Research On Our Country's Strategy Of Developing The Non-public Hospitals

Objectives:Base on the principle of the spirit of new medical and health system reform, uphold the lead status of the public medical institutions, encourage and guide the social capital to develop medical and health services, form the pattern of multi-running promotion and common development of public hospitals and non-public hospitals, aims to promote the non-public hospitals developing healthly and fairly, then form a genuine high-quality non-public hospital medical resources, to meet the people's different levels demand for medical services, deeply research the development of China's non-public hospital status and presence problems, and various stakeholders on the evaluation of non-public hospitals and their development strategy point of view, and learn from foreign experience in the development of private hospitals, combined with theoretical study, discuss and puts forward the strategy of next stage development of non-public hospitals, provide a reference for further improving China's development policy of non-public hospitals.Methods:Literature:access to a large number of private hospitals on the development of domestic and foreign problems, classification management, policy support, regulatory and other aspects of the practice and experience the major open literature and research results.On-site survey:The survey questionnaire and survey to obtain quantitative data, through depth interviews and thematic group discussions were qualitative data. Wuhan City, 7 non-public hospitals and two public hospitals in a typical survey, Shandong Province 15 non-public hospitals and 41 public hospitals, medical quality management feature typical survey.400 doctors in Wuhan,360 residents and 250 patients a questionnaire survey. In Wuhan, Shanghai, Ningbo, Jinan City Health Bureau and the non-public hospitals who were in public hospitals, non-public and public hospital doctors and managers made a total of 33 interviews, held two special group discussion.Theoretical analysis:learning from principal-agent theory, regulatory economics (with emphasis on design of incentive regulation theory and the new contract, regulatory capture theory of regulatory economics), game theory, health economics theory to theory.Statistical analysis of data:descriptive analysis,χ2 test, logistic regression analysis, two sample comparison Mann-Whitney U test, analysis of variance and Kruskal-Wallis H test were used between groups, SNK and Games-Howell method were used to compare every two groups. All data were analyzed using SPSS for Windows 12.0 professional statistical software.Results:1.Part of the non-public hospitals develope better, embarked on a healthy development.2. Non-public hospitals meet part of the medical needs of the masses in certain extent.3. A lot of non-public hospital has many problems itself, and not really the formation of high-quality medical resources. As follows:many non-public hospitals over the pursuit of philosophy, on the economic interests; the majority of non-public hospitals is difficult to attract the best talent, personnel and technical weakness; many non-public hospitals lack self-discipline, lack of integrity, health behavior is not normative and even fraud.4. Most people lack of knowledge on non-public hospitals, there are significant information asymmetries.5. Part of the policy or system is imperfect, is not conducive to fair and healthy development of non-public hospitals. Include:the non-public hospitals facing unfair treatment, increased the difficulty of its development; non-public hospital access management systems; on non-public hospital system price (paid) management system is unreasonable; non-public hospital classification management policies and measures imperfections; non-profit non-public hospitals less attractive to investors, faced with funding difficulties; medical services and public information disclosure system is imperfect; tax policy on heavy profit hospital tax, local tax standards are not uniform.6. System and mechanism for monitoring non-public hospitals are incomplete with inadequate supervision. Include:long supervision, decentralization; major regulatory agencies lack independence and neutrality; regulatory system is not perfect; regulatory performance without examination, no accountability mechanism, there is "regulatory capture"; unreasonable regulatory methods and procedures; violation penalties small, non-compliance and low cost.7. Public hospital supervision of medical acts is not in place, there is an impact on non-public hospitals.Conclusions:Give the following aspects of non-public hospitals in our country's development strategy:The general idea:Based on four aspects, first, the optimization of non-public hospital personnel and technical personnel; second, to avoid moral hazard behavior of non-public hospitals; third, to create a fair environment for the development of non-public hospitals; Fourth, improve management systems and mechanisms to improve regulatory effectiveness, puts forward the development of specific non-public hospitals policy. And should be integrated to take various measures to play a coordination role in order to maximize the promotion of healthy development of non-public hospitals.Specific strategies:1. Improve access management systems of non-public hospitals. Ajust non-public access to the hospital institutional arrangements and investment management, strengthen access to medical personnel management, improve access to medical standards, to enhance access to medical technology and medical equipment management.2. Encourage social capital to participate conversion of existing hospitals.3. Encourage the development of non-profit, non-public hospitals, the rational development of for-profit hospitals. First, encourage the development of proposed non-profit non-public hospital measures, including expanding non-profit non-public hospital funding sources, such as issuing tax-free bonds to encourage investment and other residents; improve the management of hospital classification on the approved non-public nature of the principles of hospital. Second is to strengthen non-profit, non-public hospitals, financial supervision, to ensure their non-profit. Third, the rational development of for-profit hospital care. Ascertain their services rationally due mainly to allow information asymmetry to a lesser extent its conduct clinics project, or treatment clear, effective, safe, easy to develop "clinical pathway" diagnosis and treatment of disease project, or basic medical insurance will not pay for beauty, plastic surgery, infertility (pregnant) disorders, sexual dysfunction and other special needs services. Reduce its conduct to the best there is no clear effects of current medical therapy, inaccurate or difficult to observe the treatment of refractory chronic treatment projects. Adjusted and improved hospital profit tax policy, exempt from business tax and additional; lower income tax rates; adopted special policies to specific uniform tax standards and methods.4. Policy gives equal treatment for non-public hospitals, and to improve policy implementation mechanisms, such as clear to the implementing agencies of the specific operational requirements and accountability provisions to ensure that policies have been implemented to create a fair environment for development.5. To further improve system of information disclosure and opening of the non-public hospitals. From information disclosure and public content, organization, procedures and methods were improved in four areas.6. Strengthen the construction of credit system of the non-public hospitals. Establish a national network system of non-public hospitals credit files. Actively promote the practice of medical bad points management system.7. Improve the non-public hospital medical price (cost) management system. Change the current payment by way of service. Profit hospitals on the consultation between doctors and patients sign a "single disease contract the total cost of health care" system, file and record system to an open society. On the non-profit non-public hospitals, in government guidance based on the combined development of clinical pathways, the formation of the standard cost of a single disease, the single disease scale fees. Belonging to the medical insurance paid for services, fees paid in total, the fixed per capita payment system should be implemented, and set the upper and lower limits, to take a different billing method, to prevent the lower quality of service.8. Improve the monitoring system and mechanism of non-public hospitals to improve control effectiveness. First, to construct joint meeting system. Joint Drug Administration by the health administrative departments, health care, finance, audit, price, quality supervision, Home, Business, Construction of the tax department and other related departments. Second, to further improve the regulatory system. Including monitoring the establishment of government departments, industry self-regulatory organizations and consumer protection organizations, including participation and public supervision by public opinion than the perfect modern regulatory system. Third, the establishment of independent, professional regulatory bodies. Fourth, improve the transparency of regulatory procedures and improve monitoring methods. Enable the public to monitor the situation, monitoring the results have to understand; the regulatory approach, the proper use of "assault-style inspections", "check-up Act," specifically (and) recruited doctors rotational stagnation inspection. Fifth, a clear regulatory focus, the establishment of non-public hospital performance assessment monitoring and accountability mechanisms. Performance appraisal regulatory objectives set to address the current weaknesses in the focus of medical quality, medical practices, medical advertising, non-profit non-public hospital financial dominance, the index of medical costs; a regulatory system of accountability for dereliction of duty to improve public participation level, give full play to the consumer protection organizations, industry self-regulatory body and the supervisory role of public opinion, and subject to public accountability and effective. Sixth, increase penalties for violations of non-public hospital efforts to increase non-compliance costs.9. Perform synchronized control on non-public hospitals and public hospitals.