生命力

12年前，全国第一家“民营控股、国有参股”的股份制非营利性医院--西安唐城医院正式挂牌。12年后，这家医院一跃发展成为西安地区实力最强的二级甲等医院、西安地区最大的颇有影响力和竞争力的综合性平民医院！12年，弹指一挥间，但对于唐城医院来说，却是12载的厚德载物，12载的春华秋实，并成功实现了“破茧成蝶”般的华丽转身。     

浅议加入WTO后政府对医院管理职能的转变

加入世界贸易组织后 ,我国医院将更加严格按照国际规则办事 ,医疗市场将进一步对外开放 ,医院面临着医疗市场、医疗质量、人才流失等方面的挑战 ,而目前我国的医院管理体制与西方国家相比存在较大的差异 ,一定程度上制约了我国医院的发展 ,我国政府急需转变对医院的管理职能 ,给予医院广阔的发展空间 ,从而使我国医院在国际市场中更具有竞争力。1　现阶段我国政府对医院的管理模式及不足1.1　与西方国家相比有差异 ,西方国家的医院大都采用了“国有民营”和“医院自治”的管理体制 ,医院是自主经营、自负盈亏的经济实体 ,享有很大的自主权 ,…     

论国有医院产权形式多样化的实现条件

论述阵有医院产权形式多样化的五个实现条件：（１）政府和医院的关系。企业与企业医院的关系改变为市场经济下的平等协商关系；（２）确保国有财产神圣不可侵犯；（３）必须建立以非本院职工社会代表为主体的董事会，医院决策权必须同执行权分离；９４）政府对医院的社会公益性服务要予以扶持和资助，医院继续承担社会福利载体的功能；（５）改革劳动人事制度。     

在多种选择中实现企业医院社会化

企业医院与母体企业分离，实现社会化运作，是国有企业改革的即定目标之一。如同当初企业办社会、建医院是实行计划经济的产物一样，今天提出企业医院社会化的问题也是发展市场经济的内在要求。企业医院社会化不是简单地由企业举办转为地方政府举办，而是需要全新的思路，在多种选择中实现企业医院社会化。     

Housing tenure as a focus for reducing inequalities in the home safety environment: evidence from Growing Up in New Zealand

Objectives: To determine whether specific demographic characteristics are associated with the presence or absence of household safety strategies. Methods : This study was conducted within Growing Up in New Zealand, a contemporary longitudinal study of New Zealand (NZ) children. Multivariable analyses were used to examine the maternal (self‐prioritised ethnicity, education, age, self‐reported health) and household (area‐level deprivation, tenure, crowding, residential mobility, dwelling type) determinants of household safety strategies being present in the homes of young children. Results : In comparison to family‐owned homes, privately owned rental homes were less likely (OR=0.78; 95%CI 0.65–0.92), and government‐owned rental homes were more likely (OR=1.74, 95%CI 1.25–2.41) to have eight or more household safety strategies present. Conclusions : Living in a privately owned rental home in NZ exposes children to an environment where there are fewer household safety strategies in place. Implications for public health : Housing tenure provides a clear target focus for improving the household safety environment for NZ children.     

Back to the market: yet more reform of the National Health Service.

Yet more reform of the National Health Service in England has been announced by the Department of Health. In opposition, the Labour Party criticized the creation of an "internal market" for health care by the Conservative government, but five years into the Blair administration, market incentives are to be reinvigorated and the private sector is to be embraced in ways not seen hitherto. New guidance signals the introduction of competitive contracting using cost-per-case currencies, more choice for patients in where they will receive hospital treatment, and the freeing of NHS care providers from the direct political control of ministers. It is intended that the monopolistic features of the NHS in England should give way to greater pluralism, in particular through contracts with privately owned health care organizations. However, there is little evidence to suggest that these policies will be effective, and a number of practical problems may obstruct implementation.     

当前我国医院产权资本经营理论和实践上的误区

文章通过对我国当前在医院产权资本经营方面所存在的公立医院产权主体多元化、盲目私有化、产权资本规模经济、投机产权资本经营、主体错位等理论和实践上的误区的分析,提出了正确理解医院产权资本经营的作用,使医院产权资本经营动机理性化;以长期发展为战略指导,规范产权资本经营行为;从政策的角度杜绝公立医院产权主体的多元化,并保持一定数量的公立医院数;建立政府引导型管理模式的对策.     

Japanese hospitals--culture and competition: a study of ten hospitals

Japanese health care is characterized by a pluralistic system with a high degree of private producers. Central government regulates the prices and the financing system. All citizens are covered by a mandatory employment-based health insurance operating on a nonprofit basis. The consumer has a free choice of physician and hospital. A comparison between Japan, Sweden and some other countries shows significant dissimilarities in the length of stay, number of treatments per hospital bed and year and the staffing of hospitals. About 80 per cent of the hospitals and 94 per cent of the clinics are privately owned. The typical private hospital owned by a physician has less than 100 beds In this paper, data collected (1992/93) in an empirical study of Japanese hospitals and their leadership is presented. Also discussed are the hospitals' style of management, tools and strategies for competition and competences—personal and formal skills required of the leadership in the hospital There follows a study of ten hospitals, among which hospital directors and chief physicians were interviewed. Interviews are also made with key persons in the Ministry of Health and Welfare and other organizations in the health care field. The result is also analysed from a cultural perspective—‘what kind of impact does the Japanese culture have on the health care organization?’ and/or ‘what kind of sub-culture is developed in the Japanese hospitals’. Some comparisons are made with Sweden, USA, Canada and Germany. The different roles of the professions in the hospital are included in the study as well as the incentives for different kinds of strategies — specialization, growing in size, investments in new equipment, different kind of ownership and hospitals. Another issue discussed is the attempt to uncover whether there is an implicit distribution of specialities—silent agreements between hospitals, etc.     

Legitimacy, trustee incentives, and board processes: the case of public and private non-profit nursing homes

Using a unique data set, this study explores how type of ownership (government/private) is related to processes of governance. The findings suggest that the neo-institutional perspective and the self-interest rationale of the agency perspective are helpful in explaining processes of governance in both government- and privately owned non-profit organizations. Due to adverse incentives and the quest for legitimacy, supervising governance bodies within local government-owned non-profit institutions pay relatively less attention to the development of high quality supervising bodies and delegate little to management. Our findings also indicate that governance processes in private institutions are more aligned with the business model and that this alignment is likely driven by a concern to improve decision making. By contrast, our data also suggest that in local government-owned institutions re-election concerns of politicians-trustees are an important force in the governance processes of these institutions. In view of these adverse incentives - in contrast to the case of private organizations - a governance code is unlikely to entail much improvement in government-owned organizations.     

Effects of competition on hospital quality: an examination using hospital administrative data

This paper investigates the effects of competition on hospital quality using hospital administration data from the State of Victoria, Australia. Hospital quality is measured by 30-day mortality rates and 30-day unplanned readmission rates. Competition is measured by Herfindahl–Hirschman index and the numbers of competing public and private hospitals. The paper finds that hospitals facing higher competition have lower unplanned admission rates. However, competition is related negatively to hospital quality when measured by mortality, albeit the effects are weak and barely statistically significant. The paper also finds that the positive effect of competition on quality as measured by unplanned readmission differs greatly depending on whether the hospital is publicly or privately owned.     

衡阳市村卫生室建设及村医培养现状调查

村卫生室是解决广大农村居民健康问题的第一道防线.通过座谈与问卷调查的方式对湖南省衡阳市120个村卫生室进行了调研,内容包括农村卫生室的所有权、业务开展、资金投入、乡村医生执业资格与职称、乡村医生的工作满意度及培训等情况.结果发现,衡阳市村卫生室主要为私人所有,仅能开展简单业务,资金投入严重不足,乡村医生职称晋升渠道不畅,工作满意度差,主要以接受短期培训为主.针对上述问题,政府应重视村卫生室建设及村医培养,加大政府投入和管理力度,完善相关法规与制度,努力推进我国农村卫生状况的整体改进.     

A case for government ownership of primary care services in New Zealand: weighing the arguments.

Primary care services provide continuing and coordinating care, cater to most health care needs, and serve as a point of first contact with the health system. This article addresses the issue of government ownership of primary care. Ownership confers governance responsibility (ultimate control) for an organization, and accountability for its actions. Primary care organizations can be classed as government owned and operated or privately owned and operated, the latter with or without community governance. The authors address two policy questions: Does the ownership form of a primary care organization matter? What ownership frameworks should be used to guide policymaking? Arguments for and against government ownership are examined from political and economic perspectives, informed by a governance framework. Government ownership of primary care may solve problems associated with private for-profit ownership that are related to lack of control of strategic assets, lack of direct political accountability, contracting, and market failure, but it may raise potential problems of lack of responsiveness to minority and local needs and capture by interest groups. In response to the problems associated with government ownership, community-governed private nonprofits have an essential role as a vehicle for indigenous self-determination, catering for minority populations, experimenting with policy options, and providing public goods particularly for minority populations. The authors argue that private organizations that lack community governance have a lesser role.