公立医院业务运营与财政投入成效——以2012-2015年北京21家市属公立医院为例

摘要

Since the new healthcare reform in China,public hospitals have received a huge amount of financial support from governments.However,they are still faced with severe problems of deficits.Thus,how to understand such deficits and how to evaluate the results of government financial inputs are crucial to determine the next step of the healthcare reform.Based on the soft budget constraint theory,and after an in-depth case study of 21 state-owned hospitals in Beijing,it is found that financial inputs will not improve the operational performance of public hospitals,but will cause a competition among hospitals in raising up staff salaries,leading to the situation of "more financial inputs,more operational deficits".Thus,it concludes that increasing direct financial inputs is likely to push up the cost of the reform,rather than improving the quality of public service and public welfare.%新医改以来,大量财政资金投入公立医院,但公立医院运营持续亏损,在此背景下,如何理解公立医院亏损、评估财政投入成效,对实施下一步医改至关重要.本文在"预算软约束"的理论框架下展开分析,通过研究2012-2015年北京21家市属公立医院的案例发现,财政投入本身并不能改善公立医院的运营状况,甚至会引发公立医院之间的攀比、追赶,进一步刺激人员经费支出,造成"越补越亏".因此,增加对公立医院的直接财政投入很可能导致公共资金无效流出,推高改革成本,而不是提高公共服务的质量、改善民生福利.