我国公立医院补偿机制的系统动力学分析  

Analysis of Compensation Mechanism of Public Hospitals in China Based on System Dynamic Method

作　　者：陈振生 卢钱红 甘筱青 曹高明[2] Chen Zhensheng(School of Management, Nanchang University, Nanchang, 330031)

机构地区：[1]南昌大学管理学院,南昌330031 [2]江西省社会科学界联合会,南昌330029

出　　处：《医学与社会》2019年第8期34-38,共5页Medicine and Society

基　　金：国家自然科学基金项目“医保支付方式与公立医院系统绩效的关系研究”,编号为71663034

摘　　要：补偿机制是公立医院公益性的重要影响因素。文章在明确公立医院的定位和职能的基础上,利用系统动力学因果关系图分析在取消药品加成政策前后,患者、政府与公立医院之间的利益关系。政府可通过提高医疗服务价格或单位补助标准弥补公立医院的收入缺口;提高医疗服务价格,存在两个方向相反的力的作用,能否增加医疗服务收入取决于两个力的相对大小,以及低收入人群的承受能力和医疗服务的可及性;如果提高单位补助标准,在弥补收入缺口的同时也会降低医疗服务收入。建议加大政府对公立医院的财政补助;为了确保公立医院公益性需加强监管;在合理测算医疗服务成本的基础上确定财政补助标准和医疗服务价格。Compensation mechanism is an important factor affecting the behavior of public hospitals. On the basis of defining the orientation and functions of public hospitals, this paper uses the causality diagram of system dynamics to analyze the interest relationship between patients, government and public hospitals before and after the abolition of the "pharmaceutical markup" policy. The government can make up for the income gap of public hospitals by raising the price of medical services or the standard of unit subsidy. There are two opposite forces in raising the price of medical services. Whether it can increase the income of medical services depends on the relative power of both forces, as well as the affordability of low-income people and the accessibility of medical services. If improving the standard of unit subsidy, it will make up for the income gap but reduce the income of medical services. It is suggested that the government should increase financial subsidies to public hospitals, strengthen supervision to ensure public hospitals’ behavior consistent with the public interests, and determine the standard of financial subsidies and the price of medical services on the basis of reasonable calculation of medical service costs.

关 键 词：公立医院 补偿机制 系统动力学 公益性 

分 类 号：R197.3[医药卫生—卫生事业管理]