政事分开视域下的公立医院法人治理研究

总体来看,我国公立医院自主权呈不断扩大态势,多数处于“预算制组织”与“自主化组织”之间。根据决策权在政府与公立医院间的分配情况,中国公立医院与政府间关系存在着三种类型:政医不分、政医分离、政医分开不分离。政医不分与政医分离两种类型的具体表现形式有公立医院不自主、依附式自主、膨胀式自主与萎缩式脱离。研究发现,中国公立医院治理中存在政医不分、政医分离、办医职能分散于政府以及政府与公立医院以及公立医院内部的委托代理问题。对此,提出“政医分开不分离”,将以“法人治理结构”为核心的制度安排作为调整政府与公立医院关系的抓手,提出基于多中心治理理论的公立医院法人治理结构、制衡与激励约束机制。

Public Hospitals Corporate Governance from the Perspective of Separating Public Service Units from Government

Overall, the autonomy of China's public hospitals extends continuously, most of which are nearly between budgeting organization and autonomous organization. According to the distribution of decision-making powers between the government and the public hospital, the paper puts forward three kinds of relationship type: the public hospital being entangled with the government, the public hospital breaking away from the government, and separating the public hospital from the government with organic connection. The relationship of entanglement type manifests as affiliated administration and restricted dependent autonomy. The detachment type manifests as inflated autonomy and atrophic detachment. A series of incurred problems and contradictions originate from such problems as the entanglement, the detachment, the principal-agent chain between the government and the public hospital, and the hospital building functions dispersing in various government departments and the fragmentation of external governance in the course of public hospital governance. To solve these problems the paper puts forward separating the public hospital and not breaking away from the government, taking the institutional arrangement centering the corporate governance structure as the grasp to readjust the relationship between the government and the public hospital. Based on the polycentricity governance theory, the paper designs and analyzes the corporate governance structure of public hospitals, the check-and-balance system, and the incentive-restraint mechanism.