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本文基于新制度经济学的理论框架,着重对我国医药腐败的原因进行了解释性研究。通过对构成现行医药体制的大量的正式制度和非正式制度的梳理,作者认为,其中三项制度安排是最关键的。这三项制度安排分别是:高度行政垄断以及顺加作价的特殊医疗服务定价政策;保护强势一方的信息不对称政策;医疗事故鉴定、举证责任安排失当的医患纠纷处理机制。随后,文章对这些制度安排下各行为方的最大化选择进行了细致的解释,从而支持了医药腐败的根本原因在于现存体制的假设。研究还指出,不彻底改变这些基础性的制度安排,像药品采购这样的反腐对策都不可能发挥作用。文章最后提出了三个方面的医药体制改革政策建议。
Based on the theoretical framework of new institutional economics, this paper focuses on the explanation of the causes of Chinese medicine corruption. By reviewing a large number of formal and informal systems that make up the current medical system, the author believes that three of the institutional arrangements are the most crucial. The three institutional arrangements are: a high degree of administrative monopoly and the price of special medical services Shunjia pricing policy; protection of the strong side of the information asymmetry policy; identification of medical malpractice, improper arrangements for the burden of proof of the doctor-patient dispute resolution mechanism. Subsequently, the article gives a detailed explanation of the maximization of the choice of actors under these institutional arrangements, thus supporting the hypothesis that the root cause of the medical corruption lies in the existing system. The study also pointed out that not completely change these basic institutional arrangements, anti-corruption measures such as drug procurement can not play a role. Finally, the article proposed three aspects of the pharmaceutical system reform policy recommendations.