【作者】 陈蓉；

【导师】 石柏林；

【作者基本信息】 湖南大学 ， 经济法， 2013， 博士

【摘要】 民营医疗机构是指自然人、法人或其他组织以民间全资或控股形式在我国境内依法设立，自主经营、自负盈亏、自担风险，从事疾病诊断、治疗活动为宗旨的医院、个体诊所等一系列机构的总称。依据经营目的不同，其分为营利性医疗机构和非营利性医疗机构。民营医疗机构作为非公有制经济的组成部分，属于社会主义市场经济的重要组部分而非补充部分，其与公立医疗机构在宪法上应具有平等法律地位。然而作为行政相对人，其与卫生行政部门处于不平等地位。民营医疗机构与政府是规制对象与规制者的关系。与公立医疗机构相比，其处于弱者地位，民营医疗机构的弱者地位导致其市场准入受阻。因此，应在权利配置上予以倾斜，对其实行特别保护。当前，我国民营医疗机构作为独立的民事主体可以股份制、股份合作制、合伙、个人独资等形式设立。民营医疗机构的法律地位应依据其法律组织形式确定，而不应依据其所有制形式或经营目的确定。由于立法至今未对“非营利性”的含义作出界定，同时又将法人型民营非营利性医疗机构界定为“民办非企业单位”，使其无法划归到现有四类法人类型中，这成为制约其市场准入和发展的瓶颈。民营医疗机构市场准入制度是指国家对具备法定执业条件的民营医疗机构，依一定程序许可其进入或退出医疗市场形成的一系列制度和规范的总称。这一制度具有准入目标的双重性、准入依据的法定性和准入方式单一性的特征。当前，民营医疗机构实行市场准入制度，这是因为健康权是公民的一项基本权利，是实现公民其他基本权利的核心和基础。医疗服务的可供性和可及性是保护公民健康权的两个重要条件。而尊重、保护和实现公民健康权是宪法赋予政府的职责，也是政府维持政治统治职能的基本要求之一。近年我国医疗事业虽迅速发展，但医疗服务供给仍无法满足消费者多元化的医疗需求。因此，政府有责任增加医疗服务供给，鼓励民营医疗机构市场准入。民营医疗机构市场准入是为了在确保医疗安全前提下，进一步促进医疗事业发展，保证医疗资源公平分配。但民营医疗机构的逐利性与其价值目标之间却存在不可调和的冲突。面对这一冲突，加上医疗市场的外部性、垄断、公共产品供给短缺和信息不对称等市场失灵现象，市场机制无能为力，需要政府干预。而政府干预只是一种手段而非目的。因此，民营医疗机构市场准入的关键不在于是否需要政府干预，而在于应如何把握政府干预民营医疗机构进出市场的范围和力度。因此，政府干预应考虑医疗服务的产品性质、医疗服务供给需求现状、民营医疗机构的应然地位和实然地位、民营医疗机构发展的现实需求、民营医疗机的二元化格局、民营医疗机构的经营目的及其技术诊疗项目等因素；立足于“弥补性”和权力有限性原则；厘清政府与市场的边界，即政府应干预什么、政府应当如何干预。目前，我国民营医疗机构市场准入制度虽初具雏形，但仍存在准入范围不明确、准入条件过于粗糙、准入方式单一、准入程序繁杂、市场退出制度缺失等缺陷。这些缺陷既是政策目标定位偏差所致，也与传统行政管理方式下民营医疗机构市场准入规制越位与缺位、公立医疗机构行政垄断有直接关联，更是现有医疗机构市场准入体制下规制机关规制过度与规制乏力所致。上述缺陷和原因致使民营医疗机构发展不足，规模小且结构单一、所占市场份额小、提供的医疗服务量有限、民营医疗市场秩序混乱以及整个医疗市场竞争不足，医疗机构所有制形式单一。为促进民营医疗机构市场准入，首先应打破束缚民营医疗机构发展的政策桎梏，作出正确的政策目标选择，坚持民营医疗机构与公立医疗机构并重；坚持医疗安全与医疗事业发展并重；坚持从严规制与从宽规制并重。其次，在立法模式上，采用单行法立法模式，制定《民营医疗机构促进法》，对民营医疗机构市场准入实行特别保护，明确其市场准入的相关问题。具体而言，第一，依据医疗产品性质合理界定其市场准入范围。公共产品供给和公共产品生产是两个不同概念，政府供给公共医疗产品并不意味着一定要由其生产公共医疗产品。因此，不仅应允许民营医疗机构进入具有私人产品属性的医疗领域，还可允许其进入具有公共产品属性的医疗领域。对纯粹公共医疗产品，可由民营医疗机构生产，然后由政府通过合同购买的方式提供；对准公共医疗产品，则以政府供给为主，民营医疗机构供给为辅；对具有私人产品性质的医疗服务，则可由民营医疗机构生产并提供。第二，完善民营医疗机构准入条件。就国内民营医疗机构而言，应不断丰富其法律组织形式，引入医疗法人制度，删除“能够独立承担民事责任的单位”的提法；依据其法律组织形式，规定其设立时的必要经费数额；增加“良好信誉”作为其准入条件等；对港澳台自然人在内地短期执业的次数和申请延期的具体期限作出限制，完善其注册程序；允许“自然人”成为中外合资合作医疗机构的中外双方投资主体，建立多种类型的医师注册制度。第三，依据民营医疗机构市场准入范围及其执业设置标准的不同、申请人是否为医师等因素，确立行政许可主义和严格准则主义并行的准入方式。第四，完善市场准入体制。重塑独立、专业、中性的准入规制机构，构建多元化、多层级的市场准入规制机制，转变政府职能，克服市场失灵。第五，简化并规范准入程序，完善准入救济措。同时，完善市场退出制度，明确市场退出的条件及其法律责任；完善市场退出程序，建立市场退出预警机制，强化其市场退出的后续监管。更多还原

【Abstract】 Private medical institution refers to a series of institutions, which are set up bynatural person, legal person or other organization, in the form of folk wholly-ownedor holding form in our country territory, and they manage their own businessindependently, assume sole responsibility for their profits or losses, take risk bythemselves. Private medical institution may be set up in the form of hospitals, clinicsand so on, which are engaged in disease diagnosis, treatment of activities. Accordingto its’ different business purpose, private medical institutions are divided into profitmedical institutions and non-profit medical institutions. As a part of the non-publiceconomy, Private medical institutions should have the equal legal status with thepublic medical institutions in the constitution, both of them are the importantcomponent of socialist market economy rather than supplementary part. However, asthe administrative relative person, it is not equal with the health administrativedepartment. As far as private medical institutions and government are concerned, theybelongs to regulation relationship.Compared with the public medical institutions,private medical institutions are in the weak status. The weak status of private medicalinstitution makes it be hampered in the market access.Therefore, we should be tiltedin the right configuration, to implement special protection.At present At present, private medical institution in China as an independentcivil subject can be set up in the form of share-holding system,share cooperativesystem, partnership, sole proprietorship.Therefore, legal status of the private medicalinstitutions should l be determined according to its’ legal organizational form, andshould not be base“non-profit” has not been determined by legislation, in themeantime, private non-profit medical institutions is defined as “private non-enterpriseunit”, which causes it not to be divided into the existing types of legal persons, andthat becomes the barrier to its market access and development. Market access systemof private medical institution means that a country permits private medicalinstitutions, which has legal practice conditions, to enter or exit the medical market inaccordance with certain legal procedures. This system has such characteristic, accessto the dual target, access based on the legislation, singleness of access mode。Atpresent, the necessity of market access system of private medical institution lies inthat the right to health is a basic right of citizens, which is the core and foundation to realize other fundamental rights of citizens. The medical service availability andaccessibility are two important conditions to protect the right of citizens’ health.However, to respect, protect and realize the right of citizens’ health is government’sliability which is empowered by constitution law, and that is one of the basicrequirements for government to maintain political rule function.Medical career in China has been developing rapidly in recent years, but medicalservice supply is still unable to satisfy consumers’ diversified medical needs.Therefore, the government has the responsibility to increase the supply of medicalservices and encourage private medical institutions’ market access. The value targetof market access to private medical institutions is to ensure medical safety, furtherpromote the development of the medical career, and guarantee the fair distribution ofhealth resources. But the profit-driving of private medical institutions and its valuetarget have irreconcilable conflicts. Faced with this conflict，at the same time, medicalmarket has market failure phenomenon, such as externality, monopoly,shortage ofpublic products supply and asymmetric information, the market mechanism is unableto overcome market failure, which needs government’s intervention. But thegovernment intervention is only a means rather than purpose. Therefore, the key ofprivate medical institution’s market access is not whether we need governmentintervention, but how we grasp the degree of government intervention in privatemedical institution access or exit the market, namely we should clarify the boundarybetween the government and the market. Therefore, government intervention shouldconsider such following factors, the nature of medical service, medical servicesupply and demand conditions, private medical institution’s status in the law and inthe practice, development of private medical institution, the dualistic character ofprivate medical,private medical institution business purpose and technology ofdiagnosis and treatment project. Government intervention is to make up market failure,and its’intervention should be limited to the frontier of power. And governmentshould know what to intervene and how to intervene.At present, market access of private medical institution in China has embryonicform, but there are still many failures,such as access scope is not clear, accessconditions are too rough, general,access mode is single,access procedures arecomplicated, market exit system is not set up,and so on.These defects are not onlycaused by policy target deviation, but also related with public medical institutionadministrative monopoly and traditional administrative mode,which leads to marketaccess regulation offside and absence.And these defects also have related with existing medical institution market access system, which leads to regulation authorityexcessive regulation and regulation deficiency. Due to the above defects and causes, itresults in that private medical institution is in small scale and structure single,market share is small, medical service provision is limited, private medical market isin disorder and the form of medical institution ownership is single.Therefore, in order to promote market access to private medicalinstitutions,firstly, we should break the policy shackles of private medical institutiondevelopment, adhere to equal emphasis on private medical institution and publicmedical institution, pay equal attention to medical security and medical development,adhere to strict regulation and light regulation.Secondly, in the legislative mode, weshould learn from foreign experience to adopt single legislation mode, enactpromotion Law of private medical institution, and implement special protection forprivate medical institution market access.Specifically speaking, first of all, according to the nature of medical productsdefines the scope of market access reasonably. For public health products and quasipublic health products, they can be produced by the private medical institution, andthen provided by the government through the way of contract purchase. For privatemedical health products, we can completely allow private medical institution toproduce and provide for consumers. Because public products production and publicproducts supply are two different concepts. Although public medical products areprovided by government,and it seems reasonable.However it does not mean thatpublic health products must be produced by the government. Private medicalinstitution can have access to the medical field of both private products and publicproducts.Secondly, to improve the access conditions of private medical institution. As forprivate medical institutions in China, we should continue to enrich its’ legal forms,adopt medical legal system, delete the provision that private medical institutionshould be able a unit to assume civil liabilities independently. we should decide its’necessary funds for the establishment on the basis of the legal forms, increase "goodreputation" as one of its’ access conditions.As for natural persons in Hong Kong,Macao and Taiwan, when they provide medical service in the mainland as a short-termservice provider, the number of their short-term practice and specific deadline limitshould be defined, at the same time registration process should be improved. It isallowed that natural person should become investors of both Chinese and foreign inSino-foreign joint venture medical institutions, and establish many types of physician registration system.Thirdly, according to the scope and different standards of practice of privatemedical institutions market access,whether the applicant is a p doctor, to establishaccess ways,which can be administrative licensing and strict norms.Fourthly, to improve market access system. To reconstruct an independent,professional, and neutral regulation organization, to build diversified, and multi-levelmarket access regulation mechanism, to transform government functions andovercome market failure.Fifthly, to simplify and standardize access program and improve access remedyprocedures. At the same time, to improve market exit system. It should be defined theconcept,conditions and legal responsibility of private medical institutions, marketexit.It is necessary to improve market exit procedures, establish market warningmechanism and strengthen the supervision of market exit.更多还原