改革开放以来我国的国民经济迅速发展，截止 2017 年年末，我国经济总量为 82 万 亿人民币，居世界第二位，已经达到中等收入国家标准。随着我国经济的高速发展，与 之带来的社会问题也日益显现：人口老龄化日益加剧、各地区之间医疗资源差距过大。 截止到 2016 年年末，中国大陆每千人口医院床位数仅为 6.14 张，低于世界均值标准。 近年来，我国对居民医疗卫生服务的标准也在不断提升。目前大陆地区公立医院的营运 资金大多来自各级地方政府的财政补贴，由于经济不景气，政府财政赤字不断增加，我 国公立医院的生存发展面临着极大的考验，部分公立医院设备陈旧、管理落后、规模狭 小、难以满足人民群众的看病需求。 PPP 模式（Public-Private-Partnership），是指国家资本与社会资本通过达成某项特 许协议，双方共同合作建设某项基础设施项目，项目的风险双方共担、发展的成果双方 共享。PPP 模式不仅能够有效减轻地方政府、公立医院资金紧张的局面，还可以有效增 加私人资本投资的新领域。有助于缓解医疗资源紧张、医患矛盾突出的局面，有利于促 进我国医疗卫生事业的进步和发展。然而，受制于成本因素，并非所有项目都适用于 PPP 模式，对于是否采用 PPP 模式应当对具体案列进行具体分析。当前，国家鼓励 PPP 模式的原因是 PPP 模式相比传统模式更加节约成本。因此，在大型项目投入建设之前， 应当进行 PPP 模式物有所值评估。目前的科研水平还无法满足 PPP 模式物有所值的评 价要求，不利于政府部门对 PPP 项目做出正确的决策。 本文从政府部门的角度出发，对于我国公立医院 PPP 合作办医项目的可行性进行全 面评估。论证 PSC 及 PPP 项目物有所值定量评价方法的可行性并加入不确定性分析理 论。加入蒙特卡罗模拟原理，构建起不确定性研究的物有所值定量评价方法：公共部门 比较值法（PSC）法。将 PPP 项目物有所值评价由单纯的确定性的点决策转为更加合理、 科学的分布区间决策。利用概率论与数理统计中有关假设检验的原理，建立 PSC 和 PPPs 分布均值差假设检验的物有所值定量评估理论，根据不确定性理论推导出物有所值定量 评价的相关结论。由理论联系实际，以 D 市 M 医院为例，对 D 市 M 医院项目在开工建 设前针对 PPP 模式进行物有所值评估，对本文所构建的数学模型进行案例展示，检验该 方法是否合理、可行。 关键词：PPP 模式；公立医院；物有所值；PSC；合作办医我国公立医院PPP 合作办医的可行性研究—以D 市 M 医院为例 - II- The Feasibility Study Of PPP Cooperation In Public Hospitals In China -- Taking M Hospital In D City As An Example Abstract Since the reform and opening up policy, China's national economy has been developing rapidly. By the end of 2017, China's total economic volume has reached 82 trillion yuan, ranking the second in the world, and has reached the standard of middle-income countries. With the rapid development of China's economy, the social problems have brought by it are increasingly apparent: the aging of the population is becoming ever more serious, and the gap of medical resources between regions is too large. By the end of 2016, the number of hospital beds per 1000 populations in mainland China was only 6.14, lower than the standard of the world average. In recent years, the standard of health service for residents in China is also increasing. At present, the operating funds of public hospitals in the mainland are mostly from the financial subsidies of local governments at all levels. In recent years, due to the economic recession, the government's fiscal deficit is increasing. The survival and development of public hospitals in China are facing great challenges. Some public hospitals are outdated, backward and narrow in scale, which is sometimes difficult to meet the demand of people. PPP model (Public-Private-Partnership) refers to the state capital and social capital reach a certain concession agreement, and the two parties work together to build an infrastructure project. The risk and development of the project is preferred to be shared by both parties. The PPP model cannot only effectively reduce the tense situation of local government and public hospitals, but also can effectively increase the innovative field of private capital investment. It is useful to alleviate the situation of the shortage of medical resources and the contradictions between doctors and patients and help to promote the progress and development of medical and health services in China. However, constrained by cost, not all projects are applied to the PPP model, and specific case columns should be whether or not to the use of the PPP model. At present, the reason why the State encourages the PPP model is that the PPP model is more cost saving than the traditional model. Therefore, before larger projects are put into construction, the value of PPP model should be evaluated. The current scientific research level cannot meet the evaluation requirements of the value of the PPP model, which is not conducive to the government departments to make a correct decision on the PPP project. From the perspective of the government department, this paper makes a comprehensive assessment of the feasibility of the PPP Cooperative Medical Project in public hospitals in China. The feasibility of the quantitative evaluation method of the value of PSC and PPP辽宁师范大学硕士学位报告 -I II- items is demonstrated and the theory of uncertainty analysis is added. The Monte Carlo simulation principle is added to construct the quantitative evaluation method of the value of material for uncertainty research: the public sector comparative value method (PSC) method. The value evaluation of the PPP project is converted from a simple deterministic point decision to a more reasonable and scientific distribution interval decision. Based on the principle of hypothesis testing in probability theory and mathematical statistics, we establish the theory of quantitative evaluation of value for money under the hypothesis of mean difference hypothesis of PSC and PPPs distribution and deduce the relevant conclusions of the quantitative evaluation of value for money based on the uncertainty theory. From theory to practice, taking M Hospital of D city as an example, we evaluated the value of money for PPP mode in the M hospital project of D city before starting construction and demonstrated the mathematical model built in this paper to test whether the method is reasonable and feasible. Key Words: PPP model; public hospital; value; PSC; cooperative medical我国公立医院PPP 合作办医的可行性研究—以D 市 M 医院为例 - IV - 目 录 摘要..................................................................................................................................... I Abstract...................................................................................................................................... II 1 绪论.........................................................................................................................................1 1.1 研究背景与意义...........................................................................................................1 1.1.1 研究背景............................................................................................................1 1.1.2 研究意义............................................................................................................2 1.2 相关概念介绍...............................................................................................................3 1.2.1 PPP 模式的含义................................................................................................3 1.2.2 PPP 模式的特征................................................................................................4 1.3 研究的内容和方法......................................................................................................5 1.3.1 研究的内容.......................................................................................................5 1.3.2 研究的方法.......................................................................................................5 1.4 本文创新点与不足......................................................................................................6 1.4.1 本文的创新点...................................................................................................6 1.4.2 本文的不足之处........................................................