医疗费用上涨与医德医风下降:组织架构变革角度的解释

改革开放以来,我国医疗卫生事业在快速发展过程中产生两个突出的问题:一是医疗费用增速过快;二是部分医院医德、医风下降。关于医疗费用增速过快,以往的研究主要从“成本驱动”的角度进行解释,而对医院医德、医风下降则从“环境诱导”的角度进行解释。本项研究选择6家大型国有综合医院作为案例,对医院组织架构的核心——决策权分配、业绩评估和激励政策的变革进行了考察,对变革的影响从医院与内部职工、患者和第三付费方的角度分别进行了分析,对医疗费用增长和医德医风下降从医院组织架构变革角度进行了解释。本文也对研究结论的政策意义进行了讨论。

Rising Medical Cost and Deteriorating Professionalism: from an Organizational Architecture Perspective

Since the reform and the adoption of opening up policy, two extraordinary problems have appeared in the rapid development of China's health care: the medical cost has risen too fast; and doctors' integrity has been worsening. In the previous studies, the first issue was interpreted largely from the aspect of "cost-driven", while the latter one from the angle of "environment-induced". With the cases of six large state-owned general hospitals as our study cases, we have investigated the transformation of hospital organizational structure in the assignment of decision-making right, performance evaluation and stimulation policies, analyzed the effect of this change respectively from the views of hospitals, hospital staff, patients and the third party payers, and accounted for the two problems mentioned above from the aspect of change in the organizational formation of hospitals. Furthermore, this paper discusses the policy implications of the conclusion made in this article.