The Theoretical Analysis And Empirical Research On Public Hospitals Operating System Reform

Aim: Government's policy outputs play an important role in the reform and development of the public hospital system. More than 96 percent of China's hospitals are public, and, as the main body of national public health and medical institutions, public hospitals take the responsibilities of providing social basic medical protection and public health services, which is considered to be a social welfare undertaking involved with certain public welfare and benefits. However, within the 30 years of reform and opening up when China's economy maintained an average annual 10 percent growth rate and created a miracle in the world economic growth, the general public did not receive more extensive and affordable health care services. Thus reform of medical institutions is becoming one of the hot spots in China's social reform today.This study attempted to put forward the theoretical basis of public hospitals' operational mechanism reform from a macro point of view, comb the evolution of China's public hospitals' operational mechanism reform, do an empirical research of public hospitals' operational mechanism reform, explore public hospitals' value orientation in the reform of operational mechanism, so as to build a preliminary framework of the new operational mechanism for the reform of public hospitals which is suitable for the socialist market economic system and China's national conditions.Methods: (1) Spot investigation. Mainly use the pre-designed data collection tools to collect relevant data at the scene; design the interview outline in advance and take individual and group interviews. (2) Literature retrieval. Collect the literature in public hospitals' operational mechanism reform published in recent years, analyze them and select some for reference. (3) Qualitative research. Mainly do qualitative analysis on interviews conducted. (4) Empirical analysis. Do a case study of public hospitals' operational mechanism reform in Suqian City of Jiangsu Province. Analyze the reform model with "transformation of government functions, optimization of resource structure, and implementation of social hospitalization and rational flow of talents" as the main content in Suqian City.Conclusion: Reach the following conclusions through the theoretical analysis and empirical studies to current public hospitals operating mechanism reform: (1) The theory analysis of public hospitals' operating mechanism reform showed that: social and economic policies, social equity and economic efficiency objectives are not irreconcilable. We should not completely separate economic and social policies, social equity and economic efficiency goals, but should seek the best balance between these points. (2) Analysis of the degrading public nature of public hospitals showed that: before the reform and opening up, government established a funding system in which public hospitals obtain operating costs through the direct allocation and third-party payment according to the prevailing political environment and the distribution policy of low-wage, low consumption. The funding mechanism so that ensure the hospitals economic base to complete its social policy objectives. Since reform and opening up, reasons owed to the gap between the actual goal of public hospitals and social policy objectives include that of existing macro-economic environment and the hospital's own governance structure. (3) Analysis of the reform motive of public hospitals' operational mechanism showed that: the reform of operational mechanism of public hospitals is driven by transformation of government functions needs, the scientific management needs and the reform of international health. (4) Analysis of the main stakeholders in reform of public hospitals showed that: the reform of public hospitals is under influences from reformers with government characteristics and major external constraints, and all stakeholders related. To achieve the desired results, reforms must also carry out reforms at all levels, and the government is the main policy output. (5) Analysis of public hospitals operating mechanism reform showed that: health activities receive great intervention of the state, and its public service and welfare characteristics do not allow them to be fully market-oriented operated. The starting point of government intervention in health is to make medical and health industry operation fairer and bring the patients basic medical services. Public hospitals themselves should moderately introduce market mechanisms and rebuild management structure and internal organizations of public hospitals, so as to promote hospital's market-oriented activities. (6) Analysis of feasibility in the appropriate combination of public health services and market showed that: the market and the public interest belong to different areas, but the public welfare is not abstract, and it is rooted in the reality of the market and society. Public welfare is represented through other social factors including market and is involved in the connotation of market. Public welfare and market-orientation may not harmonize at a certain historical stage. On a particular thing, they exhibit like two sides of one coin, both opposite and interdependent.Suggestion: "Fair being the priority, efficiency to be improved" should be value orientation of the reform of operational mechanism for public hospitals, that is letting the "visible hand" of government to resolve equity issues and letting the "invisible hand" of market to solve the efficiency problem. (1) At government level, there should be a reasonable definition of functions and a separation of the government and public affairs; there should be an assurance of fairness and a supervision of the implementation. (2) At market levels, soliciting the market mechanism can not be deviated from the basic objectives of the charity; conflicts between institutional stakeholders and the public interests should be prevented; market mechanism should be integrated with hospital grading and classification; efficient running of modem market economy can not achieve without the effective functioning of the Government. (3) At the hospital level, relationship between government and hospital should be clear; Governance structure should be established; Hospital operating mechanism should be innovated. (4) In social dimension, to establish a channel for various social groups of interests to fully express their will; To bring into play social capital and strengthen social supervision.Innovation: Based on the study samples of the reform of the public hospital system in Jiangsu Province, this paper is innovative in two points. The first innovation is regarding the reform goals of the public hospital system. The social and economic policies, social equity and economic efficiency are not irreconcilable. Therefore, the economic policy and social policy systems would not being considered as completely against each other. Social equity and economic efficiency should be matched to achieve a balance point instead of being separated. The second innovation is regarding the reform approaches of the public hospital system. The initial cause of the government intervention is to achieve an equal operation in health care, and to benefit the masses of patients with basic health care service. The market mechanism could be adopted appropriately by public hospitals to reconstruct a running structure and an internal manage mechanism in order to expose the operation activities to the market. In this way, the equality can be solved by the government as the visible approach and the efficiency can be solved by the market as the invisible approach.