上海市某医院民营化个案研究/Case Study of One Private Hospital Reorganization in Shanghai

2018-10-03 07:28:59

改制 医院 hospitals hospital inner



上海市某医院民营化个案研究
(中文摘要)

在医院体制改革方面,部分医疗机构已经开始了很好的探索和实践,其中民营医院的崛起和发展引人注目。上海市曲阳医院是上海市医疗机构中最早进行体制改革的医院之一,也是上海市至今为止最大的民营非营利性医院。在上海市虹口区卫生局的主持下,曲阳医院于2003年3月18日被上海国泰医院投资管理有限公司全资买断正式转制为民营非营利性医院,在上海国有医院系统中率先迈出民营化步伐。
毫无疑问,改制后的民营医院所实施的一系列改革将是全面和彻底的。同时,医院改制和改革必然会对医院效益、医院效率、医院文化、医院员工、医院未来,乃至社区居民、社会和政府政策等都会产生巨大的影响。社会和政府对改制后的曲阳医院也会有着不同寻常的关注。人们所关心的就是改制后的医院将会实施怎样的改革和怎样实施改革?改制后曲阳医院到底会有什么变化?医院能否按照法律和政策要求规范运作?民营资本到底会采取什么样的方式来改变医院的现状?医院的医疗质量、服务态度是否会改善?医院会不会出现假药泛滥、伪劣用品横行的局面?医疗费用是否会大幅攀升?服务范围内社区居民的医疗服务能否得到更好的保障?接受服务的社区群众对改制后的医院反应性如何?哪些主要因素影响改制后医院的表现?等等,诸如此类的问题亟需有一个客观的、跟踪式的、连续性的前后比较评价,可以为医院的管理提供指导,为政府未来的卫生政策制订提供具体依据。
本文运用文献评阅、专家深度访谈、焦点组访谈、意向调查、现场调查等方法,从医院的企业化改造、核算和内控机制建设、业务和经济收入、病人费用、存在的问题等方面加以分析,揭示曲阳医院改制后内部改革和内部运作效率的变化,实事求是地分析存在的问题,并对国有医院改革和民营医院进一步发展提出思路和建议。
研究结果如下:
1.医院体制改革为深化医院内部改革提供了良好的条件
曲阳医院改制后,引入了国内外先进的企业和医院管理理念和方法,大胆地对医院进行了企业化改造。这些改革在原有的国有体制下是比较难以进行的,只有在体制改革成功后的医院才能顺利推行。医院体制改革已经成为医疗卫生事业改革发展的瓶颈,只有建立产权清晰、权责明确、管理到位的医院管理新体制,即建立现代医院管理制度,才能从根本上改变这种局面。
2.建立科学合理的核算办法和加强内控机制建设是医院内部管理的核心
为了把医院的“经济责任制”落到实处,充分调动各个责任层次的工作积极性和主动性,并对他们的工作实绩和成果进行考核和评价,打破平均主义观念,制定赏罚分明的监督制度,使每个职工得到的经济利益与他们的经济成果直接挂钩,贡献越大,收入越多。工作不利或造成损失要受罚,从而使医院的经济责任制的贯彻执行具有内在的动力。
3.医院改制促进医院内部运作效率的提高
相对于改制前,曲阳医院改制后的运作效率相对提高,主要表现在几个方面:出院病人明显增加;医院经济总收入显著提高;收入结构不断优化;病人费用增长幅度控制效果明显。
4.医院改制带来的新问题尤为突出
员工问题一直是十分敏感和脆弱的问题,也是直接关系到稳定大局的问题。这个问题不得到妥善的解决,不仅影响到医院内部的发展,更影响到医院与政府的关系,影响到医院发展的外部环境。医院不得不为一些能力不强的员工创造一些岗位,不得不为此付出额外的成本。

关键词:民营医院 改制 个案研究



Case Study of One Private Hospital Reorganization in Shanghai
(Abstract)

Some hospitals have begun exploration and practice on hospital system reform in Shanghai. Especially reforms among private hospitals have come to the front. Quyang hospital is one of the hospitals which take the lead in carrying out system reform and it is also the largest private nonprofit hospital in Shanghai. With the support of Health Bureau of Hongkou district, Shanghai Guotai hospital investment and management Co. Ltd bought Quyang hospital on March18, 2003. Thus the original state-owned hospital became a private nonprofit one and took the lead in state-owned hospitals’ privatizing process in Shanghai.
Undoubtedly, after the privatizing, inner reforms in hospitals will be implemented completely and thoroughly. Hospital reorganization and its consequent inner reforms are bound to bring tremendous impact on various aspects, such as hospitals’ benefit, efficiency, employment, culture, future, even community residents, society and government. Hence, society and government have paid much attention to Quyang hospital after hospital reorganization. What inner reforms will the hospital carry out and how to perform it? What changes will system reform bring to the hospital? Will the hospital operate obey the laws and regulations? What measures will private capital take to change the current situation of hospital? Will the health service quality and attitude be improved? Whether will fake pills or poor quality pills emerge or not? Will medical expenditure increase rapidly? Will the community residents within service radius get better health services? How will health service users responseveness to reorganized hospital? What are the main factors that affect the performance of reorganized hospital? And so on. To solve these questions, objective, tracking, continuous and comparing evaluation are needed. Such an evaluation will be able to provide both guidance to hospital’s management and evidence for government to make health policies.
Through literatures review, informant interviews, focus group discussion, willingness investigation and hospital information collecting, the researcher makes analysis for hospitals’ inner reform, auditing and accounting, inner control mechanism, operation and income, medical expenses and other existing problems. The researcher reveals that the hospital reorganization has brought inner reforms and change on efficiency. The researcher also analyzes the problems of hospital reorganization and put forward clues and suggestion for further development of state-owned hospitals and private hospitals.

Following are research results:

1. Hospital system reform provide a good environment to deepen hospital inner reforms.
After hospital reorganization, Quyang hospital has introduced some advanced ideology and methods of enterprise management and hospital management both home and abroad. These reforms have been carried out to make the hospital resemble enterprise. All these reforms are very difficult for a state-owned hospital. These reforms can be advanced smoothly only after a successful system reform in hospital. Hospitals’ system has become one crucial factor that determine whether reform on health service system can be advanced smoothly. Modern hospital management system is to be established to change the current situation.

2. To establish a reasonable scientific auditing and accounting method and reinforce inner control mechanism is the core of hospital management.
To put the idea “economic responsibility” into practice and get employees more active and initiative, the hospital has implemented evaluation on employees’ performance and their output, made regulations to award and punish employees. In this way, employees’ income is directly linked with their economic output, and the more the output is, the more the income is. On the other side, poor performance or loss-cause performance brings punishment. These measures have become inner motive to carry out “economic responsibility”.

3. Hospital reorganization improve hospital inner performance efficiency.
After hospital reorganization, Quyang hospital has improved its efficiency obviously. It is embodied in many ways: there has been pronounced increase of patients discharge from hospital and total income; income structure has been optimized; medical expenditure has been controlled effectively.

4. Serious problems have emerged with hospital reorganization
Employee issues has always been a sensitive and fragile issue and one that relate with stability. If this issue is not addressed properly, the hospital development will be affected. And even worse, it has impact on the relationship between hospital and government thus influence hospital’s external environment. So hospitals have to create some positions for less capable employees with extra cost.

Key words: private hospital , hospital reorganization, case study