Public Hospital Economic Operational Mechanism Study Based On Diversified Stakeholder Cooperation

Public hospital reform is the key to the health system reform progresses. It is necessary to build a positive and effective public hospital economic mechanism through which to develop a novel health system reform. The economic operation mode in public hospital is not only an economic system with simply input-output process, but also a complex management system which integrates government, technique, market and information together, That is to say, the operational mode is running in a complex environment.After analyzing the situation of the public hospital based on the stakeholder theories, we find out the number of interest subject is increased, economic status is changed and the relationship of them becomes complicated, all of which lead to some problems in public hospital reform.A multi-agent system model for public hospital economic operation is established based on the complex adaptive system theories and methods. It is believed that the multi-agent system model for public hospital economic operation is evolutionary with government, medical insurance organization, pharmaceutical enterprise, patients and the social environment, economic environment, technique environment, trade environment.The evolution of multi-agent system of public hospital economic operation is not a simple balanced process, but a homeostasis. After establishing the cooperative evolutionary game model and analyzing the evolutionary process of system, 3 conclusions are obtained in this thesis:1. Two tendencies of multi-agent system evolving can be summed up as Cooperation and Conflict. We suppose to establish a coordinating mechanism for the stakeholder that the multi-agent system should be guided to the direction of cooperation.2. Public hospital economic operation environment influences greatly to its operational status. Public hospital economic operation is affected by health service market driven force. Due to the special characteristic of health service, the market regulation is failure in the medical service system some times, so government's intervention is crucial complement of public hospital economic operation.3. Establishing a coordinating mechanism and cooperative regulation of the stakeholder of public hospitals is a basic measure for promoting harmonious hospital economic running.Based on the study of the reform experiences of foreign and domestic public hospitals, we suggests the aim of the public hospital reform is to change the operation mode with administrative command rooting under the planned system to a novel mode with integration of the government supervision and the market regulation. In this novel mode, the macro and micro economy control can depend on government intervention and market regulation respectively. It is the responsibility of hospital to make full use of rights and benefits as a main body in the coordinating system. Furthermore, the rights of the insurance and patients should be enlarged.In the end, we make advices that the harmonious China public hospital economic mechanism should be established from the perspective of the coordination of the stakeholder. First of all, an interest community including government, public hospital, medical insurance and the patients for the development of harmonious public hospital economic operation should be established. Next, the function of government and hospital in the economic operation should be ensured. Finally, we should make full use of market regulation and social forces in the public hospital economic operation.