| 引用本文：苗豫东, 朱东方, 胡建平, 吴建.国家区域医疗中心交易费用的形成机理与政策启示[J].中国卫生政策研究,2024,17(12):14-20 |
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| 国家区域医疗中心交易费用的形成机理与政策启示 |
| 投稿时间：2024-08-26 修订日期：2024-11-18 PDF全文浏览 HTML全文浏览 |
| 苗豫东1, 朱东方1, 胡建平2, 吴建1 |
1. 郑州大学公共卫生学院 河南郑州 450001;
2. 河南省医学会 河南郑州 450003 |
| 摘要:近年来，我国积极推进国家区域医疗中心建设，旨在优化医疗卫生服务体系布局、均衡医疗卫生资源配置、提升医疗服务质量和效率。国家区域医疗中心是宏观环境变迁与多方主体博弈的结果，背后蕴含着复杂的制度谱系及其变迁，因而形成了“隐秘存在”且不容忽视的交易费用。本文在分析国家区域医疗中心建设的宏观环境、利益主体、行为选择的基础上，辨析国家区域医疗中心的形成机理，并依据国家区域医疗中心真实运作情境建构了制度谱系；进而基于“威廉姆森—张五常分析范式”，将国家区域医疗中心交易费用解构为央地协同成本、激励约束成本、业务协作成本、行为变迁成本；最后，从四个方面构建了降低交易费用的应对策略，包括：强化央地政府间制度设计协同、政府与输出—输入医院间运行管理协同、输出—输入医院间服务供给协同、供方和需方间信息搜寻协同。 |
| 关键词:国家区域医疗中心 交易费用 形成机理 政策启示 |
| 基金项目:国家社会科学基金一般项目(21BGL222)；河南省医院管理创新研究重点课题(HNYGCX-2023-03) |
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| The formation mechanism of transaction costs in national regional medical centers and policy implications |
| MIAO Yu-dong1, ZHU Dong-fang1, HU Jian-ping2, WU Jian1 |
1. College of Public Health, Zhengzhou University, Zhengzhou Henan 450001, China;
2. Henan Medical Association, Zhengzhou Henan 450003, China |
| Abstract:In recent years, China has actively promoted the construction of National Regional Medical Centers (NRMCs) with the aim of optimizing the layout of healthcare service systems, balancing the allocation of healthcare resources, and improving the quality and efficiency of medical services. The establishment of NRMCs is the result of macro-environmental changes and the interaction among multiple stakeholders, reflecting a complex institutional spectrum and its evolution, which consequently gives rise to “hidden” yet significant transaction costs. This paper analyzed the macro-environment, interest stakeholders, and behavioral choices underlying the construction of NRMCs, clarified the formation mechanism of NRMCs, and constructed an institutional spectrum based on their real operational context. Drawing on Williamson-Zhang Wuchang Framework for decomposing transaction costs, this study deconstructed the transaction costs associated with NRMCs into four categories: central-local collaboration costs, incentive-constraint costs, business collaboration costs, and behavioral transformation costs. Finally, this paper proposed strategies to reduce these transaction costs from four perspectives: strengthening the coordination of institutional design between central and local governments, enhancing operational management synergy between government and output-input hospitals, promoting service provision synergy between output-input hospitals, and facilitating information search synergy between suppliers and demanders. |
| Key words:National regional medical center Transaction costs Formation mechanism Policy implications |
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