The Research On Over-treatment In Our Public Hospital Based On Information Dissymmetry

In China, along with the rapid development of medical and health services based in public hospitals, medical expenditures have also been increasing exponentially. The difficulties and extremely high cost of seeing a doctor have become more prominent. It has caused economic, social, political and other issues, and for the most part counter-balanced the savings for the populace due to medical reforms. From the angle of the medical services practice and the results of numerous studies, widespread over-treatment in public hospitals wastes limited medical resources, which is the main reason for the aforementioned medical services problems, but the information dissymmetry between the hospitals, patients and health administrative executors is the root of over-treatment. Therefore, we can deal with over-treatment from the point of information symmetry, which would be very helpful for stabilizing the achievements of medical reform and the return of the equality, fairness and the accessibility of public hospitals in theory and practice.Firstly, how did over-treatment theoretically come into being? According to the Principal and Agent Theory, we analyze the principal-agent relationship between the patients, hospitals and health administrative executors, and we find that agents are in a relatively advantageous position insofar as the information they possess. Using an analysis based on incomplete information, as in Game Theory, the results show that hospitals induce patient demand and patients cooperate with them, as a result leading to excessive medical treatment.Secondly, we study the generating mechanism of over-treatment. We build "the elements - the interrelation among elements - acting pattern - results" model upon a deep understanding of this mechanism connotation. The medical service supply and demand, and the interior and exterior interrelation actions constitute the basic elements of over-treatment. We analyze the supply and demand for medical services through supply and demand theory, and find that the special relationship between supply and demand makes over-treatment possible. In addition, we use the logical reasoning method to analyze the internal and external interrelation of over-treatment, where the results show that the benefit stimulating mechanism which causes the main body to pursue the benefit in the medicine benefit chain is the internal interrelation, and disabled supervising behavior caused by the information dissymmetry is the external interrelation.Finally, we discuss the countermeasures to rectify over-treatment. On the basis of the experience of rectifying over-treatment abroad, we analyze the model, content and method of rectifying over-treatment. We find that the hospital is the breakthrough point for rectifying over-treatment base on the the former. We adopt the pattern which the internal government and the exterior supervision simultaneously develop to solve the information dissymmetry between the hospitals, patients and health administrative executors to rectify over-treatment. And we prove that the clinical pathway is effective in rectifying over-treatment.Furthermore, in order to evaluate the effects of rectifying over-treatment accurately and scientifically, we establish a performance evaluation system from the view of the hospitals, patients and health administrative executors, and we use the analytic hierarchy process to determine the various targets' relative weight. We comparatively analyze a variety of evaluation methods and select the fuzzy comprehensive evaluation to evaluate the performance of rectifying over-treatment in public hospitals. We propose some security measures for rectifying the over-treatment from the angle of holding down the information dissymmetry between the hospitals, patients and health administrative executors.In the end, taking the clinical pathway of caesarean birth as an example, we study the rectification of over-treatment in a practical way. We compare traditional treatment modalities with the clinical pathway to explain that the clinical pathway can rectify the information dissymmetry between the hospitals, patients and health administrative executors and can achieve the goal of rectifying over-treatment.