地方分権化と自治体立病院改革 : 契約理論を用いた経済理論分析

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The purpose of this paper is to investigate with common agency theory a relationship between governmental decentralization and the efficiency in public owned hospitals. We analyze a situation where one public owned hospital exists and he is regulated by both central government as price regulator and local government as his owner. Our main results are as follows. (l) If the local government is an obedient follower and each regulator's purpose is strongly correlated, then decentralization tends to improve consumer's benefit. (2) High decentralization such that the local government can make his policy independently from the central government tends to invite regulatory inefficiency .Then，we obtain the result such that the efficiency in public owned hospital is much correlated with the degree of decentralization. In Japan, the tendency of governmental decentralization and privatization of public owned hospitals is progressive recently. This tendency is justified when the public hospitals have no advantage in providing health care compared with private hospitals. But, if the public hospitals have an original role, then highly decentralization implies central government's free ride in health care policy. Thus, in order to design the desirable health care system, a responsibility of central government is a focal point.
広島国際大学医療福祉学部医療経営学科の論文