發(fā)布時(shí)間：2018-04-13 23:22

  本文選題：醫(yī)療衛(wèi)生行業(yè) + 政府投入規(guī)模　； 參考：《財(cái)政部財(cái)政科學(xué)研究所》2014年博士論文

【摘要】：經(jīng)過(guò)三十多年的改革發(fā)展,我國(guó)已經(jīng)建立起較為完善的公共衛(wèi)生服務(wù)體系、基本醫(yī)療服務(wù)體系、基本醫(yī)療保障體系和藥品供應(yīng)保障體系,醫(yī)療衛(wèi)生行業(yè)迎來(lái)了嶄新的發(fā)展階段。但是隨著人口老齡化的發(fā)展,應(yīng)用新藥械技術(shù)的迅速提高和我國(guó)醫(yī)療衛(wèi)生服務(wù)需求多樣化及快速增長(zhǎng)態(tài)勢(shì),我國(guó)醫(yī)療衛(wèi)生行業(yè)健康發(fā)展面臨眾多考驗(yàn)。從全球看,沒(méi)有一個(gè)國(guó)家的醫(yī)療衛(wèi)生體制是完美的,也沒(méi)有一個(gè)國(guó)家的醫(yī)療衛(wèi)生改革是一勞永逸的。世界各個(gè)國(guó)家總是持續(xù)不斷地對(duì)本國(guó)的醫(yī)療衛(wèi)生行業(yè)進(jìn)行改革,其中對(duì)政府投入管理制度的改革和調(diào)整是其中的重要一環(huán)。 科學(xué)的政府投入管理制度,是醫(yī)療衛(wèi)生行業(yè)健康發(fā)展的重要途徑。本文通過(guò)對(duì)醫(yī)療衛(wèi)生行業(yè)政府投入管理制度的研究,探求如何通過(guò)對(duì)政府投入的有效管理,在醫(yī)療衛(wèi)生服務(wù)資源不足的情況下,保證醫(yī)療衛(wèi)生服務(wù)資源分配的公平與可及性,提高醫(yī)療衛(wèi)生服務(wù)資源的使用效率和效果,進(jìn)而促進(jìn)整個(gè)醫(yī)療衛(wèi)生行業(yè)的健康可持續(xù)發(fā)展。 在第一部分導(dǎo)言的基礎(chǔ)上,第二部分介紹了國(guó)內(nèi)外文獻(xiàn)資料情況。包括醫(yī)療衛(wèi)生行業(yè)投入主體研究、醫(yī)療保險(xiǎn)保障籌資問(wèn)題研究、醫(yī)改投入方向研究、醫(yī)療衛(wèi)生行業(yè)資源分布問(wèn)題研究和醫(yī)療衛(wèi)生行業(yè)管理機(jī)制研究五個(gè)方面,為研究我國(guó)醫(yī)療衛(wèi)生行業(yè)政府投入管理問(wèn)題奠定了良好的基礎(chǔ)。 第三部分以醫(yī)療衛(wèi)生行業(yè)的相關(guān)理論基礎(chǔ)為切入點(diǎn),通過(guò)對(duì)公共產(chǎn)品理論、衛(wèi)生經(jīng)濟(jì)學(xué)理論的研究指出政府主導(dǎo)醫(yī)療衛(wèi)生行業(yè)發(fā)展的必然性。通過(guò)對(duì)制度與行為經(jīng)濟(jì)學(xué)理論、信息不對(duì)稱與代理人理論的研究指出,政府不僅負(fù)有對(duì)醫(yī)療衛(wèi)生行業(yè)投入的責(zé)任,同時(shí)必須注意政府責(zé)任的有限性；醫(yī)療衛(wèi)生行業(yè)的信息不對(duì)稱特征要求政府采取措施避免行業(yè)壟斷的發(fā)生和供給誘導(dǎo)需求的存在；對(duì)機(jī)制設(shè)計(jì)理論的研究表明醫(yī)療衛(wèi)生行業(yè)的內(nèi)在特點(diǎn)決定我們只有通過(guò)運(yùn)用正確的機(jī)制協(xié)調(diào)各方利益,才能實(shí)現(xiàn)行業(yè)的健康發(fā)展目標(biāo)。 第四部分以發(fā)達(dá)國(guó)家、發(fā)展中國(guó)家包括轉(zhuǎn)型國(guó)家醫(yī)療衛(wèi)生改革為背景,對(duì)各類國(guó)家醫(yī)療衛(wèi)生行業(yè)的政府投入管理進(jìn)行了深入的研究和比較,一方面選取具有代表性的國(guó)家進(jìn)行橫向?qū)Ρ?考察不同國(guó)家醫(yī)療體系對(duì)政府投入管理的理念、規(guī)模、效率、效果的影響；另一方面對(duì)各國(guó)醫(yī)療衛(wèi)生行業(yè)政府投入管理的經(jīng)驗(yàn)進(jìn)行歸納總結(jié),指出醫(yī)療衛(wèi)生行業(yè)政府投入管理中的共性和特性,找出對(duì)我國(guó)醫(yī)療衛(wèi)生行業(yè)政府投入管理制度設(shè)計(jì)的啟不。 第五部分介紹了我國(guó)醫(yī)療衛(wèi)生行業(yè)投入管理狀況。本部分分別從發(fā)展歷程、數(shù)據(jù)分析、成績(jī)問(wèn)題三個(gè)維度對(duì)我國(guó)醫(yī)療衛(wèi)生行業(yè)狀況進(jìn)行描述和分析,深入剖析了我國(guó)醫(yī)療衛(wèi)生行業(yè)原有政府投入管理制度形成的背景、存在的合理性、改革的動(dòng)因和目前的問(wèn)題所在,找出政府投入管理制度設(shè)計(jì)必須考慮的諸多問(wèn)題,為下一步問(wèn)題解決奠定了基礎(chǔ)。 第六部分至第九部分是論文的重點(diǎn),是前五部分論證的延續(xù)、擴(kuò)展和總結(jié)。第六部分在上文研究論證的基礎(chǔ)上,提出我國(guó)醫(yī)療衛(wèi)生行業(yè)政府投入管理制度設(shè)計(jì)需要考慮的問(wèn)題、行業(yè)發(fā)展的基本原則和下一步改革思路。第七部分至第九部分是在第六部分基礎(chǔ)上提出了改革的具體建議：第七部分和第八部分分別對(duì)政府在建立健全醫(yī)療服務(wù)體系和醫(yī)療保障體系中的職責(zé)進(jìn)行了明確。第九部分針對(duì)目前政府投入的存量管理問(wèn)題,建議以醫(yī)療國(guó)資委為主其他形式為輔的多種形式做實(shí)公立醫(yī)院國(guó)有資本的出資人,把公立醫(yī)院的資產(chǎn)管理向資本管理轉(zhuǎn)變。 本文的創(chuàng)新之處與主要貢獻(xiàn)有四： 首先,以政府投入管理制度設(shè)計(jì)為視角,通過(guò)分析醫(yī)療衛(wèi)生行業(yè)中市場(chǎng)、產(chǎn)品、各參與方訴求的特點(diǎn)入手,確定政府的角色定位,以此為基點(diǎn)確定政府投入醫(yī)療衛(wèi)生行業(yè)的責(zé)任以及政府籌資管理制度、投入管理制度對(duì)醫(yī)療衛(wèi)生行業(yè)發(fā)展的影響,奠定了政府主導(dǎo)醫(yī)療衛(wèi)生行業(yè)建立和運(yùn)行的理論基礎(chǔ),提出政府投入責(zé)任的有限性的理論依據(jù)。 第二,本文認(rèn)為政府投入規(guī)模的國(guó)際間比較如果只是單純的總量對(duì)比,是缺乏科學(xué)性的。只有在同一模式和相似經(jīng)濟(jì)發(fā)展水平下的政府衛(wèi)生支出才可以進(jìn)行有效比較,得出建設(shè)性的結(jié)論。本文在把三種醫(yī)療保障模式的國(guó)家細(xì)分的基礎(chǔ)上通過(guò)對(duì)各組數(shù)據(jù)進(jìn)行比較分析得出,我國(guó)醫(yī)療衛(wèi)生行業(yè)政府投入規(guī)�；具m當(dāng)。 第三,通過(guò)回歸分析模型對(duì)未來(lái)影響我國(guó)政府醫(yī)療衛(wèi)生投入的因素進(jìn)行研究。本文選擇了五個(gè)自變量,通過(guò)回歸模型得出人口老齡化和經(jīng)濟(jì)發(fā)展水平是對(duì)各國(guó)衛(wèi)生支出最具影響的指標(biāo)。由此認(rèn)為,隨著經(jīng)濟(jì)發(fā)展水平提高和我國(guó)老齡化社會(huì)的到來(lái),預(yù)計(jì)我國(guó)政府衛(wèi)生投入比例也將隨之上升。 第四,提出以醫(yī)院國(guó)資委為主其他形式為輔對(duì)政府投入存量進(jìn)行管理。目前公立醫(yī)院政事不分,政府對(duì)公立醫(yī)院投入存在出資人缺位的問(wèn)題。本文認(rèn)為,只有在公立醫(yī)院實(shí)現(xiàn)資產(chǎn)管理向資本管理轉(zhuǎn)變的情況下,切實(shí)完善公立醫(yī)院法人治理結(jié)構(gòu),完善政府對(duì)醫(yī)院國(guó)有資本運(yùn)行的監(jiān)管機(jī)制,才能從根本上解決公立醫(yī)院的發(fā)展問(wèn)題,才有可能給予民營(yíng)資本在醫(yī)療衛(wèi)生行業(yè)的發(fā)展打開(kāi)公平競(jìng)爭(zhēng)和合作共贏的空間,加快形成多元化辦醫(yī)格局。
[Abstract]:After more than 30 years of reform and development , our country has set up a more perfect health service system , basic medical service system , basic medical security system and medicine supply safeguard system , and the medical and health industry is facing a lot of test .

The scientific government input management system is an important way for the health development of the medical and health industry . Through the research on the administration management system of the government of the medical and health industry , how to ensure the fairness and accessibility of the resource allocation of the medical and health services can be ensured through the effective management of the government input , and the use efficiency and the effect of the medical and health service resources are improved , and the healthy sustainable development of the whole medical and health industry is further promoted .

On the basis of the introduction of the first part , the second part introduces the domestic and foreign literature and information , including the research of the main body of the medical and health industry , the research on the financing of medical insurance , the research on the direction of medical reform input , the research on the resources distribution in the medical and health industry and the research on the management mechanism of the medical and health industry , and lays a good foundation for the study of the administration of the government in the health industry .

The third part , based on the relevant theoretical foundation of the medical and health industry , points out the necessity of the government to lead the development of the medical and health industry through the research of the theory of public goods and the theory of health economics .
The information asymmetry in the medical and health industry requires the government to take measures to avoid the occurrence of industry monopoly and the existence of supply - induced demand ;
The research on the mechanism design theory indicates that the inherent characteristics of the medical and health industry decide that we can achieve the healthy development goals of the industry only by using the correct mechanism to coordinate the interests of the parties .

In the fourth part , in the background of the reform of the developed countries and developing countries , including the reform of health and health in the countries with economies in transition , the government inputs and management of various kinds of countries ' medical and health industries are deeply studied and compared . On the one hand , the influence of different national medical systems on the concept , scale , efficiency and effect of government input management is investigated .
On the other hand , the author summarizes the experiences of government input management in the national health and health industry , points out the commonness and characteristics of the government input management in the medical and health industry , and finds out the lack of the design of the government input management system of the medical and health industry in our country .

The fifth part describes the management of the medical and health industry in our country . This part describes and analyzes the situation of the medical and health industry in our country from three dimensions of development course , data analysis and achievement problem respectively . It deeply analyses the background , the rationality , the motivation of the reform and the present problems , and finds out the many problems which must be taken into consideration in the design of the government input management system , and lays a foundation for the next issue resolution .

The sixth part to the ninth part are the focus of the thesis , which is the continuation , extension and summary of the first five parts demonstration . Part VI is based on the above research demonstration , and puts forward the basic principle and the next reform thought of the government input management system design in our country . The seventh part and the eighth part are the concrete suggestions of the reform in the sixth part . The ninth and the eighth part are the concrete suggestions for the government to establish and improve the medical service system and the medical security system respectively .

The main contributions of this paper are as follows :

First , based on the government input management system design as the visual angle , the government ' s role orientation is determined by analyzing the characteristics of the market , the product and the appeal of each participant in the medical and health industry .

Secondly , the author thinks that the international comparison of government investment scale is not scientific . Only in the same model and similar economic development level , the government health expenditure can be effectively compared , and the constructive conclusion is reached .

Thirdly , through the regression analysis model , we study the factors that affect our government ' s medical and health input . This paper selects five independent variables , and concludes that the population ' s aging and economic development level is the most influential indicator of the national health expenditure through the regression model . It is expected that the proportion of the government health input will rise with the improvement of the level of economic development and the coming of the aging society in China .

Fourthly , it is suggested that the state - owned enterprises should be divided into other forms to manage the government ' s investment . At present , the administration of public hospitals is not divided , and the government ' s input into the public hospitals is vacant . In the view of this article , only if the public hospital realizes the transformation of capital management to the capital management , it is possible to improve the government ' s supervision mechanism for the operation of the state - owned capital of the hospital , so as to fundamentally solve the problem of public hospital development , and it is possible to give the private capital the space to open fair competition and cooperation in the development of the medical and health industry , and speed up the formation of diversified medical patterns .

【學(xué)位授予單位】：財(cái)政部財(cái)政科學(xué)研究所
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：F812.45;R197.1

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