区域卫生规划政策实施效果不佳的制度经济学解释

区域卫生规划政策实施效果不佳有着深刻的制度原因:首先,我国现行政府结构以及与医疗机构的关系符合“官僚多元主义国家”的特征,卫生主管部门与医疗机构之间形成的特殊利益关系决定了它们没有动力执行限制医院发展的规划;其次,医疗服务品质考核的复杂性,决定了患者、医生和医疗机构重视标志医疗质量的“代理变量”,如追求先进设备和医疗技术等,在医疗市场竞争的压力下形成了独特的医疗军备竞赛,突破区域卫生规划是市场竞争的必然结果之一;第三,区域卫生规划的核心是政府对医疗资源市场准入的管制,管制容易导致腐败,在区域卫生规划缺乏公正和公开的程序时,管理者被俘获也是符合逻辑的结果。由此可见,在中国目前这种医疗市场、补偿机制以及卫生管理体制下,区域卫生规划实施效果不佳主要是制度原因。

Economic Explanation to the Failure of Regional Health Planning in China

As a critical policy on health reform in China, The Regional Health Planning has been introduced and practiced in conceptual framework and pilot implementation since late of 1980s and it has been initiated all over China since 1999. Nevertheless, the effectiveness of the policy has not been assessed systematically. This paper indicates that the goals of Regional Health Planning is not realized in terms of the flows of the patient visits and hospital admission, flows of the National Health Expenditure and health fiscal subsidies as well as the goals of control on the hi-tech medical equipment in hospitals.