中国公立卫生系统中的病人非正常支付 = Governing informal payments in the Chinese public health care system
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NO FULL TEXT AVAILABLE. Access is restricted indefinitely. ----- 本研究进行的是探索性政策研究，采用的是重点合成研究方法。其目的是研究中国卫生系统中治理非正常支付的政策和制度，并对它们的效果进行评价和建议。本论文着重探讨了从1993年以来治理非正常支付的政策的内容，指出近二十年以来，卫生行政部门一直強调医务人员不得收受病人的非正常支付。本论文进一步探讨了治理的组织结构和制度建设，指出在组织结构上，治理非正常支付是通过属于共产党党的纪律和属于政府的行政纪律三个监察机构进行的。从制度上看，治理政策建立了“一把手负责制”、道德模范制度、医德考评制度、承诺制和民主评议行风制度。论文最后指出，这些组织机构和治理制度没能有效地遏制非正常支付。相反，非正常支付的现象愈演愈烈。论文认为政策的失败在很大程度上与中国医务人员的职业和执业制度的设计有关。中国医生在一个官僚体制中行医。这个体制既抑制了医生对国家的议价能力，又保护了医生对病人的主宰。如果不改变医生的职业和执业制度，非正常支付很难得到有效的控制。 This research is an exploratory policy study using focused synthesis as its research method. The aim is to explore the policies and institutions governing informal payments in the Chinese health care system, analysing the outcome of the policies, and providing suggestions. The thesis firstly analyses the contents of the policies implemented since 1993 and points out that in nearly 20 years the state has always made it clear that health professionals are not allowed to take informal payments from patients. The thesis then examines the governing structure and institutions, revealing that organizationally the informal payment is governed by three disciplinary organs belonging respectively to the Chinese Communist Party and the Government. Several governing institutions have been established, including "the head taking responsibility", moral model, professional ethics evaluation system, public promising, and democratic evaluation of professional conducts. However, these organs and institutions failed to curb the informal payment in the health care system. On the contrary, the unhealthy practice has become endemic. The thesis argues that the failure is partly contributable to the professional position of Chinese doctors, who practice in a bureaucratic system. The power structure of the Chinese bureaucratic system decides that the state exercises a comparatively thorough and strong control over the medical professions. In particular, the state decides doctors' economic and work conditions. In face of such control, doctors do not have much bargaining power but to accept them. In the meanwhile, the bureaucratic system protects the doctor's dominance over the patient. Without fundamental changes to the employment and practicing systems, informal payments can hardly be regulated.
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