The Research Of Principal-agent And Performance Management On The Head Of The Public Hospital In China

In china, the public hospital is playing a critical role to protect the people's health and increase the economic development of the country. The head of a hospital is a major influence to the performance of the hospital.. Therefore, it will significantly to excogitate an efficient performance management system for a head of public hospital to motive the enthusiasm that safeguard the patient benefit, promote the public health development.Aims: This thesis is to identify the relationship between heads of public hospital and the government based on the principal-agent theory that further sets up principal-agent model and a performance appraisal system to motive heads of public hospital in order to link the purpose of two parties and promot public hospital's performance.Content and methods: This thesis would analyze the principal-agent characteristic of public hospital and summary the principal-agent hazard and reasons of it. In addition, this thesis would investigate the risks of the principal-agent and discusses practice on the public hospital management pattern reform in order to design a suitable principal-agent pattern of the public hospital for the national condition.Secondly, to adaption government's goal and void risk of the principle-agent, enhance the performance of heads of hospital and create a performance appraisal system, this thesis applied literature review, Delphi method, focus group and multiple regression analysis etc. to pick up the criteria. Moreover, this thesis is submitted by probability sampling techniques to decide samples (4 hospitals in level 3, 4 hospitals in level 2) in Shenzhen and Wuhan city. Furthermore, using the synthesis exponential method, the connection analytic method, Topsis method and the projection seek out the traces the quality synthetic evaluation and so on, 4 methods to carry on the confirmation to the hospital achievements, the criteria of performance management in scientific nature.Finally, applied literature review and theory study, proposal design former and measure of inspirit and restrict. Meanwhile, the thesis also presented the implementation plan of yearly salary system and set up rank of health management.Conclusion: through the evidence-based study, such as: theory study, the expert visiting and investigation, the author develop a performance appraisal system of a head of public hospital and identify the principle-agent relationship, which is considered the principal-agent to relate"the administrative principal-agent". However, this concept is unable to fulfill the management operation, including the trustee is inconsistent with the agent respective, the trustee and the agent responsibility risk is not coordinated, the agent responsibility and the right are asymmetrical, owner vacancy, asymmetrical information and surveillance strength is weak, multi-principle and multi-goal, agent's drive restraint mechanism insufficient consummation. These problems leaded to the proxy question as: the employee management, the excessive in office expense, negligence, rent-seeking, shirking and so on behavior.Recently several years, many State-Owned enterprises reform it procedure that has carried on the positive exploration to the medical reform. Mainly may divide into two kind of patterns, one kind is"the property right privatization"model as Jiangshu Suqian representative; Another kind is"the manage separates from the ownership"as Shanghai and Wuxi representative. In general,"the property right privatization"is based on closing, stopping, and extension of public hospital property that is difficulty achieve the goal of the reforming public hospital. Moreover, the second model will make the agent level to increase, manage the cost to increase, manage the efficiency with difficulty to enhance, and the problems between trustee and agent.This thesis is to consider that the innovation of public hospital is conducted by the contract design between the trustee and the agent and innovation of management right separate from ownership, is not based on innovation of propert right. Therefore, this thesis would obtain the following achievement through the research.1. Conformation the new principal-agent pattern for heads of public hospitals.Government should found and management public hospital and select occupational supervisor. The recruitment of heads of public hospital is from job market in order to select a competent head. As a result, the health service in our country would keep in satisfaction level and people benefit from the service particularly in the public hospitals. Moreover, the appropriate principal-agent pattern within our national condition is supposed to be followed criteria: 1) appoints a head of public hospitals by the administration of public health department as a government representative; 2) multi-department carry on supervising to the hospital; 3) needs further to be clear about the responsibility every sides; 4) requests every sides benefit and reward with his achievements.2. Established a full completely and suitable performance appraisal index system to heads of public hospital.The new system is based on the concept of forwards-control in that the principle-agent contract has been clearly addressed the responsibility and the objective of government. Specifically, the criteria of new system approach the national benefits to regard as medical insurance, the concept of green hospital and the sustainable development capabilities. In order to fair appraisal different heads'achievements, this appraisal system uses 360°method that examines by four parties: higher department responsible for the work, patient, hospital staff and people from other government administrative department. At the same time, this new system also considers the situational factors in order to get more comparability and usability.3. Formulated a proper motivation and restriction measure to heads of public hospital within our national condition.According to characteristic of public hospital in our country, proposed design principle to establish motivation, restriction mechanism, rewards and punishment measure. The judgment of performance could be divided into four levels, including excellent, good, normal and fail. The thesis also proposed scheme of the yearly salary system of heads of public hospital.Innovations:1.Proposed the new principal-agent pattern for heads of public hospitals.2.Established a full completely and suitable performance appraisal index system to heads of public hospital.Ideas of the follow research:1. Continue this research on principal question in public hospitals and to promote the agent to fulfill the owner function very well in the new pattern and consolidate advantage of principal and agent;2. Makes large-scale positive research on performance appraisal system and further completes it,examines operational and scientific of the system of personal behavior and ability index;3. Further completes and validates the model of environmental effect of performance of the head of public hospital.