| 引用本文：俞卫.县医院综合改革的理论基础、困境与突破——以陕西子长医改为例[J].中国卫生政策研究,2012,5(4):16-20 |
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| 县医院综合改革的理论基础、困境与突破——以陕西子长医改为例 |
| 投稿时间：2012-02-02 修订日期：2012-03-22 PDF全文浏览 HTML全文浏览 |
| 俞卫1 |
| 上海财经大学公共经济与管理学院 |
| 摘要:从目标定位、基本理论出发，探讨了县医院改革思路，并对陕西子长县医改方案进行了分析。作为农村医疗体系的龙头，县医院的定位是以适宜的水平提供常见大病的诊断治疗，但面临如何转变利润驱动运营机制带来的挑战。公立医院治理结构的理论思路是在完成社会公共目标和提高医院自主激励机制之间的平衡，先决条件是医疗市场环境的监管水平。价格扭曲、药品流通市场垄断和医疗保险的粗放管理水平是我国公立医院的特殊运营环境，县医院改革必须充分考虑这些因素。陕西子长县通过政府承担医务人员的工资和医院的发展资金，同时进行工资和绩效管理等人事制度改革来解决社会目标和效率之间的矛盾。子长改革的挑战是克服政府集中控制带来的效率损失。 |
| 关键词:公立医院 县医院 治理 卫生改革 |
| 基金项目:上海市哲学社会科学规划课题（2009BJB027）；国家社科基金重大项目（11&ZD176） |
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| Basic theory, difficulty and breakthrough in county hospital reform: The Shanxi Zichang reform practice |
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| Abstract:From goals and basic theory, this article explores thoughts of county hospital reform, and analyzes a case in Zichang county, Shanxi province. A county hospital’s objective and obligation is to treat common serious medical conditions with appropriate cost, but facing great challenges on how to reform the profit driven management strategy. A theoretical thought on governance structure of public hospital is balancing between achieving social objectives and promoting efficiency. Price disturbance, drug market monopoly and rough management skill of health insurance are special factors in the operating environment for rural hospitals. County hospital reform must fully consider those features. Zichang county government has resolved conflicts between social objectives and efficiency through a combination of two policy reforms: fully funding employee cost and establishing a pay for performance method. The challenge faced by Zichang reform is to overcome the potential efficiency loss from government direct management. |
| Key words:Public hospital County hospital Governance Health reform |
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