Equity And Efficiency Equilibrium: The Path Of Public Hospital Reforms

The public hospital reform is not only a career which can benefit the entire population of a country and the people’s livelihood, but also a global problem. Since the Establishment of People’s Republic of China, China’s public hospitals have gone through the course of twice medical reforms with different value orientation:the old market-oriented reform and the new reform with "public welfare return" destination. At this stage, the reform of public hospitals is in the pilot phase of the new medical reform. After more than three years of exploration, we have accumulated some experience, but is still facing difficulties and challenges of the imbalance in the relationship between fairness and efficiency in some aspects:First, the imbalance on the value orientation, mainly the missing of public welfare, which specifically performs as the masses’ too heavy medical burden, the poor time and geography accessibility to the needed healthcare and the deterioration of the doctor-patient relationship; Second, the imbalance on the external environment, prominently shows as the uncoordinated government policy environment and imperfect environment for market competitive; Third, the imbalance on public hospitals’ own management, specifically reflects as the negligence of management decisions, the artificially high running costs and the outstanding personnel issues. Many reasons cause these imbalances, during which the main ones are as follows:First, our public hospitals are objectively in lack of the medical resources and in trouble with distribution imbalances; Second, policy, public hospitals and medical workers show some deviation on value orientation; Third, the double failure of the government and the market is coexisting in the actual reform; Last of all, the internal management of the public hospitals are in trouble with chaotic management system, weak cost management and unreasonable human resources management. Experience of public hospital reform abroad dealing with fairness and efficiency relations and government and market relations shows that the British model (government-led and fairness-oriented) and American model (market-led and efficiency-oriented) are more typical. They both have not only got effective results, but also encountered obstacles to reform. Combined these experience with the lessons abroad, China should explore it’s own public hospital reform path with the balanced fairness-efficiency relationship:On the value orientation aspect, the moderate balance of the fairness and efficiency should be sought; On the practice mode aspect, the cooperation mode of government and market should be established; On the process of reform aspect, blind imitation and path dependence should be alerted.