制度变迁视角下完善医师多点执业的思考

作为促进医师流动、优化卫生资源配置的重要举措,多点执业被寄予厚望,但实践中多点执业却遭受冷遇。从制度变迁视角来看,遇冷的根本原因在于既有制度和思维中存在的路径依赖：首先,政府管制体制具有强大的制度惯性将医师锁定在医院中,医师多点执业的合法性与合理性并不统一。其次,医院之间竞争的白热化,多点执业对于医院和医师责权利分配格局统一性的挑战使医院对多点执业冷淡。再次,思维观念中的求稳倾向与追求利益的欲求,使医师对多点执业采取观望态度。因此,多点执业的制度变迁需要加快政府制度创新,为多点执业解锁,实现合法性与合理性的统一;转变医院运行逻辑,扼制逐利动机,推行多点执业契约管理;转变医师思维模式,正视医师利益需求,构建多点执业激励机制。

Thoughts on improving the multiple-site physician practice from the perspective of institutional change

As an important policy, the multiple-site physician practice system is expected to promote the flow of physicians and optimize the distribution of health resources, though it is difficult to enforce in practice. From the perspective of institutional change, the fundamental reason lies in path dependence existing in system, organization and mindset: First, the government regulation system has a strong inertia to restrict the flow of physicians, and the multiple-site physician practice lacks the unity of legitimacy and rationality. Secondly, fierce competition between hospitals and the distribution pattern of rights and responsibilities between hospital and physician cause the hospitals to oppose multiple-site physician practices. Third, the stability tendency in mind and the desires for profit restrain the flow of physicians. Therefore, the institutional change of the multiple-site physician practice requires improvements in three aspects: the innovation of government systems to unlock the multiple-site physician practice must be accelerated to realize the unity of legitimacy and rationality; a change is needed in the operation logic of hospitals to control the profit incentives and management of practices by contract; the thought-pattern of physicians must be changed to confront the proper demand for interests and build innovative incentive mechanisms.