政府统筹还是医院自主?——一个贫困乡镇医改中基药制度的运行困境  

Arranged by Administration or Operated by Hospital?:A Case Study on the Predicament of the Essential Drug Scheme in A Poor Village

作　　者：李春南 

机构地区：[1]中国社会科学院研究生院社会发展系

出　　处：《社会发展研究》2017年第2期179-194,共16页Journal of Social Development

摘　　要：在医疗卫生体制改革过程中,国家向基层投入大量资源,而调查却发现一些基层医疗机构运行陷入困境。本文通过对贵州一个贫困乡镇卫生院推行基药制度的个案分析,解释其中原因:为了保证基本药物制度的结果的公益性,政府采用行政化的方式来控制基层医疗机构的运作,这种强制基层医疗机构回归公益性的做法,不仅加重了制度运行的成本,而且损害了基层医疗机构的自主性,使得基层医疗机构难以满足当地人基本医疗需求,背离了制度设计的初衷。因此,如何平衡公共医疗改革中基层医疗机构的"公益性"和"自主性",是当下医疗体制改革中需要考虑的问题。这不仅关系着基层医改的成败,也考验着制度设计者和决策者的智慧与创造力。In the reform process of medical system,government has dedicated vast resources to the primary health care institutions. However, quite a few primary health care institutions are in a sad pickle unexpectedly. Based on a case study of a poor village in Guizhou province,the author intends to outline the operational mechanism of the Essential Drug Scheme,and explore the reasons. To guarantee the commonweal of the Essential Drug Scheme,administrative control was conducted in running the primary health care institutions,which has not only increased the cost of system operation,but also harmed the independence of the institutions. As a result,the primary health care institutions could hardly meet the demands of the local residents and landed in a predicament eventually. Therefore,how to balance the 'commonweal ' and 'autonomy 'of the primary health care institutions is the basic question related to the success or failure of the medical reform.

关 键 词：医改 基本药物制度 卫生院 自主性 公益性 

分 类 号：R197.1[医药卫生—卫生事业管理]