摘要
本文讨论了城市分级诊疗体系的历史变迁与实施效果,由此检讨政府在医疗领域的职能问题。基于对田野调查资料、统计数据与既有文献的收集、整理与分析,本文梳理了分级诊疗体系在改革前后的制度设置与执行效果,并以"制度嵌入性"的视角剖析了原因。研究发现,从改革前的三级医疗保健网到改革后的医院分级管理制,分级诊疗在制度设置上一脉相承,但其施行效果在两个时期却有天壤之别。这主要由于与分级诊疗紧密关联的三个制度设置在改革前后的根本变化:卫生工作指导思想的逆转、国家-单位医疗保障制度的崩溃和政府对公立医院财政补偿的削减,而这些变化反映了政府在该领域中不合理的角色转变。因此,本文建议,政府应该履行资源投入、搭建制度框架、保障制度执行等职能,由此改变这些关联性的制度设置,最终使分级诊疗达至理想的效果。
This paper aims to examine the role of government in medical care through discussing historical change of tiered medical services system and its effectiveness of different periods in urban China. Based on the authors' fieldwork data,governments' statistical data,and relevant literature,this paper delineates the institutional arrangements and the consequences of tiered medical services system before and after the Economic Reform,and analyzes the reasons by the theoretical perspective of institutional embeddedness. This paper findsthat though Three-tiered Medical and Health Care Network before the Reform and Hospital Tiered Management System after the Reform have the same goals and institutional logic,the two systems lead to entirely different policy results. According to the perspective of institutional embeddedness,three highly relevant intuitions are examined:Guiding ideology of health affairs as normative and cognitive-cultural institutions,and health financing system and healthcare delivery system as regulative institutions. The key reason why the similar institutional arrangements of tiered medical services system before and after the Reform lead very opposite results is the fundamental change of these relevant institutional arrangements after the Reform:the overturn of guiding ideology of health affairs,the collapse of state-unit health security system,and the dramatic reducing of governmental financial support for public hospitals. These changes reflect that the government shrank its responsibility to afford and provide healthcare services for the people. Hence,this paper suggests that the government should increasing its financial support for health security and healthcare providers,construct institutional frameworks for health affairs,and guarantee the execution and effectiveness of policy arrangements. Then,the highly relevant institutional arrangements will be reserved,and the goal of tiered medical services system will be realized.
出处
《公共管理学报》
CSSCI
北大核心
2016年第3期61-70,155-156,共10页
Journal of Public Management
基金
教育部人文社会科学研究青年基金项目(14YJC840040)
上海市哲学社会科学规划青年课题(2014ESH001)
关键词
制度嵌入性
分级诊疗
政府职能
资源筹措
服务递送
Institutional Embeddedness
Tiered Medical Services System
Government Functions
Health Financing
Healthcare Delivery
