公立医疗机构民营化的路径选择与风险判断

自20世纪90年代后期以来,中国政府采用了渐进性的策略推动了公立医疗机构的转制与改革,民营医疗机构的数量得以大幅度攀升。尽管公立医疗机构民营化改革在增加医疗卫生资源供给、提高医疗机构运作效率与缓解政府财政负担方面显现了独到的优势,但是民营化的不良后果亦日渐暴露出来,尤其是民营化改革所内蕴的风险更是引起了社会各界的关注。本文在界定公立医疗机构民营化的内涵与可行性的基础上阐述了公立医疗机构民营化的实现路径,进而从医疗机构与患者的供需关系出发建构医疗服务提供体系,厘清医疗机构、患者与医疗保险机构等参与主体自身的内在风险因素,以及各参与主体间制约关系失衡时所引发的风险,包括新垄断风险、监管风险、软约束风险与社会公平风险等,力求全面地诠释公立医疗机构民营化的风险及其发生的机理。

Path Choice and Risk Judgment of the Privatization of Public Medical Institutions

With the reform of public medical institutions performed in China in late 1990s,the number of the private medical institution increases quickly. Although the privatization in public medical institutions plays a role in raising the supply of public healthcare resources,improving the efficiency of medical institutions and relieving the financial burden of the state,the adverse consequences emerge frequently. It is necessary to study the type and the cause of privatization in public medical institutions. Firstly,the paper defines the connotation of privatization in public medical institution and analyzes the possibility and the access to privatization. Secondly,the paper analyzes all kinds of risks in the health service system which is established in the relation between the medical institution and the patient. The paper concludes the risks,such as new monopoly risk,supervision risk,soft constraint risk,social justice and so on. At the same time,the paper points out that the risks are rooted in the inner risks of the actors and the unbalanced relation among the actors.