The Study Of Governance Of Large Public Hospital Based On Polycentric Governance

ObjectivesThe large public hospital is the focal point and difficult point of Public Hospital Reformwhich is the core and key of new medical reform. According to the irregularity of OmnipotentGovernment and Market fundamentalism, through analyzing the major problems in governanceareas of the large public hospitals, and comparing the governance models of the large publichospital between typical countries, the study absorbs ideas from Polycentric Governance ofNeo-institutional School, expand the concept of governance to overall interest exchange systemcentered in the large public hospital which consist of patients, medical staff, hospital managers,government, medicare offices, etc. It aims to construct a governance model of the large publichospital according with the situation of our country and achieving the interests of all parties,which could provide decision-making basis and theoretical support for the large public hospitalreform.MethodSThe study adopts the comprehensive research method which to combine qualitative analysisand quantitative analysis, to confirm each other by theoretical discussion and empirical research.Firstly, using the literatures induction and analysis as far as possible to collectsystematically the large public hospital of relevant literatures, and to carry out qualitative andsemi-quantitative research, we analyse and confirm to governance problems of large publichospital by the macro module special for health system.Secondly, using the types of comparative analysis to induce the relevant information aboutthe functional orientation, expense compensation, management system and service efficiency oflarge public hospitals in the typical countries, we seek the inherent law further of governancestructure, governance mechanism and initial condition about large public hospitals.Thirdly, using stakeholders analysis to identify the stakeholder groups of large publichospitals, we summarize Trading Capital and Trading Demands of the stakeholders which couldpay for exchange of interests through Focus Group Interview.Fourthly, selecting certain tertiary public hospital of Shanxi province as nucleatedsettlement, we organize questionnaire survey to collect data which the samples come from thestakeholders around the hospital. Fifthly, using factor analysis and measurement model of structural equation for exploratoryfactor analysis (EFA) and confirmatory factor analysis(CFA), we build the governance model ofthe large public hospital after cross validation.Lastly, using the case empirical study above the govern measures of the developed countriesand public hospital reforming examples of our country, we test and verify the large publichospital governance model based on Polycentric Governance.Results and Conclusions1. To confirm the governance problems of the large public hospitalTaking417literatures published from1998to2009on CNKI, CBM and WanFang MEDOnline as samples, we summarize70kinds of governance problems about the large publichospital, and squeez it into6kinds of problems which include to the hospital internal system andexternal environment step by step. The study finds that the root causes of problems lie in thesystem and mechanism of public hospitals not adjusting timely when it take place dramaticchanges in the social organization structure and production style of the whole nation. Whenofficial rules and regulations became invalid in regularizing transaction behaviors of the largepublic hospital stakeholders, that Hidden Rules filled space resulted in which the overall systemincreased transaction cost, decreased operating efficiency and intensified conflict. Therefore,only through strengthening the internal management of the large public hospitals frommicrocosmic angle, the achievement of Public Hospital Reform will be ineffective. We mustreconstitute governance model of the large public hospital from macroscopic and Madhyamikaview.2. To Compare the governance models of the large public hospital between typicalcountriesAccording to6modes of the world medical service organization by Janas Kornai, wechoose Britain, Germany, the United States, Singapore, Canada, Mexico and India as samples,and compare the functional orientation, expense compensation, management system and serviceefficiency of large public hospitals in the typical countries. The study finds that the aimestablishing large public hospitals by national governments are provision of diagnosis serviceand treatment service to the difficult and baffling diseases rather than the common disease. Thedifference is Whether they could shunt clinic population institutionally. The study also finds thatrelative to keep everything in governments own hand in the developing countries, the developedcountries are more emphasis on participation and cooperative governance in the large publichospitals governance that governance structure is relatively complex, direct control means of governance mechanism are less and indirect control means are relatively abundant. The studyfinds that which kind of management mode of large public hospital have something to do withthe level of economic development and social maturity, but also with the governance concept,value orientation, national historical and cultural tradition.3. To identify classification of the large public hospitals stakeholders and determinethe elements of exchange interestsAccording to the specific investment dimension and transactional contract dimension, thestudy identify the4types of stakeholder which include the government, medical staff, hospitalmanagement, medical insurance institutions, medical device manufacturers, patient, relevantprofessional organizations, other types of medical institutions, the social public and media, andto clear the means and position of exchange of them. By Focus Group Interview the study listTrading Capital and Trading Demands of the former8stakeholder groups which could pay forexchange of interests.4. To build and test the governance model of large public hospital based on PolycentricGovernanceIn order to explore the links of interest exchange of the large public hospitals stakeholdergroups in medical treatment, hospital operation, medical payment and medical supervision, weselected certain tertiary public hospital of Shanxi province as nucleated settlement, and organizequestionnaire survey to collect data which the samples come from the stakeholders around thehospital. Using factor analysis and measurement model of structural equation for exploratoryfactor analysis (EFA) and confirmatory factor analysis(CFA), the study found19links of interestexchange. Then, around the treatment contract between doctors and patients, the employmentcontract between government, hospital management and medical staff, the insurance contractbetween patients, medical insurance and hospital, we build the governance model of the largepublic hospital which include medical treatment, hospital operation, medical payment andmedical supervision.5. The governance model of large public hospital based on Polycentric Governance byempirical studyIn accordance with the law of contract elements, from the perspective of the will of theparties, the contracting capacity, object of transaction and Breach of the contract, etc.19links ofinterest exchange are analyzed one by one, and verify by the govern measures of the developedcountries and public hospital reforming examples of our country. In the last, the study offerpolicy proposal including to promoting the role of governance transformation, implementing the independent legal person status of large public hospitals, etc.Innovation1. In the choice of subjects, the study focus on the governance problems of large publichospital that is at the top of three-grade medical system, which could provide a useful referenceto decision-making institutions and hospital administrators.2. In the concept of study, the study takes polycentric governance into the governance oflarge public hospitals, in order to explore a Good Governance pathway which to be differ fromthe irregularity of Omnipotent Government and Market fundamentalism, and to avoid ineffectiveof monocentric governance formerly.3. In the research of design, the study break the traditional idea of governance in accordancewith the internal and external research division, and explore the links of interest exchange of thelarge public hospitals stakeholder groups in medical treatment, hospital operation, medicalpayment and medical supervision, reconsitute the governance model of large public hospital thatinclude the polycentric power structure, the diverse and feasible control measures.