基于“IAD+4E”框架的中国新医改制度分析与理论探讨——以三明医改为典型案例的实证考察  

Institutional Analysis and Theoretical Discussion of Chinas New Medical Reform Based on the"IAD+4E"Frame-work Sampled with A typical Case of Sanming Medicine Reform

作　　者：李立清 喻明 丁海峰 Li Liqing(Department of Public Administration and Law,Hunan Agricultural University,Changsha,P.R.China)

机构地区：[1]湖南农业大学公共管理与法学学院,湖南长沙410128

出　　处：《中国卫生事业管理》2024年第12期1321-1327,共7页Chinese Health Service Management

基　　金：国家自然科学基金面上项目“农村重大突发性公共卫生事件应急能力形成机理与提升路研究”(72274059);国家社会科学基金后期资助重点项目“我国农村公共产品供给标准理论与实践研究”(20FGLA001);湖南省哲学社会科学成果评审委员会立项资助重大项目“湖南省农村智慧健康养老体系研究”(XSP21ZDA001)

摘　　要：深化医改是公共治理研究中的重要课题,是破解“看病难与看病贵”的重要手段。“三明医改”作为中国“新医改”的典型案例,探究其改革经验对推进解决“看病难与看病贵”具有重要意义。本文基于对“三明医改”的实证考察,通过构建“IAD+4E”的中国“新医改”框架,探讨了我国“新医改”的治理环境、治理行为、治理绩效三个部分,着重分析具体制度规则如何完善三明的管理体制、运行机制、投入机制与分配制度,以及从经济性、效率性、效益性、公平性四个维度评价其绩效结果,发现三明医改能够为化解“看病难与看病贵”提供治理模板,从而提出中国“新医改”的“政治统领-市场配合-民众参与”的三角治理模式。Deepening medical reform is an important topic in the research of public governance,and an important means to solve the accessibility and affordability of health care.As a typical case of Chinas new medical reform,exploring the experience of Sanming medicine reform is of great significance to promoting it.Based on the empirical investigation of the Sanming Medical Re-form,the governance environment,governance behavior and governance performance of Chinas new medical reform were discussed by constructing the framework of"IAD+4E",focusing on how specific system rules improving the management system,operation mechanism,input mechanism and distribution system,and evaluating its performance results from the four dimensions of econo-my,efficiency,effectiveness and fairness.From which it can be found that the Sanming medical reform can provide a governance template for resolving the accessibility and affordability of health care,and the triangular governance model of"political leadership-market cooperation-public participation"of Chinas new medical reform was proposed.

关 键 词：新医改 看病难与看病贵 三明医改 IAD框架 “4E”理论 

分 类 号：R197.1[医药卫生—卫生事业管理]