新疆公立医院补偿的水平测度、维度厘清和联动机制构建

At present, China's health care reform compensate for the hospital, focusing on the "two pronged" compensation model that by the adjustment of medical service price and the increase of financial input on both political and practicical levels .The fairness of the compensation mechanism and the resource investment did not achieve the expected effect and the patients didn’t get a strong sense of enjoying the benefit.. According to the idea of management accounting, the lower limit of compensation is the break even, and the income makes up the reasonable cost to achieve the balance of profit and loss . Therefore the increase of public hospital income includes not only the narrow income increase that are brought about by the national financial investment growth and the medical service price growth, but also the broad income increase that are due to the effective cost control and reduce of the cost , in other words,the compensation mechanism of public hospitals not only involves the dimension of income, but also relates to the cost control dimension..With the vast territory and the low level of economic development, local Xinjiang government faces certain difficulties with greatly enhancing the investment of the hospital; The multi-ethnic and relatively low income levels also restricts the medical service price increases and the social stability. This topic will specify the connotation of the Xinjiang public hospital compensation level and scientifically measure ,clarifying a compensation method associated with two dimensions from the income and cost control, and will construct a multi -linkage mechanism that can not have a heavier financial burden on local government and can reflect the public intrest of the public hospital ,finally realizing the public hospital comprehensive compensation of the public hospital from the multi- subject interests equilibrium perspective .

目前，我国医改无论是政策层面还是实践层面都侧重于通过调整医疗服务价格和增加财政投入“双管齐下”的补偿模式来对医院进行补偿。这种补偿机制的公平性及资源投入未达到预期效果。依据管理会计的思路，补偿的下限是盈亏平衡，而收入弥补了合理的成本才达到盈亏平衡。因此公立医院收入的增加不仅包括国家财政投入的增长和医疗服务价格的增长所带来的狭义的收入增加，还应包括由于成本的有效控制和降低而带来的广义的收入增加，即公立医院的补偿机制不仅涉及收入维度，还应涉及成本控制维度。.新疆地域辽阔，经济发展水平较低，政府对医院的补助大幅度提高存在一定的困难；多民族聚居和相对低的收入水平也制约着医疗服务价格的提高以及社会的稳定。本课题将明确新疆公立医院补偿水平的内涵并进行科学地测度，厘清一条从收入和成本控制两个维度相联系补偿思路，并从多方主体利益均衡视角构建真正实现公立医院全面补偿的多方联动机制。

现阶段，我国医改无论是政策层面还是实践层面都侧重于通过调整医疗服务价格和增加财政投入“双管齐下”的补偿模式来对医院进行补偿。但忽略了对以下问题的思考：什么是公立医院合理的补偿水平？切实有效的补偿是否仅指收入的补偿？.基于此，本研究提出公立医院补偿的“二维多方联动机制”，认为要构建收入补偿维度内的多方主体联动机制、成本控制维度内的多方主体联动机制、收入补偿和成本控制两个维度之间的联动的多方主体联动机制。.首先，健全收入补偿和成本控制。在政府层面上，主管部门应发挥医疗卫生领域制度的设计者、制定者、宏观调控者和监管者的职能。在医保机构层面，建立并落实医疗保险基金督察制度。在医院层面，对医疗服务行为和费用的调控引导，对医务人员医疗服务行为监管。其次，优化收入补偿维度各利益主体的联动机制应考虑财政承受能力和不同地区经济发展不平衡的实际情况。再次，完善成本控制维度各利益主体的联动机制，应主导推行医疗分级双向转诊制度实现医院和患者的联动；各级行政主管部门强化政策、法规、规划、标准的制定和监督指导，实现医保部门、医院、医生和患者的联动；医保部门通过各种制度的建立和健全实现医院和患者的联动；在医院内部，从被动预算向主动预算转变；控制医院内部的变动成本、医院内部的约束性固定成本。.医联体建设是完善“二维多方联动机制”的重要举措。从组织形态看，医联体是多家公立医院的组合体，从功能上继承了公立医院代替政府进行市场干预而提供公共医疗服务的作用。同时，它通过公立医疗资源的整合形成价值链，公益性的发挥能力比单一公立医院更强，更能克服市场中的垄断行为和控制单一医院医疗服务收费。优化医联体建设，更好地实现对公立医院的补偿应关注以下几点：完善制度设计，降低协调费用；实现成果共享，降低激励费用；完善监管体系，降低监督费用；实现信息互通，降低信息费用；平衡医疗资源，降低决策费用。.