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公立医院以企业化经营虽有多年,但绝大多数医院仍不具备建立现代企业制度的条件,其内部管理、成本核算、财务制度等方面存在的问题仍未解决。再说,医院原动力也不足。 根据医疗卫生体制改革要求,医疗机构划分为营利与非营利两大类,前者享有自主定价、自主确定服务项目的权利、同时必须向国家缴纳营业税款,后者基本维持现状。后者则仍有政府财政、税收政策等“干爹干娘”的靠山,仅凭“医疗保险定点单位”这块“金字招牌”,就比营利性医院要幸运多了。因而,许多医院都拼命往“非营利”行列里挤。据北京市医疗管理部门提供的数据,市属100多家医疗机构中,只有8家申报营利性医院。河北现行登记的各级各类医院总数中,营利性医院占总数比例近45％,但占有资源总和不及全省卫生资源的1％。
Although public hospitals have been operating for many years, most hospitals still do not have the conditions to establish a modern enterprise system. Problems with internal management, cost accounting, and financial systems remain unresolved. Moreover, the hospital’s motivation is not enough. According to the requirements of medical and health system reform, medical institutions are divided into two categories: profit-making and non-profit. The former enjoys the power of independent pricing and self-determination of service items. At the same time, it must pay sales tax to the state. The latter basically maintains the status quo. The latter still has government finances, taxation policies, and other “back-ups” for the backers. It is much more fortunate than for-profit hospitals to rely solely on “medical insurance designated units”. As a result, many hospitals are desperately forced into the “non-profit” ranks. According to the data provided by the Beijing Municipal Medical Administration Department, of the more than 100 medical institutions in the city, only 8 have reported to for-profit hospitals. Of the total number of hospitals of various types currently registered in Hebei, for-profit hospitals account for nearly 45% of the total, but the total resources are less than 1% of the province’s health resources.