Research On Operational Risk And Countermeasures Of Public Hospitals In Guizhou Province Under Current Medical Reform Policy

Objective: To analyze the current state of assets and liabilities of public hospitals in Guizhou Province and the situation of revenue and expenditure losses under the current medical reform policy,and to study the existing risks of public hospital operation;to explore the causes of risks based on the development of health resources,changes in medical income and expenditure structure,etc.Understand the implementation effect of the current medical reform policy and the problems existing in the comprehensive reform process of public hospitals.Drawing on domestic and foreign experiences,and providing policy suggestions for defusing operational risks for public hospitals in Guizhou based on risk causes.Methods:1.Collected the monitoring data of 185 public hospitals monitored by the medical reform of Guizhou Province from 2014 to 2018 through the Guizhou Health Commission,analyzed the changes in the scale of their assets and liabilities,asset operation efficiency and solvency,and health resource growth;calculated the revenue and expenditure balance and profit rate of public hospitals,analyzed the proportion of loss-making medical institutions;calculated the growth rate of various medical revenues and expenditures of different types of public hospitals,and analyzed the changes in the revenue and expenditure structure;analyzed the increase and decrease of the average medical expenses and drug expenses.2.Use the degree of structure variation to analyze the changes in the income structure of outpatient and inpatient services in each year,and the impact on overall income growth.Results: 1.From2014 to 2018,the number of in-service health technicians and actual beds,and building area are respectively with the average annual growth rate of 10.49% and7.21%,12.00% in 185 public hospitals in Guizhou Province.The total value ofequipment above 10,000 yuan and the number of equipment above 1 million yuan has increased rapidly in the past 5 years,the scale of the hospital expands year by year.2.The average annual growth rate of total liabilities of 185 public hospitals is 19.02%,which is faster than the average annual growth rate of total assets of 17.57%.Net assets have always been lower than the total scale of liabilities,in 2018,52.97%(98)public hospitals were insolvent;the current ratio decreased from 161.47% to151.57%,while the asset-liability ratio increased from 52.99% to 55.62%,showing an upward trend year by year.3.In 5 years,the medical income of 100 yuan in fixed assets decreased from 76.49 yuan to 67.10 yuan,and the asset turnover rate and asset balance rate decreased by 12.22 and 2.84 percentage points,respectively.4.From2014 to 2018,the average annual growth rate of total expenditures of 185 public hospitals was 14.35%,which was higher than the average annual growth rate of total income of 13.47%,and the revenue and expenditure balance rate dropped from 6.66%to 3.78%;the average annual growth rate of medical expenditure is 14.64%,which is higher than the average annual growth rate of medical income of 12.43%.The medical income and expenditure balance rate has dropped from 15.48% to 8.71%.In2018,30.81% of public hospitals did not make up for their expenditures,and 36.76%of public hospitals lost money on medical services.5.The proportion of government subsidies to total income fluctuates between 9% and 12%.After excluding government financial subsidies,84.32% of public hospitals are at a loss.6.In 5 years,the proportion of medicines has dropped from 35.41% to 26.38%.The average annual growth rates of inspection,laboratory income,medical service income,and health material income have been 14.43%,16.79%,and 20.29%,respectively.The cumulative contribution rate of drug income,inspection and laboratory income to the change of outpatient income structure reached 78%,and the cumulative contribution rate of drug income and health material income to the change of inpatient income structure reached 67.43%.7.From 2014 to 2018,the average annual growth rate of staffing,health materials expenses,and medicine expenses were 20.07%,18.75%,7.07%,respectively;the proportion of staffing to total expenditure increased from31.78% to 38.57%,Which exceeded the cost of medicines and became the largestexpenditure since 2014;the proportion of health consumables in total expenditure increased from 13.34% to 15.40%.8.From 2014 to 2018,the average outpatient and inpatient medical expenses increased by 104.65 yuan and 392.86 yuan,respectively;and the average outpatient and inpatient,hospital bed medicine cost decreased by18.85 yuan,483.12 yuan,and 45.33 yuan,respectively.Conclusion: Since the comprehensive reform of public hospitals in Guizhou Province,the zero-difference rate system has achieved remarkable results,and the public welfare of public hospitals has become increasingly prominent.However,due to the rapid expansion of public hospitals,continuous rise in operating costs,and inadequate financial compensation,financial risks exist in the operation of public hospitals.The government should bear the main responsibility for the development of public hospitals.While controlling the rapid rise in medical costs,ensure that public hospitals have a reasonable profit,use financial funds to resolve debts and make up for policy losses.Speed up the internal management reform of medical institutions and reduce medical costs.Promote the establishment of a dynamic adjustment mechanism for medical service prices,reform of medical insurance payment methods and other supporting measures for medical reform,to consolidate and eliminate the results of the reform of supplementary medicine with drugs,and improve the ability of medical institutions to resist risks.