| As a significant carrier of state political will of public health,public hospitals are invested by governments to protect public health,keep equality,promote welfare,and fulfill the citizens'rights to life and health as basic political missions and responsibilities.A public hospital himself is a provider of public health,and naturally become a monopolist in medical service fields due to his peculiar properties such as information asymmetry,externalities and uncertainty,which make“market failure”in the effectiveness of medical resource distribution.Besides,the absence of governments in supervising and investment might lead to“government failure”.Both facts result in an unbalance between performance and fairness during public hospital reforming,as well as some social issues like the decrease of accessibility of medical service and citizen's satisfaction,and the doctor-patient conflicts getting sharper.Currently,there are two opposing views upon public hospital reforms,government school,and market school.Either or other,either government school of“public benefit return”,nor market school of“de-government”,could be able to solve the above issues occurred during public reforming,especially about effectiveness,duties and equality.Therefore,this research attempts to find a more inclusive theoretical framework to overcome these problems through public value theory.In the mid-1990s,Mark H.Moore's published his article“Creating Public Value:Government Strategic Management”,which marks the start of public value theory.Later on,at the beginning of 21stcentury,this theory has been gradually developed into a new governance paradigm after coupling with public governance theory,and become a reflective researching tool towards the defects and shortcomings of traditional public administration and new public management.Public values exist in the public sphere,is a collection of citizens'expectations upon governments,and a kind of utility and significance obtained by the public,while the public value theory focuses on the public utility of public service and public goods,which were provided by governments and reflects the government's behavioral logic.It reflects value claim of governments in pursuit of public benefit,and the orientation of public benefit within government actions and behavior towards the mass.What's more,public values??shape people's public life,develop public welfare and personal well-being.Based on that,this research intends to provide a new perspective of public value for the public hospital reforming path through the input of public value theory.Starting from the“strategic triangle model”from public value theory,this thesis takes value management theory as a new public administration paradigm that is different from the traditional bureaucracy and new public management views,to guide the reform of public hospitals and strengthen the equality and justice during public hospital reforming.With an aim of creating the public value for public hospitals,this research is committed to building a cooperative and co-governing mode in which multiple entities participate in the reform of public hospitals,to realize a continuous integrated health care service model based on value,and build a“mass health”medical service system,as to offer references to public hospitals to deepen the reforming path.The thesis could be divided into six parts as following,The first part is the introduction,which includes the background and significance of the theme selection.After expounding the necessity of the public value theory embedded in the reform of public hospitals in China,it refines a theoretical framework,then reviews and analyzes the research status home and abroad,determines the definition of related concepts,and highlights the main content,research methods and innovations of this research.The first chapter systematically combs the relevant theories and explains the ideological basis and logical starting point of the public hospital reform with the perspective of public value.Such theoretical basis mainly involves in three aspects:1)the views of??equality and justice,2)the theory of public goods,3)the thoughts of government duties.The second chapter reviews the history of public value practice in public hospital reform.Mostly it gazes at the historical development of public hospitals in China,then analyzes public value orientation at each stage of reform,and examines the practice of domestic public hospitals reforming,which has experienced 6 stages,the planned economic management stage,the marketization start-up stage,the market-oriented reforming stage,the reform-transition stage,and the new medical reform stage.The characteristics of each stage reflect and accord with the overall political and economic development strategy at that time complementarily.Meanwhile,this part of thesis defines the positioning of public values??from each reforming stage.And it picks up several representative cases from local or regional reforming experiments in China to accumulate useful experience for the future public value practice of public hospital reform.The third chapter analyzes the main problems and their causes during public value practice of public hospitals in China at the present stage.Through the theory of public value,with the perspectives of public value orientation,government and market,social relations,and public appeals individually,this chapter dissects the prominent problems of“difficulty in seeing a doctor and expensiveness of medical treatment”,the serious phenomenon of“returning to poverty due to illness”,and the dilemma of low satisfaction,the poor equality,the hard accessibility and the declining welfare to medical services,and try to find the root causes integrated with government power structure and hospital performance evaluation system.The fourth chapter demonstrates the evolution history and institutional characteristics of some representative reforming examples of public hospitals abroad,and focuses on the preliminary practice of the public value theory in the reform of public hospitals in various countries and regions,so to refine some references and enlightenments for the future reform in public hospitals in China.Chapter 5 discusses the reform of public hospitals in the Chinese context of public value theory.The public value theory re-structures governmental functions and provides theoretical support for public hospital reforms,thus this chapter demonstrates a strategic planning for public hospital reform with four dimensions under public value theory,the core objectives,policy making,policy implementation and policy evaluation.Based on this framework,this thesis attempts to discover a reforming path,which shall include three aspects,the value orientation of returning to people's health,the re-construction of combined medical service,and an optimized hospital performance evaluation system.A public value embedded hospital reforming planning shall,1)let governments fulfill their responsibilities and ensure the equality to medical service offered by public hospitals;2)realize the integration of top-level design of medical service system,and impel process re-engineering at the supply-side reform and internal-linkage reform of public hospital;3)establish a performance evaluation system oriented by public values,enhance the assessment of social satisfaction,and coordinate the individual systems from multi entities. |
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