| 1. PurposeThe proposed study is based on the theory of novel public administration. By referring to the supervision experience of domestic and international public hospitals, with integration of case studies, the study is to establish the multi-supervision mode of public hospitals in China and analyze the implementation strategies, after a thorough review on current supervision situation in public hospitals in China. This proposed study aimed to help with the transformation of Chinese public hospitals to an efficient, law-regulating and responsible public service system, to provide theoretical support for the sustainable development of Chinese medical and health affairs.2. MethodsThe study utilized a method of integration of theory with case studies.On the theory part, by conducting literature review and consultation from experts, we obtained the theory basis for multi-supervision mode, supervision experience of international public hospitals, as well as the overview of supervision and future direction of Chinese public hospitals. We also used the game theory and cost-benefit analysis, to study the strategies for supervision and evaluation procedure in the multi-supervision mode.We conducted case studies by collecting literatures regarding to the public information and data from annuals of health and medication, from regions that have typical supervision mode in public hospitals (Shanghai and Hainan). We analyzed their characters of revolution mode and their initial advances in order to provide experience to exploring multi-supervision mode in this study.3. ResultsFirst, analysis of experience from regions with typical revolution. The revolution of supervision mode in public hospital in Shanghai was conducted from supervision and management of the overall network. It was a typical revolution region with whole situation. During the revolution they improved working efficiency, controlled increasing of medication service price, and promoted public beneficial effect of medication. The revolution mode exploration in Hainan was carried out from micro-aspects from safety and quality of medication. A major and primary advancement was the establishment of the third-party supervision agency. The efficacy of the evaluation mode in the third-party was accepted and supported by public hospitals, research institutions and health administrative government bodies. The public hospitals have a significant improvement in 2011 with regards to medication quality, efficacy and safety, compared with 2010. However, as there was no simultaneous revolution in the supervision mode for medical bill control, patients have an increase burden for medical bills. Hence, when it comes to the promotion of public beneficial effect of public hospitals, several aspects should be involved. A corresponding special supervision institution should be established based on different beneficial target. The realization of overall goals in supervision of public hospitals will only be achieved by formation of multi-supervision mode so that every supervision agency can play the corresponding roles in supervision.Second, the definition of connotation and main body in multi-supervision mode. The multi-supervision mode in public hospitals is a mode which emphasizes cooperation and integration of resources. Government, as the dominator of supervision, integrates and coordinates various supervisions by establishing regulations, supervising, and evaluating, with the ultimate goal to form the multi-supervision mode as a system that has relative stable laws, social supervision as well as self-regulation of public hospitals. The main body in the multi-supervision mode in public hospitals should consist of official and non-official institutions. The supervision from official institutions involves every procedure in supervision, whereas the unofficial institutions are responsible for execution of supervision.Third, definition of right and obligation of the main body of multi-supervision. Government should act as a service government for separation of the right from decision making, execution and supervision. Medical insurance companies, as the third party who pay the bill, should supervise the price for services in public hospitals. As an entrusted agency of government supervision, the third party evaluation agency should be responsible for evaluation of capital operating and service capability of public hospitals. The evaluation behavior should be authorized and mandatory, however, they should not have the right of punishment. Association of related business and industry, as the important supplemental agency for government supervision, should supervise the public hospitals on eligibility, standardization, policy-making, and news releasing. They should have the right of punishment out the side of the law. Media and association of consumers should defend the right and benefit for patients and provide accurate and efficient service information of public hospitals, by news releasing and assisting government supervision from the social public. They should also direct patients for rational medication-seeking and deal with medical issues rationally. The ultimate goal of multi-supervision mode, a strict self-regulation, is the accomplishment and establishment of self-regulation in public hospitals.Forth, analysis of supervising and evaluating strategies of multi-supervision. Supervising strategies:the design of quota of supervision and responsibility identification actually enhances the capability of responsibility identification of the supervising agency and staff. The study established the quota from evaluation of aims, approach for realization of aims, participation in decision-making, as well as census of decision-making. Establishment of census agency with scientific and rational census policy and systematic operation guarantees a lower collusion, a higher cost of collusion, a larger degree of punishment execution of collusion as well as supervision of public opinions. It is also efficient by strengthening the education for public hospitals. Evaluating strategies:during initial phase of supervising policy execution, we can increase the cost of supervision in order to enhance the efficiency of supervision in public hospitals and to social satisfaction. During the middle phase, which is the suitable region in supervising efficiency, the cost of supervision reaches the nadir with a relative stable. Attentions should be paid to the dynamic change of supervising efficiency in order to discover and correct potential problems so that the supervising efficiency remains optimal. During the last phase we should prevent from over-supervising. An increase in supervising efficiency in public hospitals will not necessarily result in an obvious crease in social satisfaction. By contrast, the cost of supervision will be increased dramatically. At this stage, enhancing the supervision efficiency will not satisfy the social needs but a new supervision policy should be considered to be published.4. SuggestionFirst, establish a system with related laws and policy for supervision of public hospitals. It is aimed to form a frame design in supervision mode for public hospital nationwide, to establish laws and policies for public hospital operation, setting-up and operation of supervising agencies, as well as rules for supervision execution for supervision agencies, and regulations related to supervision and responsibility identification.Second, establish a standardized system for supervision of public hospitals. By establishment of supervision responsibility policy for public hospitals, establishment of supervision administrative policy, standard operating procedures as well as related supervision quota for public hospitals, standardization of supervision behavior, each procedure involved in supervision will be fit with related laws and regulations, so that both supervisor and supervisee will work in an orderly manner to reach the ultimate goal of self-regulation in public hospitals.Third, establish the "Chinese Hospital Supervision Management Committee". Supervising Committee of Public Hospitals in China, as the core agency of supervision and administration of hospital by government, should be authorized by the State council. Theoretically, it consists of committee of policy making for supervision of hospitals, committee of supervision and evaluation for supervision of hospitals, committee of responsibility identification for supervision of hospitals, and the committee of information for supervision of hospitals. These committees will provide macro-supervision and coordination, resource allocation for the supervision system of public hospitals.Forth, establish the mode of juridical person management for public hospitals, and accomplish the separation of the executive management function and and operating. This includes establishment of administration mode consisting of administrative committee, leaders of hospitals, supervision committee in public hospitals. Based on this mode, changes should be gradually made on administrative theory, administrative management system and function of health administrative management in order to establish the "servicing government", with a clear definition of the duty of the government to provide a better environment for the multi-supervision mode in public hospitals.5. InnovationFirst, this study is not limited to the perspective of the health sector or government, but through the analysis of interest groups, analysis on every entity that might play a supervisory role in public hospitals from various aspects. Second, based on the overall planning of supervision procedure, with the integration of supervision core that is established earlier, various aspects, including formation of supervision regulation, evaluation of supervision, accountability, are involved in the study. We used game theory and cost-benefit analysis, with the emphasis on study of the supervision and evaluation strategies, to explore the theory strategies involved in public hospital multi-supervision and evaluation, to analyze the factors that influence the supervision behavior from supervision execution agencies, as well as the methods to maximize the efficiency of supervision, which has not been widely used in previous studies on supervision in public hospitals.Third, based on analysis of the right and responsibility of the government in the multi-supervision mode in public hospitals, we proposed to establish the concept of"" (referred to as ""), as the core authority, to provide supervision, coordination and resource allocation from various aspects for the public hospital supervision system. |
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