四川省医院市场结构的变化发展

利用2002—2017年四川省医院机构数据,从市场规模、市场份额和市场集中度方面分析医院市场结构的变化发展。结果:近年来医院数和床位数逐年上升,2002—2017年,医院总数从1 163所增长为2 219所,床位总数从118 593张增长为411 911张;医院数量的变化主要由一级公立医院的减少和一级民营医院增加引起。民营医院市场份额不断增加(2002—2017年床位、门诊服务、住院服务市场占比分别从3.71%、3.08%和3.12%增长为32.10%、17.78%和25.21%),但仍小于公立医院。医院市场竞争保持增大趋势,2017年约1.11%的医院市场处于完全竞争,11.11%垄断竞争,87.78%高度垄断。当前,公立医院继续主导医院市场,在新时代下,医疗供给侧改革的深化应仍然关注公立医院,同时尚有较大空间实施鼓励社会办医和促进竞争的相关政策。

Trends on hospital market structure in Sichuan Province

This paper used administrative data of all the hospitals in Sichuan Province during the period from 2002 to 2017 to analyze the trends in the development of hospital market structure from market size, market share and market concentration. The results showed that the hospital market size is expanding, since the number of hospital and beds increased from 1 163 and 118 593 to 2 219 and 411 911 respectively during the same period under study. But, the change in the number of hospitals was mainly caused by the reduction of first-level public hospitals and the increase of first-level private ones. The trend of the market share development in private hospitals, namely the share of beds, outpatient service and inpatient service, slightly increased from 3.71%, 3.08% and 3.12% to 32.10%, 17.78% and 25.21%, respectively, but it is still lower than that of public hospitals. The market competition in the hospitals became more intense, but in 2017, about 1.11% hospital markets were highly competitive, 11.11% moderately concentrated and 87.78% highly monopolized. At present, the hospital market is still dominated by public hospitals, indicating that governments should still focus on public hospital reform. Besides, the present degree of privatization and hospital competition is relatively low. Therefore, it is suggested that China should encourage the private hospitals establishment in order to promote the hospital competition, if this could generate positive results in hospital market. Additionally, there is large space for the implementation of policies that should encourage social education and promote the targeted competition.