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<section class="" style="padding: 10px; max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; display: inline-block; width: 556px; border: 1px solid rgb(192, 200, 209); word-wrap: break-word !important; background-color: rgb(239, 239, 239);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><p style="max-width: 100%; min-height: 1em; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="max-width: 100%; font-size: 14px; box-sizing: border-box !important; word-wrap: break-word !important;">促进医疗资源合理配置是我国医药卫生体制改革的重要内容，医院托管则是实现优质资源下沉的一种便捷的方式。目前医院托管作为一种市场自发行为越来越受到医院管理者的青睐，以托管契约的形式约定双方责任与权利，保障了技术、人才等优质医疗资源从大型医院向中小型医院流动。</span></p></section></section></section></section></section><p><br /></p><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; width: 670px; word-wrap: break-word !important; background: -webkit-linear-gradient(left, rgb(95, 156, 239), rgba(255, 247, 234, 0)) rgba(174, 81, 81, 0);"><section class="" style="padding: 5px 10px; max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; color: rgb(255, 255, 255); font-size: 19.2px; word-wrap: break-word !important;"><p style="max-width: 100%; box-sizing: border-box; text-align: left; margin-bottom: 5px; margin-top: 5px; word-wrap: break-word !important;"><span style="font-size: 18px;">国外医院托管经验</span></p></section></section></section></section></section></section></section></section><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section><section class="" style="padding-right: 3px; padding-left: 3px; max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; line-height: 1.2; word-wrap: break-word !important;"><section style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><span style="font-size: 14px;"> <span style="max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="font-size: 14px; max-width: 100%; color: rgb(0, 128, 255); box-sizing: border-box !important; word-wrap: break-word !important;">美国</span></strong></span> </span></section></section><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section></section></section><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;"> 根据美国医院协会（American Hospital Association）数据显示，2009年美国的医院构成中公立医院为1303所，占总数22.5%[1]。美国公立医院主要病人多属弱势群体，因此政府采取第三方托管公立医院的方式来保证医院的运营效率和公益性。如美国纽约市立健康和医院公司（New York Cityand Hospital Corporation，HHC），成立于1969年，其前身是纽约医院管理局，采取私营医院管理公司托管的模式来管理当地的公立医疗机构，聘用职业管理人员和医生代表来管理公立医院。</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;"> 相比政府的直属管理，HHC拥有很大的独立性和自主权，决策和运作效率得到提高。政府通过对董事会的人事任命和财政拨款对公立医疗系统进行宏观上的控制。同样类似的还有佛罗里达州迈阿密市的公立医院托管机构（Public Health Trust）。</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;"> 对于经营不善的私立医院而言，在市场化程度较高的美国，通常以商业化的形式被实力雄厚的医疗集团收购或托管。如美国医院管理公司（Healthcare Corporation of America，HCA），是世界上最大的私立医疗机构运营商之一，截至2012年，HCA公司在20个国家拥有163家医院和109个独立的诊疗中心，托管约40多个医院和800多个独立的诊疗中心。</span></p><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section><section class="" style="padding-right: 3px; padding-left: 3px; max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; line-height: 1.2; word-wrap: break-word !important;"><section style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><span style="font-size: 14px;"> <span style="max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="font-size: 14px; max-width: 100%; color: rgb(0, 128, 255); box-sizing: border-box !important; word-wrap: break-word !important;">新加坡</span></strong></span> </span></section></section><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section></section></section><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;"> 1985年起，新加坡开始重组国有医院，医院所有权属于卫生部，但经营管理权委托给公司。政府将资产按照市场化的方式托管给公司进行运作和管理，使医院的运营效率提高而费用降低，实行以“社会效益为主，不追求利润”的运作方式。管理医院的公司则必须与卫生部签订协议，保证临床指标、医院指标、临床服务类型、津贴服务、人员培训等达到一定要求，并定期接受卫生部的监督。政府的另一大任务是向医院提供年度财政拨款，及向患者提供政府医疗津贴。政府对医院及患者就医的补偿资金占医院总收入的50％，剩下的50％为患者自付。</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;"> 医院重组后相当于非营利性组织，需服从政府部门的政策指导[2]。公司化的管理让医院得以施行更为灵活的人事制度及运营管理策略，可以更好地满足病人的需求。</span></p><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section><section class="" style="padding-right: 3px; padding-left: 3px; max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; line-height: 1.2; word-wrap: break-word !important;"><section style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><span style="font-size: 14px;"> <span style="max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="font-size: 14px; max-width: 100%; color: rgb(0, 128, 255); box-sizing: border-box !important; word-wrap: break-word !important;">日本</span></strong></span> </span></section></section><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section></section></section><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;"> 日本的医院改革主要采取将一部分公立医院委托给民间机构运营的方式来进行，即国有民办和医院自治相结合。政府根据社会医疗需要和医院运营状况，将一部分公立医院予以废止；在一部分公立医院中引入民间资本，实行民营化的运营方式；保留一部分公立医院，由政府继续提供资金支持，产权不变，但是委托民间机构来进行运营；还有一部分极其重要的公立医院，采用独立行政法人的方式来运营，即委托内部管理层来运营。</span></p><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; width: 670px; word-wrap: break-word !important; background: -webkit-linear-gradient(left, rgb(95, 156, 239), rgba(255, 247, 234, 0)) rgba(174, 81, 81, 0);"><section class="" style="padding: 5px 10px; max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; color: rgb(255, 255, 255); font-size: 19.2px; word-wrap: break-word !important;"><p style="max-width: 100%; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="font-size: 14px;">国内医院托管经验</span></p></section></section></section></section></section></section></section></section><p><br /></p><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section><section class="" style="padding-right: 3px; padding-left: 3px; max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; line-height: 1.2; word-wrap: break-word !important;"><section style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><span style="font-size: 14px;"> <strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="font-size: 14px; max-width: 100%; color: rgb(0, 128, 255); box-sizing: border-box !important; word-wrap: break-word !important;">仁济托管模式</span></strong> </span></section></section><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section></section></section><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; word-wrap: break-word !important;"> 上海仁济管理公司成立于2003年，由上海仁济医院倡议，社会资本入股，共同成立医院管理公司，借鉴了国外医疗管理公司的经验。上海仁济管理公司以公司运作的模式来管理医院托管行为，同时向被托管医院输出大型医院的品牌、管理、技术和资金。仁济管理公司是独立法人单位，对外独立承担经营风险和法律责任。目前仁济管理公司共托管医院15家。<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;" /></span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;">仁济托管对我国医院托管的一大贡献是，提出了托管的“七个不变原则”，具体为：</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;">（1）医院独立法人地位不变；</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;">（2）医院的性质和功能不变；</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;">（3）医院资产归属关系不变；</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;">（4）政府及卫生行政部门对医院的领导、指导职能不变；</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;">（5）政府对医院的财政拨款渠道不变且标准不低于托管前水平；</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;">（6）党、工、团等医院组织的地位、职责和隶属关系不变；</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;">（7）医院在编职工身份不变，基本工资、福利待遇不低于现有水平[3]。</span></p><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section><section class="" style="padding-right: 3px; padding-left: 3px; max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; line-height: 1.2; word-wrap: break-word !important;"><section style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><span style="font-size: 14px;"> <strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="font-size: 14px; max-width: 100%; color: rgb(0, 128, 255); box-sizing: border-box !important; word-wrap: break-word !important;">同济医院托管模式</span></strong> </span></section></section><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section></section></section><p><br /></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; line-height: 1.75em; font-size: 14px; box-sizing: border-box !important; word-wrap: break-word !important;"> 同济医院拥有十多年对口支援边远地区医院建设的经验，在实施“以大带小”，帮助中小型医院进行品牌建设、技术提升、人才培养、管理发展等方面有着丰富的经验与独到的做法。在华中地区，同济医院较早进行了医院托管方面的探索，2008年即托管了武汉市汉南区人民医院，2011年又托管了咸宁市中心医院，运营3年后，取得了优异的成果。</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;"> 同济医院主要采取派驻管理人员担任院长、定期派驻医疗专家进行技术扶持和学科建设的方式，来帮助被托管医院进行医院管理体系的建设和医疗能力的提升。同时畅通学习通道，让被托管医院医务和管理人员无偿赴同济医院进修学习。在前期全面摸底调研的基础上，通过移植和引进同济医院的成熟且行之有效的管理经验与先进技术，挖掘被托管医院发展潜力，使被托管医院实现跨越式发展。这种模式被称为同济医院托管模式，且在不断探索与完善中。</span></p><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section><section class="" style="padding-right: 3px; padding-left: 3px; max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; line-height: 1.2; word-wrap: break-word !important;"><section style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><span style="font-size: 14px;"> <strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="font-size: 14px; max-width: 100%; color: rgb(0, 128, 255); box-sizing: border-box !important; word-wrap: break-word !important;">港台地区医院托管经验</span></strong> </span></section></section></section></section><p><br /></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; line-height: 1.75em; font-size: 14px; box-sizing: border-box !important; word-wrap: break-word !important;"> 我国香港地区医院托管主要是由政府成立的医院管理局来托管公立医院。1990年成立的香港医院管理局负责将香港所有公立医院进行整合，以集团化经营的方式来运营，从而提高经营效率。我国台湾地区公立医院一般采取国有民营的方式进行运营，医院的产权归政府所有，民营管理机构则受托取得医院的经营管理权。民营管理机构主要采用现代化的管理方法来提高医院运营效率。</span></p><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; width: 670px; word-wrap: break-word !important; background: -webkit-linear-gradient(left, rgb(95, 156, 239), rgba(255, 247, 234, 0)) rgba(174, 81, 81, 0);"><section class="" style="padding: 5px 10px; max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; color: rgb(255, 255, 255); font-size: 19.2px; word-wrap: break-word !important;"><p style="max-width: 100%; box-sizing: border-box; text-align: left; margin-bottom: 20px; word-wrap: break-word !important;"><span style="font-size: 14px;">医院托管的成功条件与现实困难</span></p></section></section></section></section></section></section></section></section><p><br /></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px; line-height: 1.75em;"> 2010年，原卫生部发布了[2010]20号文件《关于公立医院改革试点的指导意见》，在试点的主要内容“完善公立医院服务体系”一条中提出，“通过合作、托管、重组等方式，促进医疗资源合理配置”，肯定了十几年在全国各地开展的医院托管工作。</span><span style="max-width: 100%; line-height: 1.75em; font-size: 14px; box-sizing: border-box !important; word-wrap: break-word !important;"></span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;"> 发生在我国的医院托管，作为一种自发的市场行为，毫无疑问是有利于托管双方的。以同济医院托管咸宁市中心医院为例，首先是建立了比双向转诊更为有效的医疗支援模式，由同济专家到咸宁市中心医院坐诊，使当地群众不出门就可享受到省城顶级医疗服务，节省了群众时间和经济成本；其次是使被托管医院诊疗能力提升，各方面得到长足的发展；第三，同济医院通过托管地市级医院的方式体现了医院的社会公益性，提高了同济医院知名度，更重要的是体现了深化医改的重要内容，为实现“管办分离”的公立医院改革目标提供了借鉴，最终实现群众满意、医院满意、政府满意的良好局面。地方政府支持给予充分管理权、精细调研以定位医院发展方向、取得被托管医院职工支持认可、同济医院在技术和管理的全面输出是托管得以成功的4个必要条件。</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;"> 但并非所有的托管都能取得良好效果，也有一些托管失败的案例。如2009年2月厦门大学第一附属医院托管集美区灌口医院，由于编制、业务批复、员工需求矛盾等问题，于2010年7月提前终止托管协议[4]。黄淇敏等认为，职工文化冲突、政府支持态度改变、对托管方期望过高、对收取托管费不理解、托管团队能力不够是导致托管遇到困境的重要因素[5]。上海仁济医院院长范关荣认为体制瓶颈、文化理念差异、利益冲突、基层医院人才缺乏是当前医院托管存在的问题。</span></p><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; width: 670px; word-wrap: break-word !important; background: -webkit-linear-gradient(left, rgb(95, 156, 239), rgba(255, 247, 234, 0)) rgba(174, 81, 81, 0);"><section class="" style="padding: 5px 10px; max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; color: rgb(255, 255, 255); font-size: 19.2px; word-wrap: break-word !important;"><p style="max-width: 100%; box-sizing: border-box; text-align: left; margin-bottom: 20px; word-wrap: break-word !important;"><span style="font-size: 14px;">讨论</span></p></section></section></section></section></section></section></section></section><p><br /></p><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section><section class="" style="padding-right: 3px; padding-left: 3px; max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; line-height: 1.2; word-wrap: break-word !important;"><section style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><span style="font-size: 14px;"> <strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="font-size: 14px; max-width: 100%; color: rgb(0, 128, 255); box-sizing: border-box !important; word-wrap: break-word !important;">政府对医院托管具有监管职能</span></strong> </span></section></section><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section><p><br /></p></section></section><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; word-wrap: break-word !important;"> 由上述不同国家和地区的托管经验可见，美国、新加坡等国医院托管主要由政府主导，将经营不善的公立医院改由私营化的医院管理公司来经营管理，以减轻政府的管理成本，并提高医院运营效率。政府不直接管理医院，但通过协议的方式监管医院，并履行出资人义务，有效地明确了政府的职能。<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;" /></span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;"> 私立医疗机构被托管则是一种市场自发行为，是经济规律在医疗市场中的一种体现，有利于医疗服务供给的标准化和资源配置，知名的如美国的HCA公司、新加坡的百汇医疗集团。但资本的逐利性会导致过度医疗，增加患者负担，还需政府明确监管责任。</span></p><section style="max-width: 100%; box-sizing: border-box; color: rgb(62, 62, 62); font-size: 16px; line-height: 25.6px; white-space: normal; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section class="" powered-by="gulangu" style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-right-width: 0.6em; border-right-style: solid; border-right-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section><section class="" style="padding-right: 3px; padding-left: 3px; max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; line-height: 1.2; word-wrap: break-word !important;"><section style="max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><span style="font-size: 14px;"> <strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="font-size: 14px; max-width: 100%; color: rgb(0, 128, 255); box-sizing: border-box !important; word-wrap: break-word !important;">医院托管在我国具有良好前景</span></strong> </span></section></section><section class="" style="max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: top; word-wrap: break-word !important;"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; opacity: 0.6; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span><span style="font-size: 14px; max-width: 100%; box-sizing: border-box; width: 0px; display: inline-block; border-left-width: 0.6em; border-left-style: solid; border-left-color: rgb(95, 156, 239); word-wrap: break-word !important; border-top-width: 0.5em !important; border-top-style: solid !important; border-top-color: transparent !important; border-bottom-width: 0.5em !important; border-bottom-style: solid !important; border-bottom-color: transparent !important;"></span></span></section><p><br /></p></section></section><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 1.75em; text-align: left; margin-bottom: 20px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="font-size: 14px;"><span style="font-size: 14px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; word-wrap: break-word !important;"> </span>医院托管作为医院与地方政府<span style="font-size: 14px; max-width: 100%; line-height: 1.75em; box-sizing: border-box !important; word-wrap: break-word !important;">自发选择的一种方式具有使多方共赢和具备合约保障稳定性等优点，值得政策制定者与学者的进一步关注。现在，不仅遭遇经营困境的医院需要托管支持，甚至出现了地区新建医院也选取托管共建的方式来进行，说明医院托管作为一种现代医院契约式对口支援的方式受到了医院管理者的欢迎。仁济公司将大型医院对口支援和公司化管理进行了有机结合，相比较大型医院的托管，属于托管效率较高的模式，同时还避免了医院管理公司在人才、品牌、技术支援方面的不足，在我国有良好的前景。</span></span></p><section class="pEditor " style="line-height: 25.6px; white-space: normal;"><section data-css="background-color: rgb(239, 239, 239);border-radius: 5px;border: 1px solid rgb(153, 153, 152);margin: 0px;padding: 5px" style="padding: 5px; border-radius: 5px; border: 1px solid rgb(131, 147, 209); text-align: center; background-color: rgb(239, 239, 239);"><section data-css="color: inherit;display: inline-block;margin: 1px" style="margin: 1px; color: inherit; display: inline-block;"><span style="padding: 2px 10px; border-color: rgb(204, 204, 204); border-radius: 2px; color: rgb(1, 1, 3); font-weight: bold; font-size: 18px; background-color: rgb(109, 205, 25);">推荐阅读</span></section><section data-css="color: inherit;margin: 0px;padding: 10px" style="padding: 10px; 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发表于 2020-10-21 12:34:48