当代中国医疗服务公私合作研究

【作者】 陈龙；

【导师】 崔运武；

【作者基本信息】 云南大学 ， 行政管理， 2013， 博士

【摘要】 文章研究医疗服务公私合作(Public-Private Partnerships, PPP),旨在为医疗服务改革提供一种新的社会资本办医途径。目前,世界各国都面临着医疗卫生融资、管理和供给的挑战。2009年,中国新一轮医改拉开序幕,新医改的指导原则是“注重发挥市场机制作用,动员社会力量参与,促进有序竞争机制的形成,提高医疗卫生运行效率、服务水平和质量,满足人民群众多层次、多样化的医疗卫生需求。”这一原则体现了政府医改的基本方法和思路,即政府主导,发挥市场机制作用。PPP是基础设施改革和服务提供的一个工具,是公共服务供给更多依赖社会资本和私人部门的一种供给模式。公私合作是公共部门与私人部门为提供公共服务而建立起来的各种协议和长期合作关系。各国PPP的实践经验说明,通过PPP,可以吸引社会资本参与到医疗服务供给中来,弥补财政投入的不足,同时引进私人部门的专业技术和管理经验来提高服务质量和效率,转移经营风险,实现资金的最佳使用价值,此外,政府还可以通过改革重新定位角色,理顺激励机制和监管机制。在过去的二十年里,我国民营化改革有了巨大发展,政府开始认识到仅仅依靠政府办的公立医疗机构无法满足公众多样化的医疗服务需求,而市场却能发挥其“看不见的手”的作用。近几年来,中国各地医疗服务领域出现了不少PPP案例,例如业务外包、特许经营和私有化,但系统地从PPP视角对公立医疗机构改革进行研究的成果并不多。2008年,云南省昆明市开始探索新的社会资本办医模式,这种模式被当地政府称为“改制重组模式”,即政府与企业合作办医。这种政企合作模式对中国医疗服务PPP而言,具有很高的研究价值。目前,中国的医疗服务PPP处于起步阶段,一方面没有成熟的经验可循,另一方面在法律上还缺乏支撑。因此,本文首先研究国外医疗服务PPP的基本现状和经验,整理医疗服务PPP的一般运行规律,通过案例研究总结其对中国的启示。其次,研究我国医疗服务PPP的探索案例,其中又以云南省昆明市的案例为主,分析其改革的动因和取得的成效,总结中国医疗服务PPP的特点、关键成功因素和存在的问题。最后,通过将PPP的基本理论与中国实际国情相结合,建构出中国医疗服务PPP的基本框架和途径,并提出政策建议,供决策者参考。更多还原

【Abstract】 This paper of Public-Private Partnerships in health aims to provide an innovative way to encourage and guide social capital to sponsor health care undertakings for the health care reforms. Many governments are confronted by the challenges in healthcare finance, management, and provision. In2009, the Chinese government kicked off a new round of health care reforms. One of principles of the reforms is that we should emphatically give full play to the role of market forces, call on social participation, promote the formation of orderly competition mechanism, upgrade operational efficiency, service level and quality of the health care system, and satisfy the people’s multi-layer and diversified demands for health care services. Combining government’s leading role with the role of market forces is the core strategies for the reform. PPP is one tool available to decision makers in reforming infrastructure or service delivery, and initiative to try and create a greater reliance on the private sector to deliver public service.PPP, namely each kind of agreement and long-term cooperation relations established in the process of public sector working with the private sector to provide public good and the service. Experience shows that PPP contracts can attract private capital investment (as a supplement for public financial), transfer risk, increase efficiency, make value for money, and reform health sectors through a reallocation of roles, incentive, and regulatory. Over the past two decades, privatization reforms in China have generated remarkable growth. During this period, the Chinese government has been promoting health service reforms to meet the healthcare needs of diverse populations associated with shift to the market-driven economy. Recent years some cases of PPP in health in China have come to the stage, such as contracting out. concession contracts and privatization. However, there were little of the researches of reform by PPP perspective.In order to encourage and guide social capital to sponsor health care undertakings, a new model called Gaizhi Chongzhu (joint-stock reform of a public hospital) has been used in Kunming in2008. This government-enterprise cooperation model is worth studying for PPPs in health in China. Two problems that hindered the implementation of PPP in health in China were the lack of experience and legal support at present time. Therefore, this paper introduces and defines PPPs and their context within health in various countries firstly, and offers implications for China. Secondly, it provides an overview of the topic and key types of PPPs in practice in China (especially cases in Kunming), the associated motivation and benefits, key success factors and problems. Finally, this article describes a PPP framework and policy recommendations associates with designing and preparing a PPP project that will attract bidders for policy maker.更多还原