中国医疗卫生服务改革中的监管体系建设.pptVIP

2006-2-26、7 竞争与监管 申明：所有观点均属课题组成员的看法，与所供职的单位无关。 Disclaimer: Views expressed here are all of the authors and do not necessarily represent those of the institutions to which the authors are affiliated. 基本思路和讨论范围 Outline of Discussion 基本概念和分析框架：Conceptual Framework 医疗服务复杂的技术经济特征 Techno-Economic Features of Heath Care 医疗服务供给系统的多样性 Diversified Health Care Systems 政府在医疗服务供给中的多重角色 Multiple Roles of government 主要结论和建议 Main Conclusion and Policy Proposal 监管体系建设是任何改革方案中不可或缺的组成部分 Regulatory System Building Should Be an essential Part of the reform plan 医疗监管体系的基本框架：A Regulatory Framework 政府主办模式下的监管：从行政命令到政府内监管 Regulation-inside-Government 市场竞争下的监管：多层次的监管体系 Multiple-Layered Regulatory system 医疗服务的基本结构 Structure of Health Care System 医疗服务的技术经济特征 Techno-Economic Characteristics of Health Care Services 资源永远稀缺；买方/卖方垄断;需求和供给方面的不确定性；信息不对称；第三方付费的道德风险；专业的准入壁垒；社会公正和道德良知；需求的多样性；个人隐私。 Scarcity, monopoly; uncertainty; information asymmetry; moral hazard; professional qualification and entry barrier; social justice and moral concerns; diversified demand; protection of privacy 政府干预的合理性：政府干预矫正市场失灵Rationale for Government Intervention: Correcting Market Failure 对稀缺资源的配置 Allocating Scarce Resources：Two Fundamentally Different Ways 计划：政府供给 Government Supply and Rationing 市场：通过竞争形成价格 Market: Bidding for Service 从直接出资的角度可以将医疗服务的供给分为：Classified by Funding 全民免费医疗：政府直接供给（英国），以公平的方式. Free services for all (UK model) 个人付费：通过市场竞争 Fee based model: 在现实中，如何医疗体系都是计划与竞争机制的结合。由于医疗服务在“面向大众、在提供过程存在着潜在的严重市场失灵（被宽泛地解释为公平与效率原因）, 所以属于公共服务（public services) 范畴 ，政府可以以直接提供服务、出资购买服务和对医疗服务进行监管三种方式介入医疗服务。 （Grout和Stevens，2003）。In reality, all health care systems are of mixed type with government interventions. Government are involved simultaneously in directly supplying services, buying services by provide funds and regulating service provision. 政府干预的三种主要方式 Three Ways that Governments Can Intervene 但根据医疗服务提供方的单位治理结构、服务购买方的组织方式可以分为多种医疗服务的组织方式。There are diversified health care systems in the world that