Research On Mechanism To Guarantee The Public Welfare Nature Of China's Public Hospitals

ObjectiveApplying the theoretical basis of Managerial economics, this paper aims at defining hospital's public welfare nature and its function, and:(1) Discussing the institutional arrangement and the mechanism design principles, exploring a suitable operation system and establish a safeguard mechanism that ensures public welfare nature from three aspects, subject, dynamics and environment, of the mechanism. (2) Carrying out empirical study and quantitative study to provide evidence and decision making suggestions for government to design regulations and policies related to hospital reform and development, thus providing a new approach for the studies of China's healthcare system.Methods(1) Literature method. (2) Typical scene investigation, which collected and collated data of 12 public hospitals in Hubei and Guangdong Provinces. (3) Insider depth interviews. (4) Expert consultation. (5) The coefficient of variation method was applied to determine the weight of each index, which was based on the use of the coefficient of variation of the above method, including the indicators mean and standard deviation, coefficient of variation index, and the index coefficients normalized so on. (6) Using TOPSIS method to evaluate public welfare programs and comparing its results with the best programs relatively close to the worst degree of 12 public hospitals. (7) for the data collected by the survey, using EpiDate3.0 (English) to establish a database and SPSS 15.0 statistical software to analysis data, data by-x±s using t test to count data between groups; using Kruskal-Wzllis to rank sum test cognitive investigation difference between the results and P <0.05 was considered statistically different. Results and analysis1. The meaning of public welfare nature of hospital is to guarantee the characters of non-profit and mutual welfare when providing medical service, especially in the means how medical service is provided and paid. It is also specifically reflected in the following factors such as the percentage of medical costs paid by patients and how they pay it, the availability, equality and result of the medical service, but not the ownership of the hospitals. The research found out that the providing of medical service with public welfare nature should not be limited in public hospitals.2. From the system structure, the hospitals'public welfare nature safeguard mechanism consists of 3 factors, subject, dynamics and environment, which are dialectically united. Because medical service is a Quasi-public products, an individual medical service that bears public welfare nature doesn't means the whole industry has the feature, neither is it in contradiction with the marketization of the sector, while it is possible to design systems and monitor mechanisms to help all subjects to reach a balance and flexible integration with incentive compatibility.3. Using TOPSIS to analysis the data of 19 key factors of public welfare nature in 12 hospital shows that①assessment index is 0.2981-0.5254, suggesting the low level of public welfare nature. (1 is the max level of public welfare nature)②important factors of public welfare nature such as, average costs of in-patients, average costs of out-patients, percentage of drug income in total revenue, percentage of public funding in total budget and percentage of fiscal special expenditure, suggest that most public hospitals now have strong tendency of profit-oriented.③TOPSIS sorted result suggests that other major factors that influence the level of public welfare nature are, increasing rate of the income of technical service, treatment efficiency rate, mortality rate, scale of cost relief, scale of free medical aid, total in-patient number, number of total diagnosis and treatment, patient satisfaction, staff satisfaction, government satisfaction, community satisfaction, total service in public health and numbers of services supporting community and village.④the adjustment research of assessment index and its weight suggests that health administrative departments can influence the assessment result of the hospital by adjust the assessment index and its weight. 4. The factors that mostly influence the hospitals'public welfare nature in China are, the macro system reconstructing and policy adjustments have weaken the expression of public welfare nature in hospitals; the long term short fall of investment in health is the major economic structure problem in health resources distribution; the hospitals'current operating mechanism, governance mechanism and payment methods are not suitable for the expression of hospitals'public welfare nature; government has less efficient monitoring and intervention on hospitals'public welfare nature; the mechanism of only relying on income of medical service to reimburse staff's welfare and salary had limited the expression of hospitals'public welfare nature.5. The sub-mechanisms that could influence the expression and realization of hospitals' public welfare nature are①the fiscal budget allocation mechanism of government.②the monitoring and assessment mechanism of government③the pricing and management mechanism of drugs④the internal financial management mechanism of public hospitals⑤the human resources management mechanism of public hospitals⑥the information publicity mechanism of hospitals⑦the media monitoring mechanism⑧the ownership management mechanism of hospital⑨the payment mechanism of medical service.RecommendationsChanging surface mechanism alone will not be able to make decisive progress in building an effective mechanism to guarantee the public welfare nature p in hospitals, while in-depth reform in the internal mechanism of 3 major aspects, i.e. subject, dynamics and environmental, could be more effective.1. Subject:(1) building and improving hospitals'decision-making mechanisms and governance mechanisms can help to eradicate hospitals'motivation to for profit; (2) it is important to adjust and expand the existing functions of the Ministry of Health to effectively supervise medical service, pharmaceutical practice and healthcare. Additional health care institutions should be established to achieve higher professional monitoring on the hospital industry.2. Dynamics:(1) the reform of payment mechanisms is critical for scientific pricing to control cost.①changing health care payment mechanisms from post-paid scheme to pre-paid scheme will help to realize the public purchase of health services. Universal health care scheme can be used as a lever to attract concerns on the cost-efficient of choosing appropriate therapy and drugs, eradicating the situation of "medical services supported by selling drugs to patients"; Establishing accounting mechanism for financial reimbursement and adopting proper regular information disclosure so that patients are fully informed; Improving the "Dual subsidy and one control" compensation mechanisms for public hospitals to guarantee the public welfare natures of public hospitals; Establishing full-budget compensation mechanism of public hospitals②ptimizing medical service pricing mechanism;③tandardizing pricing mechanism of drugs; (2) establishing an evaluation mechanism in the hospital that focusing on the public welfare natures; (3) innovating human resources and salary system; (4) introducing professional medical health insurance to curb unreasonable medical practice; (5) reconstructing medical service delivery system so that public general hospitals can integrate with community healthcare centers to provide a complete system with both general practitioners and specialists.3. Environment:(1) improving and completing relevant laws and regulations of basic health system; (2) emphasizing on the innovation of institutional mechanisms; (3) encouraging private hospitals to carry out medical service with public welfare nature; (4) establishing and improving taxation system to define clear categories of duty-free medical services with public welfare natures and taxable private medical services.Innovation and characteristics1. In theoretic research:(1) This research analysises and comprehensively describes related issues in hospitals'public welfare nature from three aspects, subject, dynamics and environment. From this new aspect, it proves the notion "the nature of quasi-public goods of healthcare service determines the delivery of public medical services should not be confined to public hospitals" and provides significant implication for the government to clearly define the concept of public welfare nature and effectively design related polies.(2) From the perspective of how those key factors that influence the expression and realization of hospitals'public welfare nature, this research studies important dynamic elements of the mechanism and providing sufficient evidence to the notion that the public welfare nature of medical services does not contradict the marketization of the health care industry and through re-arrangement and system design, main participants of the mechanism can achieve incentive compatibility.(3) Based on the theory that the meaning of hospitals'public welfare nature is to ensure the charaters of multi-welfare and non-profit when delivering medical service, and taking into consideration of the fact that public hospitals play an essential role in this industry, this paper takes the lead by suggesting the using of taxation tool can curb public hospitals' tendency of making profit. It also indicates that by establishing and improving taxation system to define clear categories of duty-free medical services with public welfare natures and taxable medical services, the government can also control unreasonable durg utilization and excessive medical treatment to guarantee public welfare nature.2. In empirical research:(1) This paper takes the lead in applying TOPSIS method on the evaluation of 19 indicators that influence the expression of 12 hospitals'public welfare nature in Guangdong and Hubei. Those key indicators are of the broadest scope in related research.(2) Using TOPSIS to set the sort order for the 19 important indexes that influence the expression of hospitals'public welfare nature, this paper also establishes an assessment structure for it, from quantative perspective. The research results of the evaluation index and its weight contains valuable information for healthcare administrative authority.