The Government Supervision Mechanism Forming Research On Public Welfare Oriented For The Public Hospital In China

1. PurposePublic hospital is the important element in Chinese health service system. In general,the public hospital play import role in delivering basic medical services, constructingmedical disciplines and training health workforce, evaluating moderate health technologiesand selecting essential drugs, innovating medical technologies and disseminating newtechnologies and development the professional clinical researchs. This propose of this studyis aimed to form the supervision mechanism for public hospitals under the goal of publicwelfare. In the past30years, the device of market mechanisms has mobilized theenthusiasm of the medical service, improved the the medical service system and improvedthe technology and equipment standard. But the government supervision mechanism ofpublic hospitals developed behind of the medical market. Therefore, the establishment ofpublic hospital government supervision mechanism is necessary to pomote fair competitionand improved the utilization efficiency of public funds to ensure the quality of service.2. MethodsLiterature analysis to understand the concept and history of supervision systemFiled surveys in the pilot cities with supervision reform in public hospitalsComparative analysis method implemented in comparaing the data of supervisionsystem in different countries and in different period.3. ResultsThe paper is aimed to clarify the factors causing “difficult&expensive medicaltreatment” in the view of government supervision. The topic of the thesis is to form thesupervison mechanism of public hospital and summarize the reasons for supervisionfailture. The main achievements of the paper include the following contents as beolow:1) History of supervision policies of public hospital in ChinaWith the rapid development of the medical service system, the periods of publichospital developments have devided into four phases as the traditional planned economyperiod (1949-1977year), regulatory reform in early stage of development (1980-1996years), market-oriented hospital regulatory period (1997-2005year) and new health reform(2006year-now). In the first stage, the government supervision of public hospital administrativesupervision mode is highly centralized, the public hospital service "welfare". In the secondstage, the policy of public hospital is decided by the government, but the other aspects havenot supervised by the government. In the third stage, the new medical reform program putforward new demand to the public hospital regulation and set up health medicalmanagement department. The government paid attention to the quality managementthrough the Quality year and clinical pathway, and also abolished the drug addition, tocontrol of medical expenses in order to strengthen hospital management and financialsupervision, improve personnel income distribution system to mobilize staff enthusiasm.But the success of health reform can not be decided by one policy, the mechanism ofsupervision is necessary to form after the analysis.2) The internal and external factors of public welfare analysisThe contradiction of "expensive to see doctor" and “difficult to see doctor" involvesmany factors including drug production system, the price management system, medicalservice system and medical resources allocation. The deficiency of public hospital financialand operational supervision is one of the main causes of “over prescription" and “overinspection". Through the analysis of PEST and Porter theory, we think the governmentshould introduce competition mechanism into the medical market.3) Current status of public hospital supervision in ChinaAs China’s market economic system improved continuously and the greatperformances have taken in the internal and external environment of medical serviceprovision. But there are still some shortages including the health supervision legislation inlagging behind of social supervision. Indirect economic regulation is the premise ofeffective competition and the government should encourage the industry and the medicalinsurance payment to realize the control of public hospital behavior.4) The supervision experiences of typical countriesCompare the public supervision system in the four typical counties including the U.K,the United States,Germany and Singapore as an example, we found the indirect supervisioninstead of the direct supervision of government through medical insurance and medicalservice. The independent supervisor representative the third part to achieve continuousimprovement for hospital; all the supervision policies focused on the patients; expand the evaluation of medical quality and safety with emphasis on social supervision; supervisionand evaluation of these ideas, enhance the enthusiasm and initiative of parties, improve theevaluation efficiency.5) Design of supervision mechanism of public hospitals in ChinaThe public hospital supervision system consists of three systems: the legal supervisionsystem, the administrative supervision system and the social supervision system. Betweenthem, the legislation is the basis for supervision system; administrative supervision is themain body and social supervision system is the complement.4. Suggestions1) For the price regulation: It is the trend to merge State Development and ReformCommission Price supervision and the Department of human resources and SocialSecurity Department of medical insurance medical service integration togetherand explore new price formation mechanism.2) Social supervision: The government should encourage the growth and establish thesocial supervision and self-discipline3) The construction of the supervision mechanism of public hospital should designfrom the top-level and determine the responsibilities of government-society–marke firstly4) Health administrative departments should establish the information system topublish the results of public hospital inspectio. In addition, it is trend to to analyzethe cost-effectiveness of regulatory policy5) Encourage social capital to enter the medical market and promote the reform ofpublic hospitals through equal competition.5. InnovationThe paper is to study the mechanism forming of public hospital as the main contents,analyze the relationship between the elements of the supervision mechanism, andunderstand the reasons of the regulatory failure in the history.