公立医院改革中几个难点问题的思考

公立医院改革是医药卫生体制改革的重点和难点。虽然新医改明确了公立医院要回归公益性的改革方向,但在改革的具体操作上仍然存在一些困惑,这也是公立医院改革进展缓慢的重要原因。改革试点城市中的绝大部分将"改革公立医院管理体制和法人治理机制"作为切入点,认为管理体制改革是公立医院回归公益性的前提。事实上,导致公立医院公益性丧失的因素是多方面的,诸如公立医院医疗服务的"逐利"行为、大型公立医院对"分级而治"的抵制、大型公立医院的无限扩张等,而剖析和厘清这些因素形成的深层次原因,才是公立医院改革取得成功的基础。

Reflection on several difficulties in reform on state-owned hospitals.

Reform on state-owned hospitals is the focus and difficulty in health system reform.It has been directed by the new health care reform that state-owned hospitals should return to the nature of public welfare.However,some difficulties still exist in operations,which is the vital reason for the slow progress of reform on state-owned hospitals.Most pilot cities take "reforming management system and corporate governance mechanism of state-owned hospitals" as the start point,and believe that management system reform is the prerequisite for state-owned hospitals’ returning to public welfare.In fact,many factors will result in the absence of public welfare,such as profit-driven medical services,boycott to rule by classification,and infinite expansion of state-owned hospitals.Based on analysis of these factors,reform on state-owned hospitals can be achieved.