本文選題：多元視角　切入點：廣西　出處：《廣西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：【目的】本研究旨在對廣西壯族自治區(qū)民營醫(yī)院現(xiàn)狀調(diào)查及基礎上,通過文獻分析法,了解目前廣西壯族自治區(qū)民營醫(yī)院發(fā)展的主要特點、發(fā)展中存在的問題以及廣西壯族自治區(qū)民營醫(yī)院監(jiān)管的現(xiàn)狀,對廣西壯族自治區(qū)目前監(jiān)督管理民營醫(yī)院進程中存在的問題展開分析,找出問題產(chǎn)生的原因,建立符合廣西特點的民營醫(yī)院多元監(jiān)管機制并分析其實現(xiàn)策略,并提供政策建議,推動廣西壯族自治區(qū)民營醫(yī)院快速而穩(wěn)定、健康且可持續(xù)發(fā)展�！痉椒ā勘狙芯拷Y合了理論研究與實證研究方法。首先,本研究通過文獻研究法收集整理相關文獻資料,總結借鑒國內(nèi)外醫(yī)院監(jiān)管的有利經(jīng)驗,以及我國民營醫(yī)院監(jiān)督管理概況及未來發(fā)展方向。綜合運用不完備法律理論、激勵規(guī)制理論、監(jiān)管博弈理論等理論,探討構建廣西壯族自治區(qū)民營醫(yī)院多元監(jiān)管機制。其次,通過查閱、收集、整理廣西民營醫(yī)院的基本信息、衛(wèi)生統(tǒng)計數(shù)據(jù)及監(jiān)管情況,并通過專家訪談法和利益相關者分析法,探索研究和分析目前廣西壯族自治區(qū)民營醫(yī)院監(jiān)管過程存在的缺陷和主要問題,為探討廣西壯族自治區(qū)民營醫(yī)院的多元監(jiān)管策略奠定基礎�！窘Y果】(1)民營醫(yī)院多元監(jiān)管主體及其職責界定。民營醫(yī)院多元監(jiān)管機制是強調(diào)多方協(xié)作、資源整合的一種監(jiān)管機制。該監(jiān)管機制中政府是主導者,政府承擔的主要是針對民營醫(yī)院監(jiān)管方面法律法規(guī)的制定和督促法治規(guī)范的執(zhí)行。除了政府外,監(jiān)管主體還包括行業(yè)協(xié)會、醫(yī)療保險機構、第三方評估團體、社會公眾、醫(yī)院內(nèi)部治理等。醫(yī)療保險機構主要負責監(jiān)督評估民營醫(yī)院醫(yī)療服務行為的合法性與合理性;行業(yè)協(xié)會負責參與政策制定、規(guī)范執(zhí)業(yè)標準、信息披露和使用非法律性措施懲罰違規(guī)民營醫(yī)院;第三方評估機構則受政府監(jiān)督部門委托,對民營醫(yī)院某方面施行專業(yè)的監(jiān)督與評估,構建公正與公平的監(jiān)督環(huán)境,推進信息公開;以新聞媒體和消費者協(xié)會為公眾監(jiān)督的典型部門,主要負責引導正確的社會價值觀,對違法違規(guī)行為的曝光以及對先進機構和個人的輿論宣傳,保障患者的合法權益等;醫(yī)院內(nèi)部則設立理事會和監(jiān)管會,作為醫(yī)院與外部監(jiān)督機構的銜接部門。(2)廣西民營醫(yī)院發(fā)展的現(xiàn)狀分析。2011-2015年,廣西壯族自治區(qū)民營醫(yī)院在醫(yī)院總數(shù)、醫(yī)院編制床位數(shù)、醫(yī)院衛(wèi)生人力資源數(shù)等方面呈現(xiàn)逐年上升的趨勢,年平均增長率分別為9.95%、18.45%和6.42%。醫(yī)療服務量也有了逐漸提升,門、急診服務量和住院服務量年均增長率為5.07%和24.6%。但較公立醫(yī)院來說,廣西民營醫(yī)院總體發(fā)展還處于起步階段,尤其是發(fā)展規(guī)模、服務量等方面與公立醫(yī)院相比還存在明顯的差距。(3)廣西民營醫(yī)院監(jiān)管現(xiàn)狀分析。當前,廣西民營醫(yī)院在監(jiān)管過程中存在的問題主要有:缺乏系統(tǒng)性和針對性的法律法規(guī)及相關政策;醫(yī)療監(jiān)督管理執(zhí)法隊伍力量不足;醫(yī)院信息公開機制不健全;民營醫(yī)院監(jiān)管評估機制尚未健全,違法成本低;不完善的民營醫(yī)院監(jiān)管機制,監(jiān)管缺乏持續(xù)性和整體性;監(jiān)管主體局限,政府外多元監(jiān)管主體未能發(fā)揮優(yōu)勢等�！緦Σ摺繕嫿◤V西壯族自治區(qū)多元監(jiān)管機制,充分發(fā)揮各多元監(jiān)管主體的監(jiān)督職責。第一,政府部門聯(lián)合行業(yè)協(xié)會,要建立健全民營醫(yī)院監(jiān)管法律保障制度,加大違規(guī)懲處力度,對民營醫(yī)院運行過程中的各個活動環(huán)節(jié)起到硬性約束的作用。民營醫(yī)院監(jiān)管相關法律法規(guī)及規(guī)則體系主要應包含民營醫(yī)院運行法律制度、監(jiān)管機構建立與運行法規(guī)、監(jiān)管機構監(jiān)督執(zhí)行規(guī)則,以及監(jiān)管問責法律制度等。第二,量化分級管理,建立統(tǒng)一的衛(wèi)生服務信息平臺。在日常監(jiān)督或?qū)ｍ棛z查中,根據(jù)檢查結果對各民營醫(yī)院進行分級量化評價,確立不同的等級,并依照不同的評價等級采取不同的監(jiān)督檢查頻率。此外,完善廣西壯族自治區(qū)民營醫(yī)院的醫(yī)療信息公開制度,向社會公開公示民營醫(yī)院的醫(yī)療具體信息和監(jiān)管結果,加強信息的透明度,不僅有利于督促民營醫(yī)院進行誠信合法經(jīng)營,還有利于促進醫(yī)療服務市場的公平競爭。第三,健全民營醫(yī)院監(jiān)管評估機制,以防止發(fā)生民營醫(yī)院監(jiān)管部門濫用權力等的現(xiàn)象,不斷糾正監(jiān)管過程中的偏差并改進監(jiān)管中存在的主要問題。第四,培育行業(yè)組織,發(fā)揮行業(yè)監(jiān)管的力量。由于行業(yè)協(xié)會因在其行業(yè)領域中是具有一定的權威性,通常能夠參與制定與本行業(yè)相關的法規(guī)、政策,具備一定的法規(guī)制定和管理權限。因此,要在保證第三方行業(yè)監(jiān)管組織的獨立性與權威性情況下,鼓勵民間成立專業(yè)化的醫(yī)療行業(yè)監(jiān)管機構,培育廣西民營醫(yī)院的社會監(jiān)管力量。第五,完善民營醫(yī)院退出機制,促進良性競爭。為了能真正發(fā)揮民營醫(yī)院在醫(yī)療服務市場上的作用,在逐步放寬民營醫(yī)院的準入限制的同時,還應完善民營醫(yī)院的退出機制,避免大量低水平的民營醫(yī)院間無序地在低層次上的競爭,才能保證民營醫(yī)院保持良好的軟硬件設施,為社會公眾提供更好的醫(yī)療服務。
[Abstract]:[Objective] the purpose of this study is to the investigation on the current situation of the private hospitals in the Guangxi Zhuang Autonomous Region and on the basis of the literature analysis, understand the main features of the development of private hospitals in the Guangxi Zhuang Autonomous Region at present, the problems existing in the development and current situation of supervision of private hospitals in the Guangxi Zhuang Autonomous Region, the Guangxi Zhuang Autonomous Region on the supervision of private hospital management problems in the process of analysis, find out the causes of the problem and establish the Guangxi private hospital characteristics of multiple regulatory mechanisms and the analysis of its implementation strategy, and provide policy recommendations to promote the private hospitals in the Guangxi Zhuang Autonomous Region rapid and stable, healthy and sustainable development. [method] the study combines theoretical research and empirical research methods. Firstly, this study through the literature research method to collect relevant literature summary from the beneficial experience at home and abroad for hospital supervision, and I Overview of the supervision and management of private hospitals and the future direction of development. The comprehensive use of incomplete law theory, incentive regulation theory, regulation game theory, to explore the construction of private hospitals in the Guangxi Zhuang Autonomous Region multiple regulatory mechanism. Secondly, through inspection, collection of basic information of camp Guang Ximin hospital, health statistics and supervision, and through expert interviews and the stakeholder analysis method, research and analysis of defects in the current the Guangxi Zhuang Autonomous Region private hospitals and the main problems existing in the process of supervision, to lay the foundation of multiple regulation strategy for the study of the Guangxi Zhuang Autonomous Region civilian battalion hospital. [results] (1) multiple regulatory bodies and responsibilities of private hospitals defined. Private hospital multi regulatory mechanism is emphasized the cooperation of a the supervision mechanism of resource integration. The government supervision mechanism is dominant, the government is mainly aimed at The formulation of laws and regulations and supervise the private hospital supervision of the rule of law enforcement. Apart from the government, the regulatory body also includes industry association, medical insurance organization, the third party evaluation group, the public hospital internal governance. Medical insurance agency is responsible for supervision and assessment of the private hospital medical service behavior of the legitimacy and rationality; Industry Association is responsible for participate in policy formulation, standard practice standards, information disclosure and use legal measures to punish illegal private hospitals; third party assessment agencies entrusted by the government supervision departments, a private hospital on aspects of the implementation of supervision and assessment of professional, fair and equitable environment construction supervision, and promote information disclosure; in the news media and Consumer Association as a typical Department of public supervision, mainly responsible for guiding the correct social values, the illegal behavior of exposure as well as the advanced institutions and individuals The propaganda of public opinion, safeguard the legitimate rights and interests of patients; hospital set up the Council and the supervision department as the hospital, cohesion and external supervision mechanism. (2) analysis of the current situation of the development of Guangxi private hospital in.2011-2015, the Guangxi Zhuang Autonomous Region private hospital in the total hospital beds, hospitals, health human resources with respect to the number of year by year the rising trend, the average annual growth rates were 9.95%, 18.45% and 6.42%., the amount of medical services has gradually improved, the door, emergency services and inpatient services with an average annual growth rate of 5.07% and 24.6%. but lower than the public hospitals, the overall development of the Guangxi private hospital is still at the starting stage, especially the development of the scale, service quantity etc. compared with public hospitals, there is still a significant gap. (3) analysis of Guangxi private hospital supervision. Currently, Guangxi private hospital in the supervision of the existing problems in the process of the main To: the lack of systematic and specific laws and regulations and related policies; the medical supervision and management of law enforcement personnel shortage; hospital information disclosure mechanism is not perfect; private hospital supervision and evaluation mechanism is not perfect, the illegal cost is low; the private hospital supervision mechanism is not perfect, supervision of the lack of continuity and integrity; supervision of the main limitations. The government failed to give full play to the advantages of multiple regulatory body. [] on construction of the Guangxi Zhuang Autonomous Region multi supervision mechanism, give full play to the supervisory duties of the multiple regulatory body. First, government departments Joint Industry Association, to establish and perfect the supervision legal system of private hospitals, increase illegal punishment, to a rigid constraint function to each step of operation process of private activities in the hospital. Private hospitals supervision of relevant laws and regulations and rules of the system mainly should include private hospital operation of the legal system, regulatory mechanism The establishment and operation of laws and regulations, regulatory supervision of the implementation of rules, supervision and accountability of the legal system. Second, quantitative classification management, establish a unified information platform for health service. In the daily supervision or special inspection, the quantitative classification and evaluation of each private hospital according to the inspection results, the establishment of different levels, and in accordance with the different evaluation take the supervision and inspection of different frequency levels. In addition, to improve the medical information disclosure system of the Guangxi Zhuang Autonomous Region private hospitals, private hospitals to the public announcement of medical information and specific supervision results, strengthen the transparency of information, not only conducive to supervise the private hospital for legitimate business integrity, and to promote the fair competition of the medical service market. Third, improve the private hospital supervision and evaluation mechanism, to prevent regulatory departments of private hospitals in abuse of power phenomenon, continue to correct the regulatory process The deviation and improve the main problems existed in supervision. Fourth, cultivate industry organizations, play industry regulatory power. As the Industry Association for its industries have a certain authority, usually able to participate in the development of the industry and the relevant laws and regulations, policies, regulations and management have a certain authority. So to ensure the supervision organization, in third industries of the independence and authority of the circumstances, the medical industry regulators encouraged the establishment of private professional cultivation, social supervision power of Guangxi private hospital. Fifth private hospitals, improve the exit mechanism, and promote healthy competition. In order to really play the role of private hospitals in the medical service market. In the access of private hospitals gradually relax the restrictions at the same time, should also improve the exit mechanism of private hospitals, to avoid a lot of low levels of private hospitals in order to lower the level of competition, We can ensure that private hospitals maintain good hardware and software facilities and provide better medical services for the public.

【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.3

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