【作者】 朱炜；

【导师】 朱善宽； 马伟杭；

【作者基本信息】 浙江大学 ， 卫生政策与管理， 2012， 硕士

【摘要】 近30年来,在美国、欧洲以及一些亚洲国家和地区掀起了一场以医院产权制度改革为主要内容,利用社会资本举办医疗机构实现多元化办医的改革浪潮。这些改革的基本原则是引进或加大市场机制在医疗服务领域的作用,起到了提高卫生服务效率,弥补政府资金不足,发挥市场机制优势,改善公共部门运行绩效的积极作用。这项改革举措,也得到了政府的鼓励和支持,并促进了卫生服务公私合作伙伴关系的形成。然而社会资本办医是一项复杂的系统工程,支持者认为可以消除公私并存发展卫生服务体系的障碍,反对者则认为不利于费用控制、影响公平性。随着我国深化医药卫生体制改革的启动,医疗市场的开放度明显增高,社会资本大量进入医疗服务行业,特别是2010年国务院《关于鼓励和引导民间投资健康发展的若干意见》、《关于进一步鼓励和引导社会资本举办医疗机构意见的通知》和新医改的系列文件等都对社会资本办医做出了具体规定。原有单一的政府办医体制的弊端日益显露,如总量供给不足,政府财政投入有限,公立医院之间竞争不足,管理运营效率不高。面对这样的矛盾,出路只能是改革。一方面要研究如何通过政府引导,探索动员社会资本以多种形式参与医疗卫生机构建设；另一方面要研究社会资本办医的体制和机制建设,从税收价格、资源配置、准入制度等方面加强监管。这些社会资办医的具体改革探索,值得深入探讨与研究。本研究提出了社会资本办医中的社会资本概念表述,即除政府资本以外的所有物力资本、人力资本和社会行动力资本的总和,并分析了社会资本办医的理论来源与基础；较全面地叙述了国内外社会资本办医的发展现状、趋势和研究重点,并开展了政策分析研究；重点阐述了社会资本办医面临的内外部环境影响因素,并从价值观、法律制度、市场机制、政治保障、医疗技术、物力资本、人力资源和社会行动力等七个方面提出了社会资本举医的战略思考和政策建议。期望本研究能够形成我国社会资本办医研究的基本框架,并为我国制订社会资本办医政策提供依据。更多还原

【Abstract】 In the last30years, a world-wide reform about hospital property system has been spreading through the US, Europe and some Asian countries. It is a reform trend aims to utilize social capital to establish diversified medical institutions. These reforms with the principle of introducing or strengthening the impact of market mechanism in medical care service, have positive effects on enhancing efficiency of health service, compensating deficiency of government funds, displaying advantages of market mechanism, and improving performance of public sectors. The reform is also encouraged and supported by governments and contributes to the promotion of the relationship between public and private partnership. However, it is still a complicated systematic project which is thought to have advantages in eliminating obstacles to co-development of public and private health service by proponents, yet is considered to have disadvantages in expense control and medical fairness by opponents.As the new rounds of China’s health care system reform began, the medical market, with abundant social capital pouring into the health care industry, is becoming more and more open.’Several Opinions on Encouraging and Guiding Healthy Development of Private Investment’,’Notice of Further Encouragement and Guide on non-state owned medical institutions’and a series of documents about new medical reform have made specific provisions of non-state owned medical institutions. As a matter of fact, drawbacks of original simplex state-owned medical system are revealed day by day, such as decifiency in total supply, limited government financial input, few competition among public hospitals and poor efficiency in management and operation. The only way to solve these conflictions is to reform. On one hand, approaches are needed to be explored to mobilize social capital to participate in construction of mecial institutions by government guide. On the other hand, system and mechanism of non-state owned medical institutions are needed to be studied, and tax price, resource allocation and access system demands stronger supervision. These reforms and explorations require further discussion and research.This study suggests that the definition of social capital in non-state owned medical institutions is the sum of material, human and social action capitals except for government capital, comprehensively explains the development status, trend and research focus of non-state owned medical institutions at home and abroad for policy analysis, emphasizes the internal and external environmental factors associated with non-state owned medial institutions, and puts forward strategic thinking and policy suggestions following eight aspects which are values, legal system, market mechanism, political security, medical technology, material capital, human resource and social action. We try to form the elementary frame of studies on non-state owned medical institutions and provide the basis for relative national policy.更多还原