【摘要】：在現(xiàn)代文明社會中,醫(yī)療衛(wèi)生服務(wù)變得日益重要,這從各國衛(wèi)生總費用占GDP比例逐年上升這個簡單事實即可看出。人們選擇用更多的收入投入到購買醫(yī)療服務(wù)之中,不僅僅是因為生命健康的重要,而醫(yī)療服務(wù)提供者選擇更昂貴的手段提供醫(yī)療服務(wù)也不僅僅是因為其擁有優(yōu)勢的交易地位。生產(chǎn)者和消費者的選擇,都受所面臨的現(xiàn)有生產(chǎn)體系和市場環(huán)境限制。對于醫(yī)療服務(wù)業(yè),政府對其的規(guī)制制度體系及其制度體系的變遷過程,決定了當前醫(yī)療服務(wù)體系市場特征。當前醫(yī)療服務(wù)業(yè)中所存在的費用快速上漲,公平性、方便性和醫(yī)療質(zhì)量問題,都可以政府的規(guī)制制度上找到原因。 本文回顧了我國醫(yī)療體制的演進過程,分析了建國后四個主要階段我國醫(yī)療服務(wù)體系中存在的問題及其制度原因,并利用產(chǎn)業(yè)組織的方法分析了我國當前醫(yī)療服務(wù)業(yè)的市場集中度、產(chǎn)品競爭特點、進入壁壘、行業(yè)結(jié)構(gòu)特點和區(qū)域分布特征,并結(jié)合與國際上典型國家的醫(yī)療服務(wù)體系比較,得出了我國的醫(yī)療服務(wù)業(yè)區(qū)域市場集中度過高、大型公立醫(yī)院壟斷勢力太大、進入壁壘較大、城鄉(xiāng)二元結(jié)構(gòu)等特點導(dǎo)致了市場競爭強度不夠的結(jié)論。 為了找到形成我國具有如此特點的醫(yī)療服務(wù)產(chǎn)業(yè)體系的原因,本文深入分析了我國政府對醫(yī)療服務(wù)行業(yè)的準入、布局規(guī)劃、價格和質(zhì)量規(guī)制制度,并通過近幾年來的醫(yī)療服務(wù)業(yè)的各項統(tǒng)計和調(diào)查數(shù)據(jù)考察其規(guī)制的規(guī)制成效,發(fā)現(xiàn)了準入制度不完善、作為監(jiān)管主體的政府直接辦醫(yī)、扭曲的醫(yī)藥價格規(guī)制措施和還未形成有效的質(zhì)量監(jiān)管體系的等因素是造成醫(yī)療服務(wù)業(yè)布局不合理、“以藥養(yǎng)醫(yī)”和醫(yī)療質(zhì)量問題的直接原因。 為了解決當前醫(yī)療服務(wù)業(yè)中存在的問題,一些地區(qū)進行了各種探索,本文通過總結(jié)各地以“管辦分開”和“醫(yī)院集團”化為代表的公立醫(yī)院改革試驗經(jīng)驗,并結(jié)合近年來基本藥物制度實施效果,公立醫(yī)院改革方案和醫(yī)療保障體系的建設(shè)經(jīng)驗等改措施的分析,提出了加大向需方投入、政府退出直接辦醫(yī)、放松布局規(guī)制、調(diào)整準入制度、弱化醫(yī)藥直接定價、完善醫(yī)師培養(yǎng)制度,把醫(yī)療服務(wù)的支付方式從按項目轉(zhuǎn)到總額預(yù)付制等規(guī)制政策建議。
[Abstract]:In modern civilized society, health service is becoming more and more important, which can be seen from the simple fact that the proportion of total health expenditure to GDP is increasing year by year. People choose to invest more of their income in the purchase of medical services not only because of the importance of life and health, but also because health care providers choose more expensive means to provide medical services, not only because they have an advantageous trading position. The choice of producers and consumers is limited by the existing production system and market environment. For the medical service industry, the government's regulatory system and its changing process determine the market characteristics of the current medical service system. At present, the cost of medical service industry is rising rapidly, the problems of fairness, convenience and medical quality can be found out in the regulation system of the government. This paper reviews the evolution process of China's medical system, analyzes the problems existing in the medical service system in the four main stages after the founding of the people's Republic of China and the causes of the system. Using the method of industrial organization, this paper analyzes the market concentration, product competition, entry barriers, industry structure and regional distribution of medical service industry in China, and compares with the medical service system of typical countries in the world. It is concluded that the regional market concentration of medical service industry in China is too high, the monopoly power of large public hospitals is too large, the barriers to entry are large, and the dualistic structure of urban and rural areas leads to insufficient market competition. In order to find out the reasons for forming the medical service industry system with such characteristics in our country, this paper makes a thorough analysis of the government's access, layout planning, price and quality regulation system to the medical service industry. And through the statistics and investigation data of medical service industry in recent years to investigate the regulation effect of its regulation, it is found that the admission system is not perfect, and the government, as the main body of supervision, runs medical treatment directly. The distorted medical price regulation measures and the lack of effective quality supervision system are the direct causes of unreasonable distribution of medical service industry, "raising medicine with medicine" and medical quality problems. In order to solve the problems existing in the current medical service industry, some regions have carried out various explorations. This paper sums up the experience of the public hospital reform experiment, which is represented by the separation of management and the "hospital group". Based on the analysis of the effect of the implementation of the essential drugs system in recent years, the reform scheme of public hospitals and the experience in the construction of the medical security system, it is proposed that the government should increase the input to the demand side, the government should withdraw from running the medical treatment directly, and the layout regulation should be relaxed. To adjust the admission system, weaken the direct pricing of medicine, perfect the training system of doctors, and transfer the payment method of medical service from the item to the total advance system, and so on.
【學位授予單位】：西南財經(jīng)大學
【學位級別】：博士
【學位授予年份】：2012
【分類號】：F719;R197.1

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