Social Capital Involvement Into Public Hospital Reform:Mode, Risk And Path Selection From The Perspective Of Stakeholder Theory

BackgroundThe key to new medical reform is to solve the problem of difficulties and high expense in medical care, which is to solve the contradiction between high public medical demands and insufficient medical resources. Domestic and foreign experiences have inspired us that whether to increase governmental investment or to encourage social capital to join in medical field is the best choice to balance medical resources. Under the circumstance of insufficient governmental investment, diversified medical demands and imperfect competitive medical service pattern, innovation must be realized from the perspective of social capital.Domestic public hospital reform is not only influenced by international public hospital reform and the thought of new public management, but also the reform of state-owned enterprises. Under the circumstance of financial austerity and public hospital self-management dilemma, the government proposed the idea of reform. On March 17 2009, Opinions of the CPC Central Committee and the State Council on Deepening Health Care System Reform proposed that social capital should be actively guided into partial public hospital reform in multiply manners. Therefore public hospital reform used to be the focus of medical reform, however got no substantial progress due to the difficulties of implementation in three-years’medical reform period. In October 2013, Opinions of the State Council on Promoting Health Care Industry proposed that our country has confirmed the trial reform of public hospitals in partial areas. In January 2014, Opinions on Accelerating Social Capital Involvement in Hospital Management proposed that social capital can take part in public hospital reform in multiply manners. A series of polices have stimulated enthusiasm of social capital and pushed public hospital reform the focus of all interest parties.Although national policies have explicitly encouraged social capital to take part in public hospital reform and development, there are a lot of theoretical confusion, institutional lack and operational difficulties in the promoting process. With the national trial and practice of social capital’s involvement into public hospital reform, more and more problems have exposed. For example, some public hospital directly sell the hospital or part of it, result in the loss of state assets. Somebody takes advantage of reform to transfer benefits. Some reforming hospitals’staff’s identities, salaries and welfare are not guaranteed. The disposal method of public hospital assets and solution of remaining debts are lack of legal basis. The positioning of stakeholders’right, responsibilities and interests are not cleared, such as government, investors and hospitals. The selected objects and manners of social medical institutions are not normative and the entry barrier is vague. The performance evaluation system is not established. How to build up reasonable motivation and restriction mechanism of social capital involvement into hospital management, how to prevent risks and how to select reform patterns are in need of exploration.Based on the background and in combination with the practices of social capital involvement into public hospital reform, the thesis is to carry on a systematic research and explore the selection of reform patterns from the perspective of stakeholder theory and from the dimension of the cause of reform, theory, pattern, risk and path selection, in the aim of providing theoretical and practical meanings for patterns, risk analysis and control and path selection of social capital involvement into public hospital reform.ObjectiveBased on the analysis of current situation and problems of social capital involvement into public hospital reform, the thesis selects four reform modes that have been practiced:Trusteeship management mode, PPP-ROT mode, Joint-stock Cooperation mode and Charitable Donation mode. The thesis is to analyze the four modes and evaluate applicability of different modes in multiply manners, including the reform background of different modes, the aim, the process, existing problems, risk analysis and reform effect. In combination with stakeholder theory, the thesis is to propose the stakeholder common management mode for social capital involvement into public hospital reform. Through analyzing the risks and management paths of different patterns, the thesis can make sure of the path selection of social capital involvement into public hospital reform and propose relative suggestions, therefore providing theoretical basis and decision reference for the establishment of social capital involvement into public hospital reform and nation medical and health care system reform.Methods1. Documentary Analysis MethodThrough searching the literature on social capital involvement into public hospital management by means of looking up relative books, journals, proceedings, magazines and electronic resources like CNKI, CDDBFT, VIP Database, Pubmed and ScienceDirect, the writer collects domestic and foreign relative theories and practices on hospital reform, concludes current situation and trend of hospital reform, analyzes the characteristics of different reform modes and related influencing factors, and provides references and study basis of the thesis. In the meantime, through classifying, collecting and quantitative describing and analyzing relative contents of literature and summarizing the main points to get referential experience, opinions and effects, the documentary analysis method has laid substantial foundation for the thesis.2. Semi-structural Depth InterviewOn the basis of the effect of documentary analysis, construct interviews on predetermined questions. In the thesis, the interviews are mainly aimed at stakeholders related to hospital reform, such as medical administrative department staff, hospital administrators, doctors and nurses, social capital investors and patients, so as to collect stakeholders’opinions and advice on reform mode and provide path selection of the mode of social capital involvement into public hospital reform.3. Comparative Analysis MethodThe comparative analysis method can better help conclude path selection. In the empirical analysis of four different modes of social capital involvement into public hospital reform, the comparison among the reform philosophy, aim, implementation steps, practicing obstacles, risk consideration and actual effects, can not only help to recognize the connotation and advantages and disadvantages of different modes, but also offer beneficial inspirations for social capital involvement into public hospital reform.4. Field Survey MethodThe method selects some typical hospitals of social capital involvement into public hospital reform to conduct field investigations. Through various ways of internship, visits and interviews, the writer gets a thorough knowledge of practical materials and first-hand information through communication with local medical administrative department staff, hospital managers, social capital investors, doctors and nurses and patients, which helps to better understand the theory and practice of social capital involvement into public hospital reform, as well as offering informative information and database for the research.5. Combination of Quantitative Analysis and Qualitative Analysis MethodQuantitative analysis and qualitative analysis are well applied research methods in Management Science. The thesis uses quantitative analysis widely in analyzing the realistic reasons, the comparison among four modes’reform effects of social capital involvement into public hospital reform. In the aspect of backgrounds, characteristics, risks and realization paths of social capital involvement into public hospital reform, qualitative analysis is more applied. Through the combination of the two methods, the thesis uses qualitative method to analyze and summarize the problems of social capital involvement into public hospital reform and uses quantitative method to conclude the result of analysis as the inspection standard.6. Case AnalysisThis study provides case material in practice of social capital involvement into public hospital reform in recent years.This article will use case analysis of four different models to study public hospital system,and to find out the reasons for its success or failure from a qualitative point of view to study the effect of the reform.Then sorting and processing problems,to put forward their own proposals and solutions. Strive to select from valuable part of a number of cases to analysis, and the article proves the argument auxiliary.And in the course of the case study, conditional selective participant observation, personal interviews and indepth investigation.ConclusionFirstly, the realistic reasons of social capital involvement into public hospital reform are the problems caused by administrative management system and the theoretical basis of public hospital reform are public choice theory, principal agent theory and transaction cost theory. The administrative management system lead to lots of problems, such as the inefficient public hospital management, the rapid increase of medical expense, confused identification of medical service, the external problems of unclear property rights, the imbalance of medical resource allocation caused by uncoordinated ownership structure, the problem of drug-maintaining-medicine, lack of development assets, simplex financing channels and the clear will of governmental reform.Secondly, through multi-perspective analysis of Trusteeship Management mode, PPP-ROT mode, Joint-stock Cooperation mode and Charitable Donation mode of social capital involvement into public hospital reform, differences exist among the reform backgrounds, operating procedures, characteristics, constraints, existing risks and practical effects. Different reform modes have different influences on public hospital, that is to say, different modes have different applicability. Therefore we should act according to hospital circumstances and choose reform modes prudently.Thirdly, there are a lot of uncertainty and risks during the process of hospital reform, due to the characteristics of medical industry, such as policy sensitiveness, pseudo-market character, management complexity, capital intensiveness and long operating cycle. Moreover, the complex relationships among stakeholders such as government, social capital investors, patients, public hospital deepen the risk degree and generate rent-seeking risks, supervision risks, collusion risks and risks of the loss of state-owned assets. The thesis is to construct a risk prevention frame of social capital involvement into public hospital reform through the stakeholders’behavior analysis and risk formation mechanism.Fourthly, the path selection of social capital involvement into public hospital reform will be proposed, including confirming the reform mode, selecting reform objectives, defining participation scales of social capital, evaluating assets, confirming basis reform procedures, personnel placement and management structure, and defining the nature of operation, change of registration and corresponding safeguard measures.Lastly, the inspirations of public hospital reform is to confirm the reform principles, define reform scales, choose reform modes, formulate strict approval procedures, take mild, gradual and flexible reform strategies, pay attention to reform of relative corresponding measures, coordinate internal and external governance environment and promote the development of social capital involvement into public hospital reform.InnovationThe innovation of research perspective. From the perspective of stakeholder theory, the thesis explores the topic of social capital involvement into public hospital reform from the dimension of theoretical basis, realistic reasons, reform modes, reform obstacles, specific constraint and risk consideration, which not only theoretically expends the study field of social capital involvement into hospital management, but also practically holds the developmental trend of social capital involvement into public hospital reform.The innovation of research methods. The thesis adopts various methods of the combination of quantitative analysis and qualitative analysis, stakeholder analysis, empirical analysis, which can avoid the restriction of theoretical description or qualitative analysis in all directions. In the meantime, the comparative analysis method is applied in the analysis of the realistic reasons and specific reform modes of social capital involvement into public hospital reform, which can help to clarify the path selection.The innovation of research opinion. The thesis does not think the social capital involvement into public hospital reform will prevent public hospitals from returning to public welfare. In some cases, the reform is a better choice which needs to identify the reform objectives, aims and paths. Of course, there are a lot of risks in social capital involvement into public hospital reform, which needs a mature management frame to prevent risks. What’s more, the thesis proposes a path selection mode of reform based on the systematic analysis of our country’s current reform modes of social capital involvement into public hospital reform.