【文章內(nèi)容簡(jiǎn)介】 83。致謝摘 要中文摘要鄉(xiāng)鎮(zhèn)衛(wèi)生院是農(nóng)村三級(jí)醫(yī)療預(yù)防網(wǎng)的樞紐，在農(nóng)村防病治病中發(fā)揮著重要的作用，在整個(gè)醫(yī)療系統(tǒng)中也發(fā)揮著重要作用，其運(yùn)行是否良好對(duì)我國(guó)衛(wèi)生事業(yè)起著不容忽視的作用，但目前鄉(xiāng)鎮(zhèn)衛(wèi)生院并不能滿足農(nóng)村看病問(wèn)題。本文依據(jù)相關(guān)文獻(xiàn)及部分地區(qū)的實(shí)例提出在部分鄉(xiāng)鎮(zhèn)衛(wèi)生院實(shí)施股份合作制的探索性研究。對(duì)于我國(guó)的經(jīng)濟(jì)制度，黨的十五大報(bào)告明確指出：以公有制為主體，多種所有制經(jīng)濟(jì)共同發(fā)展，是中國(guó)特色社會(huì)主義基本經(jīng)濟(jì)制度，它是被實(shí)踐證明了的適合中國(guó)國(guó)情和現(xiàn)實(shí)生產(chǎn)力發(fā)展要求的一項(xiàng)正確的經(jīng)濟(jì)制度。鑒于我國(guó)某些地區(qū)鄉(xiāng)鎮(zhèn)衛(wèi)生院已經(jīng)實(shí)施的股份合作制，本研究大量借鑒前人研究的文獻(xiàn)本文擬把股份合作制運(yùn)用到鄉(xiāng)鎮(zhèn)衛(wèi)生院的發(fā)展中。主要論述了我國(guó)部分鄉(xiāng)鎮(zhèn)衛(wèi)生院實(shí)施股份合作制的動(dòng)因以及可行性，動(dòng)因主要有：現(xiàn)鄉(xiāng)鎮(zhèn)衛(wèi)生院呆滯的運(yùn)營(yíng)導(dǎo)致鄉(xiāng)鎮(zhèn)衛(wèi)生院無(wú)法發(fā)揮自身活力，從而導(dǎo)致其經(jīng)營(yíng)效率底下，收益悲觀。可行性主要有：有部分鄉(xiāng)鎮(zhèn)衛(wèi)生院的成功案例可資借鑒，實(shí)施漸進(jìn)式的股份合作制改革，政府主導(dǎo)下建立完善、公平、自由競(jìng)爭(zhēng)的運(yùn)行機(jī)制等。最終是為了更好的發(fā)展鄉(xiāng)鎮(zhèn)衛(wèi)生院，為我國(guó)醫(yī)療衛(wèi)生事業(yè)建立基礎(chǔ)。接著提出了實(shí)施鄉(xiāng)鎮(zhèn)衛(wèi)生院股份合作制創(chuàng)新的關(guān)鍵是實(shí)施股份合作制并不是私有化，而是將改制后的衛(wèi)生院按《公司法》要求運(yùn)行，設(shè)立股東大會(huì)、董事會(huì)、監(jiān)事會(huì)，董事長(zhǎng)為衛(wèi)生院法定代表人，衛(wèi)生院長(zhǎng)由董事會(huì)聘任或解聘，衛(wèi)生院實(shí)行董事會(huì)領(lǐng)導(dǎo)下的院長(zhǎng)分工負(fù)責(zé)制。享受的政策待遇與轄區(qū)內(nèi)的其他醫(yī)院一樣，仍須執(zhí)行醫(yī)療衛(wèi)生行業(yè)有關(guān)政策規(guī)定。其次，股份形式根據(jù)全院核定資產(chǎn)總額分設(shè)：國(guó)家股，集體股和個(gè)人股三種類型。國(guó)家股為固定股份，每年的股金紅利人繼續(xù)投入作為醫(yī)院建設(shè)費(fèi)用。集體股是單位職工歷年公共積累，從中劃出60%入股。個(gè)人股以股票形式出現(xiàn)。最后筆者提出了在我國(guó)部分地區(qū)的部分鄉(xiāng)鎮(zhèn)衛(wèi)生院實(shí)施股份合作制創(chuàng)新中應(yīng)該注意的問(wèn)題：合乎法理否？實(shí)施股份合作制并不等于私有化，資本尋理性與醫(yī)療公益性之間的矛盾問(wèn)題。關(guān)鍵詞： 鄉(xiāng)鎮(zhèn)衛(wèi)生院；股份合作制；董事會(huì)AbstractRural township hospitals is a necessary part ,prevent and cure diseases in the rural areas play an important role in the entire health care system also plays an important role in its operation are in good health plays in China can not be ignored effect, but not the needs of rural township hospitals and medical care issues. This according to relevant literature and some areas of township hospitals in some instances the implementation of proposed stock cooperative exploratory study. For China39。s economic system, the party39。s fifth major report clearly pointed out: public ownership dominant and diverse forms of ownership develop is the basic economic system of socialism with Chinese characteristics, it is proved by practice of the productive forces for China39。s national conditions and development requirements a sound economic system. In view of township hospitals in China have been implemented in some areas of the stock cooperative system, this study draws heavily on previous studies, the literature ,This paper applied to the stock cooperative system in the development of township hospitals. Mainly discusses the implementation of part of the township hospitals stock cooperative system and feasibility of the motives, reasons are: the sluggish operation of township hospitals are caused township hospitals can not play to their vitality, leading to the bottom of its operating efficiency, revenue pessimistic. Feasibility are: some township hospitals can learn from successful cases, the implementation of gradual reform of stock cooperative system, establish and improve the governmentled, fair and free petition in the operational mechanism. Ultimately the development of township hospitals in order to better for our health care business on a foundation. Township hospitals and then proposed the implementation of cooperative shares system innovation is the key to stock cooperative system is not privatized, but the hospitals will be restructured according to the Company Law required to run, the establishment of the shareholders meeting, board of supervisors, the chairman of Health the legal representative of hospital and health appointment or dismissal by the board president, hospitals under the leadership of the president of the board division of responsibility. Policy treatment and enjoy the area39。s other hospitals, like the implementation of the healthcare industry still relevant policies and regulations. Secondly, the form of shares authorized under the total assets of the hospital is divided into: state shares, collective and individual stocks three types of shares. Fixed shares of state shares, the shares of cash dividends each year as people continue to invest in hospital construction costs. Collective unit is the unit of public employees over the years accumulated, from which set aside 60% of the shares. The form of individual shares of stock. Finally, the author proposes some areas in my part of the shares of township hospitals in the implementation of cooperative shares system innovation should pay attention to the question: whether the legal line? Stock cooperative system does not mean the implementation of privatization, capital seeking medical reason and the conflict between public interest issues. Keywords: stock cooperative board of township hospitals；rural towns； Board of Directors 研究論文寧夏銀川市鄉(xiāng)鎮(zhèn)衛(wèi)生院實(shí)施股份合作制的探索性研究第一章 導(dǎo)論一、問(wèn)題的提出鄉(xiāng)鎮(zhèn)衛(wèi)生院雖不以盈利為目的，但在其醫(yī)療服務(wù)中的物質(zhì)消耗和物化勞動(dòng)也必須考慮經(jīng)濟(jì)效益。既然鄉(xiāng)鎮(zhèn)衛(wèi)生院在建設(shè)和發(fā)展的過(guò)程中，始終離不開商品經(jīng)濟(jì),這就為鄉(xiāng)鎮(zhèn)衛(wèi)生院發(fā)展股份合作制提供了必要性和可能性。從我國(guó)衛(wèi)生經(jīng)濟(jì)歷史發(fā)展軌跡上看，醫(yī)院的發(fā)展在很大程度上是依賴國(guó)家撥款、地方扶持、自主經(jīng)營(yíng)相結(jié)合，鄉(xiāng)鎮(zhèn)衛(wèi)生院吃國(guó)家的大鍋飯,職工吃衛(wèi)生院的大鍋飯，這種體制上的弱點(diǎn)嚴(yán)重挫傷了醫(yī)護(hù)人員的積極性,影響了業(yè)務(wù)技能的提高。同時(shí)，鄉(xiāng)鎮(zhèn)衛(wèi)生院因?yàn)榘l(fā)展資金缺乏，無(wú)法引進(jìn)新技術(shù)和新設(shè)備，無(wú)法培養(yǎng)高、精、尖人才，更談不上提高衛(wèi)生院服務(wù)的整體水平，從而使醫(yī)院難于適應(yīng)市場(chǎng)經(jīng)濟(jì)的發(fā)展，投入市場(chǎng)的競(jìng)爭(zhēng)。自80 年代中期以來(lái)，在我國(guó)醫(yī)院經(jīng)營(yíng)機(jī)制改革中，有些醫(yī)院借鑒企業(yè)股份制的做法，試行了股份合作制。據(jù)報(bào)道,河南省安陽(yáng)市脈管炎醫(yī)院于1986 年6 月產(chǎn)生了“股份合作制”的雛形，1992 年4 月正式確立了“股份合作制”的模式。1988 年4 月，全國(guó)第一家股份制醫(yī)院—沈陽(yáng)松遼激光醫(yī)院正式開診。此后，股份制改革象一股春風(fēng)吹過(guò)祖國(guó)大地,有部分省市的少數(shù)醫(yī)院進(jìn)行了股份制改革試點(diǎn),在理論和實(shí)踐上為股份制作了詮釋和注腳，并取得了明顯的成效。本研究將從我國(guó)部分鄉(xiāng)鎮(zhèn)衛(wèi)生院實(shí)施股份合作制的一般環(huán)境，實(shí)施股份合作制的動(dòng)因和可行性，實(shí)施措施以及在探索過(guò)程中存在的問(wèn)題和對(duì)策方面，嘗試著進(jìn)行初步的探索研究[1]。二 、研究的目的與研究?jī)?nèi)容 （一）研究的目的醫(yī)院股份制改革在我國(guó)雖是新生事物，有學(xué)者也進(jìn)行了一些研究，但是研究鄉(xiāng)鎮(zhèn)衛(wèi)生院股份合作制的并不多見。部分鄉(xiāng)鎮(zhèn)衛(wèi)生院已經(jīng)實(shí)踐了這種股份合作制改革模式，鑒于這些實(shí)踐的鋪墊，我們需要更進(jìn)一步的理論研究，用理論指導(dǎo)實(shí)踐，使得這一創(chuàng)新做法得以繼續(xù)發(fā)展。具體的目的與意義是要為部分地區(qū)的部分鄉(xiāng)鎮(zhèn)衛(wèi)生院實(shí)施股份合作制尋求理論上的支持與指導(dǎo)，以達(dá)到進(jìn)一步的為我國(guó)衛(wèi)生事業(yè)做鋪墊。（二）研究?jī)?nèi)容 本研究將在綜合前人的基礎(chǔ)上，在對(duì)相關(guān)理論進(jìn)行概述后，嘗試著研究在寧夏銀川市周邊的鄉(xiāng)鎮(zhèn)衛(wèi)生院實(shí)施股份合作制改造的動(dòng)因及可行性，并通過(guò)對(duì)部分案例的分析，最后提出了在做此項(xiàng)制度改造中主要存在的問(wèn)題。 研究思路是這樣的：對(duì)前人在相關(guān)方面的研究進(jìn)行綜述→分析實(shí)踐中的案例→論證鄉(xiāng)鎮(zhèn)衛(wèi)生院實(shí)施股份合作制的可行性→具體分析在實(shí)施股份合作制中存在的問(wèn)題。三、 文獻(xiàn)綜述與研究意義 （一）文獻(xiàn)綜述 根據(jù)筆者查閱中國(guó)期刊全文數(shù)據(jù)庫(kù)及其他一些資料，一些學(xué)者對(duì)醫(yī)院實(shí)施股份合作制的研究大致如下：對(duì)我國(guó)公立醫(yī)院改革的研究 關(guān)于股份制改革在醫(yī)院中的運(yùn)用，與2007年吉林省梅河口市醫(yī)院愛民醫(yī)院病案統(tǒng)計(jì)室的吳兆雪和吉林省梅河口市友誼醫(yī)院的吳兆坤就論述了“股份制”在醫(yī)院改革中的運(yùn)行，文中提出“我院的“股份制”管理體制,是全院職工通過(guò)自愿募股，形成了29 個(gè)職工持股會(huì),再由職工持股會(huì)代表全體持股會(huì)會(huì)員行使參與醫(yī)院管理和決策的權(quán)力,承擔(dān)相應(yīng)的責(zé)任和義務(wù)，醫(yī)院實(shí)行董事會(huì)領(lǐng)導(dǎo)下、監(jiān)事會(huì)監(jiān)督下的院長(zhǎng)負(fù)責(zé)制[2]。”李莉， 李建濤， 鄭建中也與2010年在《中國(guó)農(nóng)村衛(wèi)生事業(yè)管理》中運(yùn)用SWOT分析法分析了大型公立醫(yī)院的現(xiàn)狀，SWOT分析法是美國(guó)舊金山大學(xué)韋里克( )教授于20 世紀(jì)80 年代初提出， 是一種綜合考慮企業(yè)內(nèi)部和外部環(huán)境的各種因素， 進(jìn)行系統(tǒng)評(píng)價(jià)，從而選擇最佳經(jīng)營(yíng)戰(zhàn)略的方法[3]。其中“S ”即Strength