Research On The Economic Operational Mechanism Reform Ofatertiaryhospital In Tianjin City

BackgroundsThe reform of public hospitals is the focus and difficult point of the new health system reform, its outcome concerns the development of nation’s healthcare career and the vital interests of our people. Chinese healthcare field has come up some thorny contradictive problems, some of them are quite serious as disputes between patients and doctors and "expensive and difficult to get healthcare". In addition to the impact of economic reform, health system reform and other macro-environment factors, the imperfection of public internal economic operation mechanism is one of the important reasons. Public hospital reform is a top priority of China’s new medical system reform and reform of the economic operation mechanism is the highlight of reform of public hospitals. But the research in this area is quite a few, exploring and building internal economic mechanism in public hospitals consistent with national circumstances has become imperative.ObjectivesIn this paper, a certain top-three-hospital selected in Tianjin, is a reference to the operation of a modern enterprise system in public hospitals, its business model is consistent with the national public hospital reform direction. The hospital was built in 2003 and had a drastic reform on management system and operation mechanism in the beginning. It created a set of management and operation mechanism accord with the new medical system reform. It is of great value to take this hospital as an example to study. The study is to conduct systematic survey on its economic operation mechanism reform measures according to the analysis and evaluation of economic operating results. Not only can provide theoretical evidence and empirical data of pilot reform of public hospitals in Tianjin, but also provide direction and path for public hospital in the next stage and provide ideas and useful references for other areas.MethodsThis paper uses literature studies, field surveys, questionnaires and empirical research to collect relevant literature and research achievement on the internal economic operation of hospitals, references can be used after analysis. We conducted several field researches in Tianjin,did survey questionnaires and had in-depth interviews with the hospital director, finance director, head of the personnel department, the medical department heads, doctors, nurses and other medical staff. We take a three-top-hospital as a case to conduct empirical analysis, focusing on its specific contents and economic operation situation of internal operation mechanism in 10 years from the established time, summarizing its reform experiences and refining new model of its internal management and operation mechanism.ResultHospitals conducted several measures on internal operation mechanism reform, results are as follows:1. Revenue compensation mechanism reform measures. Compensation funds for retirees, such as pension gap filled two-track system, to solve the worries of workers. Local government finance allocated each year based on the actual workload regular hospital operating expenses, and give special funds for housing renovation and repair of large equipment in accordance with its need.2. Hospital management mechanism reform measures. Conducting affairs separate, management separate and implementing of director responsibility system. The hospitals are positioned as non-executive-level institutions carrying out the governance separation of ownership and management.3. Hospital personnel system reform measures. Hospitals usually set up authorized size according to the posts and determine the position according to ability. Their organizations are flat and efficient and implement lands and hospital management organization structure.4. Income distribution system reform measures. Performance pay of hospital medical staff is not linked with the prescription and checks, nor linked to business income, but with the work quality (diseases, projects), the amount of technical difficulty, efficiency (average length of stay) and satisfactory index. The performance of department was closely linked with the expenditure.5. Financial management mechanism reform measures. Learning from the financial management system of modern enterprise, hospitals develop its own financial management system at present mixing with characteristics of medical field. From the aspect of financial management, it can be separated into financial accounting and management accounting. The former is in charge of the hospital records of production and business activities, and the latter pay more attentions on making scientific decisions for leadership of the hospital, while controlling the whole production and business activities.Conclusions and suggestionsThis paper shows the hospital 2009-2014 analysis of economic performance, combined with the hospitals own reform measures and internal economic operation mechanism of public hospitals in China, the main suggestions are as follows:1. Make sure of the internal economic mechanism of public hospital reform objectives and improve operational efficiency.2. Learn from the experience of business operations and improve hospital economic management.3. Develop hospital financial strategy and make solid foundation for the fine management.4. Rationalize the relations between hospitals and government and improve the government’s compensation mechanism.