我国遏制卫生腐败行为的政策措施及效果:系统综述

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目的:归纳我国当前遏制卫生腐败行为的政策措施并评价政策实施的效果。方法:检索中国知网、万方、PubMed和ProQuest数据库中截至2021年1月发表的卫生腐败行为相关文献。同时,通过参考文献、咨询专家、检索政府官方网站、利用搜索引擎等方式收集更多会议资料、新闻、报刊、微信短文视频等文献。采用系统综述的方法,运用主题综合的资料整合方法,提取纳入文献的相关主题信息,对比归类主题并形成整合性观点。结果:共纳入147篇文献,涉及到的卫生政策有基本药物制度、药品和医疗器械的集中招标采购和带量采购、“两票制”、院务公开和商业贿赂不良记录,医德考评制度和不收不送“红包”协议,上述政策措施对医疗卫生领域的腐败行为有遏制效果,但某些腐败行为表现出新的发展趋势。结论:研究中总结的5类政策干预有效控制了药品、耗材和器械相关的腐败高发点、引导约束了行为主体的趋利行为。更强有力的腐败措施应该整合进宏观的医疗体制改革中,与机构补偿和运行机制改革结合,与医务人员激励制度结合、与现代多元化治理改革结合;同时,腐败领域的研究需要更整合地视角、关注多层面医改政策对腐败治理的直接和间接影响、关注更多类型的腐败行为、多样化研究方法,以提供更实用的政策支持。“,”Objective:To summarize the current policies and measures in curbing health corruption in China, and to evaluate the implementation results of these policies and measures.Methods:We made a systematic review to search and screen the literatures, with related thematic information extracted, compared and classified to form an integrated view by the data integration method of thematic synthesis.Results:A total of 147 literatures were included, covering such health policies and measures as the basic drug system, the centralized bidding and purchasing and centralized drug purchasing, the “ two-invoice system” , hospital information disclosure system, adverse records of commercial bribery, doctor′s virtue evaluation system and no bribery agreement. These five policies and measures prove effective in curbing the corruption, but some types of corruption tend to evade such restrictions.Conclusions:The five types of policy measures summarized in the study have effectively curbed the high risk exposure of corruptions found in drugs, medical consumables and medical devices, and also guided and restrained the profit-oriented behaviors of the behavior subjects. Stronger measures should be integrated into a broader reform of the healthcare system, in combination with institutional compensation and operational mechanism reform, medical personnel compensation and incentive system, and modern pluralistic governance reform. Meanwhile, studies in the field of corruption need to focus on the direct and indirect effects of multi-level medical reform policies on corruption governance from an integrated perspective, while attention needs to cover more types of corruption behaviors, and to diversify research methods, so as to provide more practical policy support.
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