【作者】 杨蒙莺；

【导师】 陈德棉；

【作者基本信息】 同济大学 ， 技术经济及管理， 2005， 博士

【摘要】 2002年10月-2003年8月,笔者作为同济大学投资研究所“社会资本参与公立医院产权制度改革的制度创新与实践突破”课题组主要成员,参与了苏州市第四人民医院改制课题的研究。对该课题的研究,引发了笔者对我国医疗卫生体系模型和改革政策的深入思考,并将之作为本博士论文的研究题目。 从世界范围来看,近年来,无论是以政府福利为主还是以市场机制为主的医疗保障体制,都暴露出其不完善的弊端,医疗卫生改革已成为全球性话题。 我国医疗卫生改革正处于体制大转轨、结构大调整的关键时刻。医疗卫生改革何去何从,成为人们探讨的热点话题。 根据政府和私人在医疗卫生体系中的作用、范围和具体实现形式,世界各国医疗卫生体系模式大体可以分为四个类型:以英国为代表的政府主导型、以美国为代表的市场主导型、以德国为代表的社会保险型和以新加坡为代表的公私互补均衡型。本论文对这四种模式进行了总结和评价,得出这四种模式的医疗卫生体系模型。 在此基础上,笔者运用系统科学的方法,进行了理想的国家医疗卫生体系模型设计,以期为我国建立科学、合理,且符合我国具体国情的医疗卫生体系提供指导。 为了建立我国医疗卫生体系模型,本论文回顾了我国医疗卫生体系的历史沿革概况,从中了解我国医疗卫生体系改革的历史进程和政府决策所起的作用;分别对计划经济时期和改革开放时期,我国医疗体系发展的经验和教训进行了总结;通过对当前医疗改革困局的外在表现、内在动因的分析,解析了我国当前医疗困局;根据国务院研究机构的研究报告指出了我国医疗卫生改革的政策倾向。 在国内外研究现状总结、国外医疗卫生模型评述和我国医疗卫生体系历史沿革和改革状况分析的基础上,本论文进而按照理想的国家医疗卫生体系的模型的要求,结合我国的实际情况,研究得出了由医疗卫生组织体系和医疗卫生保障体系两大模块组成的我国医疗卫生体系模型,并根据理想的模型对照系统设计目标对其进行了公平性、可及性、效率、政府财政负担和患者经济负担等指标的评价与检验。 我国地域广阔,各地区医疗卫生状况及经济社会发展的其他诸方面存在显著的差异性。根据系统理论,当系统运行过程中受到相关因素的干扰时,须对系统进行补充和修正。因此本论文根据各地区不同的医疗需求(和需要)状况和卫生资源的供给现状,综合运用多种统计方法,建立了卫生资源配置模型,作为我国医疗卫生体系的子模型,对我国医疗卫生体系模型进行必要补充和修正。更多还原

【Abstract】 As a key member of the research team on the topic of Policy Innovation and Practice Renovation on Public Hospital Property System Reform with Social Capital Involved, in Investment Research Institute, Tongji University, during October 2002 to August 2003, the author worked on the project of Reform of No. Four Hospital, Suzhou. This research caused the author’s deep ponder upon the model and reform policy of China’s medical and health care system, which finally became the topic of this dissertation.Looking in the scope of the whole world, we can find that in resent years, both the government and market dominating health care system have exposed problems of imperfection. Reform on medical and health care system has turned out to be a global topic.China’s medical and health care reform is now on the turning point. Where to go is just warmly discussed.According to the function, range and implementing means, the medical and health care systems in the world can be summarized into four types - UK’s government dominating, US’s government dominating, Germany’s social insurance and Singapore’s public and private collaborating types. The dissertation examined and summarized these four types of systems and formed models of each.On the ground of those models and by applying system methodology, the dissertation raised an ideal model of state medical and health care systems, for the purpose of indicating the establishing the scientific, reasonable and suitable system in our country.Based on the previous analysis and conclusion, the dissertation further developed the model of China’s medical and health care system in the guidance of the ideal model, which was made up of two modules of medical and health care organization system and health care ensuring system. And made evaluation and testing according to the objectives of the ideal model, in aspects of fairness, accessibility, efficiency and the affordability both of the government and individuals.Thanks to the vast territory of China and the large difference on medical and health care condition and other fields of economy and society between different regions, the dissertation worked out the model of health resource allocation as necessary complements and modification to the model of China’s medical and health care system given by the previous section, according to the system theory about disturbing factors and by using various statistic methods.At the end of the dissertation, the author got a chance to restate the major conclusion and deficiencies, and also to look into the future for further study.The innovations carried out in the dissertation are:a. The dissertation raised an ideal model of state medical and health care systems after examining and summarizing the four types of medical and health care systems in the world by applying system methodology;b. Based on overseas experiences and lessons and domestic practice, the dissertation further developed the model of China’s medical and health care system in the guidance of the ideal model;c. The dissertation worked out a sub-model of health resource allocation as necessary complements and modification to the model of China’s medical and health care system due to the large difference on medical and health care condition and other fields of economy and society between different regions in China’s vast territory.更多还原