The Study Of "Exit" And "Voice" In China Hospital Market

Steadily improving the health level of the residents and hospital market performance relationship are beneficial to the people's livelihood, which are also important goal and content of medical and health system refonn. The hospital is the main and key link of medical service system in China. To deepen the hospital reform is of great significance.In recent years, the microcosmic operation in our country's hospital market has been greatly improved; however, the macro efficiency is not simultaneously improved. The difference between the two is related to hospitals'external governance environment. In order to deepen hospital market reform and improving the hospital market performance, it is not easy to block a loophole of hospital management, instead of adjusting hospital exterior governance.Hirschman brought about "exit-voice" theory, which consider consumers'exit and voice as two important ways to improve organizational performance. The character of hospital on China fits to the organization instinct in "exit-voice" theory. Our coutry's hospital market is face to performance-improving problem. And there is necessity and rationality in our hospital market to systymetic utilizes patient exit and voice. So we analyze the effect of exit and voice on hospital exterior governance and system performance wirh the basis of Hirschman's "Exit-Voice" theory that we can provide theoretical and practical evidence on reform of hospital market.The studies on hospital market competition by foreign researchers regard the United States hospital market development as the main line, using the theory and empirical research method to discuss the effect of quality competition and price competition, as well as the competition results accompanied by the merger. In general, there is no unanimous conclusion about the competition results. Different scholars have studied patients voice from different aspects.However, there is no systematic research. Compare with abroad research on hospital market competition, domestic research is weak, the theoretical researchs are superficial, most are descriptive study; quantitative research is relatively small. Only a few studies involve patients'voice. It is worthwhile of analyzing the effect of exit-voice by combining with our hospital market characteristics.From the content point of view, hospital industry in our country belongs to multiple products manufacturers, operating inpatient departments as well as a large outpatient department. From property right, our country's hospital ownership is diversity. But because of the scale, although according to the results of measurement quality, non-profit hospitals'quality does not lower than public hospitals', non-profit hospitals still cannot form strong competition pressure on public hospitals. Public hospitals are dominant in our country's hospital marketFrom the competitive mechanism, patients are free to choose hospitals, and public hospitals are self-financing in our country's current incentive mechanism.therefore, the competition between hospitals is driven by patients. Government own high pricing power. Hospitals attract patients mainly through quality-improving, and avoid price regulation by enhancing service quantity. The main pattern of our country's hospital market competition is service quantity competition and non-price competition.In recent years, our hospital volume showed a rising trend. Hospital invests in high-tech medical services to attract patients, which leads to medical quality improvement as well as rising medical costs and the expaning scale.The introduction of exit, namely the market competition mechanism has the potential to improve hospital market performance. The market competition mechanism can inspire the hospital invests in medical quality improvment; the market competition mechanism can change the unbalanced development of profit capital, forming for-profit hospitals'competitive advantage. Public hospital and non-profit hospital can also act longitudinal competition, curbing expanding public hospital horizontal scale. The empirical research shows that competition has played an active role in the control of medical costs and improvmeng of the quality.The market competition mechanism is not omnipotent, but insufficient. Policy environment affects the outcome of competition. Under China hospital market's current policy environment, market competition mechanism can cause rash quality investment, pull the rising costs and local treatment difficult problems. Considering the competition restrictions in hospital market, as well as the difficulties in adjusting policy environment in "top-down" ways, we further study the effect of voice. At present, the channels for patients to voice in our country hospital market is relatively narrow, some channels are formalization. However, there are many available level and vertical voice channels in our hospital market which can reduce the cost and ehance the capability to voice.Due to the characteristics of multiple inputs and outputs, there are shortcomings on the evaluation of hospital performance by quality and cost, which are not comprehensive. The paper applies DEA method to evaluate the relationg between provincial hospital efficiency and "exit-voice". Exit and voice presented a complementary relationship to improve hospital efficiency.However. At this stage, the positive role of "exit-voice" in hospital efficiency has not showed. It is necessary to further promote the capability of patients'exit and voice in China hospital market.The doctors who mke decision on medical consumption play an important role in the provision of medical services. Due to the two dimension characters of public hospital operation that the market-ran public financing and the administration, the physician incentive and constraint mechanism has been distorted. Doctors are not reluctant to participate in the current public hospital reform, too. The introduction of patients" exit-voice" can reconstructe physician incentive and constraint system and effectively restrain doctors to behave properly. The market competition mechanism can also inspire doctors to actively provide reasibly medical treatment.The external management environment and the hospital internal management structure are complementary. The hospital internal management should be coordination with the external governance, so that the external governance can fall to real point. Therefore, according to the external governance environment reformed by patients exit and voice, the paper reconfigures the public hospitals'property rights and governance structure. Avout the property right system, government should relayout state-owned hospital, adjust public hospital property right structure, encourage tprofit the introduction of profit capital. On the governance structure, the corporate governance system should be appliyed. The Council is consistent with the characteristics of Chinese hospital market, so the Council governance structure should be established. Accordingly, the functions of the government should be reform and adjusted to reach the division of regulator and the owner of public hospital and establish the administrative department of public healtha as the one and only industry regulator.The paper studyes the role that competition and voice may play in our country hospital reform wirh the application of theory of "exit and voice" by the form of mathematical and model, in order to find the the retical cornerstone of the ways to deepen reform of public hospitals. It is the first time that the "Exit-Voice" theory is applied to our country's hospital market.On one hand, we develop and test the theory. On the other hand, we provide new perspective for hospital market research.The paper systematicly analyzes the competition effect in our country hospital market, based on the systematical introduction of the hospital market structure, construct and performance,the paper uses the theoretical and empirical methods to Evaluate the hospital competitive effects. The paper includes more comprehensive index such as medical care expense, quality and technical efficeiency to study exit effect, avoiding the deficiency of single index. This paper studies the voice effect on hospital market performance with empirical test for the first time, and reasons the possible that voice push health care reform from " bottom-up",bringing out new thinking for the "top-down" but stalement health reform.This paper has certain insufficiencies, remain to be perfected. In theory, the first deficiency is that because of the limited space, this paper does not analyse government regulation which profoundly affect the hospital external governance environment.The second one is that there is no specific analysis about exit and voice interaction effect on physician decision-making behavior.Considering the interaction outcome of exit and voice in physician behavior is similar to the one of hospitals,the paper doesn't include the part. The third one is that the theoretical hypothesis has yet to be further open. In Empirical research, subjecting to the microscopic data is not available, there is no analysis of exit and voice effect on physician behavior and competition is measured by rough index.