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医生和患者之间的关系是典型的委托——代理关系。但我国现行的公立医院运行体制在很多方面违背了委托代理理论中激励约束相容的基本原则,如:医患稳定代理关系缺失;医生流动性缺乏;临床医生与医疗技术部门合一;提升医患代理关系的社区卫生中心发展不完善;“医药合一”等,而医院管理体制改革的关键就是对管理者、医生和患者三者之间的关系进行调整。改革的措施是:推行病人选择医生和允许医生流动的机制;利用诊疗规范和医疗道德加强对医生的约束;强化权威第三方对医生信息的公布;推行各医院间检查、检验结果互认;强化社区卫生中心的建设;医生、医院与药品销售分离。
The relationship between the doctor and the patient is a typical principal-agent relationship. However, the current public hospital operation system in our country runs counter to the basic principles of incentive and compatibility in the principal-agent theory in many respects, such as the lack of stable medical relationship between doctors and patients, the lack of mobility of doctors, the combination of clinicians and medical technology departments, The development of community health center with agency relationship is not perfect. The key to the reform of hospital management system is to adjust the relationship between managers, doctors and patients. The reform measures include: implementing the mechanism of selecting doctors and allowing doctors’ mobility; using medical treatment norms and medical ethics to strengthen the restriction of doctors; strengthening the publication of doctor’s information by authoritative third parties; implementing inter-hospital examination and mutual recognition of test results; strengthening Community health center construction; doctors, hospitals and drug sales separation.