我国公立医疗机构的激励性规制研究.pdfVIP

摘 要 医疗服务作为人民群众的基本公共服务需求之一，由于信息不对称而存在发生机会 主义和逆向选择的较高风险。我国的医疗服务业以公立医疗机构为主体，其价格体系仍 存在众多扭曲，公立医疗机构在三十多年的快速发展过程中存在大量浪费社会资源和损 害消费者权益的问题。在公立医疗机构的所有制性质和用人体制不改变的前提下，如何 通过有效的规制设计，促使公立医疗机构和医生更好地为公共利益服务，促进医疗资源 的优化配置是一个难题。 本研究在梳理国内外有关理论的基础上，提出选择报酬和连续努力水平的委托人— 代理人模型，设计信息租金和垄断租金在不同医疗机构、保险机构进行分割和支付的多 种方式，以促使医院利益、医生个人利益的最大化与公共利益的最大化达成“激励相容” 。 本文还探讨了规制与市场治理的关系，提出联合治理的思路。本研究对我国三十多年的 医疗改革以及各地近年对公立医疗服务机构进行激励性规制的探索进行了归纳，并以广 州市番禺区的医疗改革为案例，分析公立医疗机构的运营效率和规制需求，探讨如何进 行激励性规制改革，优化医疗卫生资源配置，有效解决群众看病难、看病贵问题。 关键词：激励性规制 公立医疗服务机构 信息不对称 市场治理 I Abstract As the basic public demand, there occurs opportunism and adverse selection of high risk in medical service because of information asymmetry. There still exist many distortions in the price system of public medical institution, and there exists significant waste of social resources and damages of consumer rights in 30 years of rapid development of public medical institution. Under the premise of the ownership and the employing system of public medical institution remaining unchanged, how to make public medical institutions and doctors work better for public interest services, and promote medical resources to optimum relocation through effective regulation design, is still a difficult problem. On the base of literature review of domestic and foreign related theory, this paper put forward an incentive regulation theory model of public medical service, by designing a variety of ways of segmentation and payment of “information rent” and “monopoly rent” in different medical institutions and insurance institutions, to achieve “incentive compatibility” under the condition of maximization the benefits of hospital, doctors and the public. Moreover, this paper also discusses