中国医患关系的新制度经济学分析
New Institutional Economics Analysis of Doctor-patient Relationship in China
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摘要: 中国医疗卫生体系不完善,但医疗需求却呈现出倍数增长的趋势,这使得医患纠纷不断增加,甚至导致了严重的医患冲突,日益紧张的医患关系阻碍了中国医疗保障的进一步发展。运用新制度经济学的相关理论,对中国的医患关系发展现状如人口流动的健康红利、医师成长的成本、"看病难、看病贵"的交易成本以及医患冲突的外部性等进行分析,提出应提高统筹层次以促进成本内部化,科学厘定产权以实现医保关系转移接续,通过制度和经济手段约束医师行为,建立多方筹资的医疗风险分担机制,化解医患矛盾等途径,构建和谐的医患关系,促进中国医疗卫生事业的进一步发展。Abstract: With the imperfect health care system and the increasing needs for medical care in China, it is not difficult to find more and more reports about the disputes, or even serious conflicts between doctors and patients in domestic hospitals, which obviously hinders the further development of medical care in China. The paper tries to use the new institutional economics theory to analyze the status of doctor-patient relationship in China, such as health bonuses of migration, cost of physician growth, transaction cost of "difficult and expensive" treatment and the external factors of the doctor-patient conflicts. The paper suggests that China need to improve the overall level of health care coordination so as to achieve cost internalization, promote scientific determination of property rights so as to transfer health care relation. China also needs to constrain physician behaviors by institutional and economic means and establish a multi-party financing mechanism to share the risk of medical care and thus resolve the conflicts between doctors and patients. Only then a sustainable development of medical care can be achieved in China.