Study On Appraisal And Operating Mechanism Of The Public Welfare In Public Hospitals

In recent years, reform on public hospitals has become a hot and difficult issue and the key of health system reform. The establishment of all other systems and implementation of the supporting policies are dependent on the success of the reform of public hospitals. Under the special social concerns, the reform on the operational mechanism of public hospitals and maintaining the public welfare of health services are important and difficult in health system reform. With the development of society, public welfare in public hospitals has experienced the pain course of approved-weaken-diluted from liberation to today. Nowadays, public hospitals are facing unprecedented challenges. For the community voice of mitigating the problem of "medical treatment is difficult and expensive" getting higher and the expectations of success on the medical reform is relatively high, the reform of public hospitals have a critical influence on the success of medical reform.In this study, the public supply theory, public regulation theory, stakeholder theory, hospital operating system theory and performance evaluation theory were used in analysis of the status of public welfare in public hospitals and the operation mechanisms of domestic and international public hospitals. The study has put forward design principles of the operating mechanism based on the public welfare in public hospitals. Appraisal on the public welfare of public hospitals was conducted using the TOPSIS method after analyzing the impact factors of public hospital and a case study was implemented using a community welfare hospital. The basic framework of initially constructing the operating mechanism of public hospitals that fit for China's national conditions was proposed. Objective:1,To provide theoretical and empirical evidence for the reform policies of the development of public hospitals:One important aim of the reform of the public hospitals is how to enhance the public welfare, so the theoretical and empirical research can provide scientific basis for the government reform policies in the development of public hospitals.2,Though the evaluation of the public welfare in public hospitals, we can clarify the evaluation criteria and achieve conditions for public welfare.3,Analysis the existing difficulties and shortcomings of public hospital management systems and operational mechanisms. Identify the major factor to impact the run of nonprofit hospitals.4,We recommend a strategy that conducive to public welfare play strategy and set up operating mechanism for public hospitals to run for public welfare initially.Data Source and Research MethodsData Source:Extensive collection of relevant literature as well as policy documents, the Yearbook of Health and the study reports related to public welfare of public hospitals and its operating mechanism were conducted. At the same time, using the multi-stage stratified random sampling method, questionnaire survey was implemented in the nonprofit hospitals chosen from a variety of areas. Extract 10 public hospitals involving five regions of Wuhan, Jingzhou, Qianjiang, Suizhou and Xianning and analyzed mainly from multiple areas such as governments, public hospitals themselves and the public. In six regions of Hubei Province of Wuhan, Suizhou, Jingsha, Qianjiang, Huangshi and Xianning, selected the secondary and tertiary hospitals in a total of 10, randomly selected four private hospitals at the same time in the areas. The insider interviews were conducted in the hospital's medical staff, patients and managers to understand the operational status and difficulties of the public welfare of sample hospitals. At the same time health administrators, hospital medical business management experts were selected as participants of the focus group, through discussion to understand the existing problems and difficulties in the operation mechanism of public hospital. Research Methods:1,Literature analysis method:using the methods of network information retrieval, from Chinese journal network, WANFANG, Chongqing WEIPU, Pubmed, Medline and other databases, with key words of public hospital, nonprofit, commonweal organizations, operating mechanism, the welfare economy, Hospital, Public Welfare, Charity and other related key words, using Boolean logic search method and information feedback retrieval method searched the related Chinese-English documents of public hospitals and the operation mechanism from 2000 to 2008 collected 500 articles at home and abroad. We use method of seeking common ground of logic to analysis the evolution of public hospital's connotation and denotation as well as the operating status of public hospital through all the literature we retrieval.2,Questionnaire:using multi-stage stratified random sampling method, select non-profit hospitals from various areas to investigate, extracting 10 public hospitals involves Wuhan, Jingzhou, Qianjiang, Suizhou, Xianning, including 6 third-level hospitals, 3 second-level hospitals,1 first-level hospital, to conduct questionnaires on the hospital's medical staff, managers and patients of the level of recognition to the public of the hospital. Meanwhile, conducted a survey on the status of public project expenditures and government financial assistance of some public hospitals.3,Insider semi-structured interview:the investigation of the above-mentioned hospital and another four private hospitals random sampling, selected medical staff, patients and managers to conduct insider interviews, conduct semi-structured interviews to principal of the hospital to understand the operation and difficult of public of hospital. Conduct insider interviews with the responsible person of administrative department. Select some public service organizations and companies with certain public acts province-wide, have their relevant responsible person for semi-structured interviews, accepting more successful policy and management experience.4,Comparison of Methods:have a comparative study between the regulatory mechanism and operating mechanism in public hospitals at home and abroad. Drawing lessons from successful experiences in the operating mechanism of foreign hospitals and learning lessons from the failures in national public hospital reform. 5,Stakeholder analysis:according to the theory of stakeholder, the relation of major public health stakeholders and secondary stakeholders, conflicts of interest, assess the importance of the interests of stakeholders to determine policy priorities of stakeholders and their interests.6,SWOT Analysis:have a SWTO analysis of macro environment and micro features of the public activities of public hospital. Analysis problems and difficulties of public hospitals run, and establish improvement measures of various public welfare activities.7,Benefit analysis:using the input-output analysis of economic and social benefits, conduct a reasonably objective evaluation to the benefits of public hospitals, to construct a reasonable management system and operation mechanism.The results and analysis:1,Our public hospitals have superiority of the number of absolute and technological advances and the monopoly position of financial, and the favorable policies and the loss policies of income, but appearing polarization in the development, because of many restrictions to the institute aims to the original of the public and in the pursuit of profit, leading to the lighten of the public, but owing to the survival question of hospital, can not alter the status for the time.2,Basic principle of enhancing operation mechanism of the public hospital is to be guided by the spirit of reform document of public hospital, meanwhile enhancing the public, still stimulate the initiative of the hospitals and medical personnel, and having local adaptations and maneuverability.3,Suitable management system and duty system of hospital should have clear responsibilities and the corresponding duties, and to solve the relationship of ownership, management and decision-making power. Effective decision-making mechanism, science and reasonable compensation mechanism in public hospitals and standards of financial management mechanism, and vigorously promote reform of personnel and distribution mechanisms can greatly increases the initiative of the medical personnel and pave the way for public hospitals to play welfare better.Innovation: 1,Through surveys and questionnaires in this study found that:in the recognitions of welfare of public hospitals, both doctors and patients that, "reasonable medical service price" is primary content public hospitals to provide public service, medical personnel also that "actively participate in public health emergency relief and medical aid" and the "health education to patients," is also important that patients are more focused on "for the sake of patients" and "standard medication and check" and therefore, better reflect the public interest in public hospitals should focus on more reasonable price of medical services.2,This study on the theory of public goods and public interest theory of regulation, as well as influencing factors of operating mechanism of nonprofit hospitals, proposed the building of mechanism of public hospitals consider not only the hospital's survival and development but the realization of social function of public hospitals, to ensure the bottom line of public welfare of social functions.3,This is the first time defined the concept of public welfare from six aspect, and clearly define the external and internal operation mechanism concept reflect public welfare, and TOPSIS method was first used in evaluation of the public welfare.4,This study summarizes the eight aspects of construction of public hospitals operating mechanism of public welfare, including the establishment of efficient institutional mechanisms, innovation of policy-making mechanism, improve the compensation mechanism, standardized financial management system, and vigorously promote the performance pay based on position of personnel and distribution and incentive mechanisms to establish long-term management mechanism, and from how to expand channels for fund-raising mechanisms, so as to achieve self-recommendations and build the evaluation system of public welfare.Policy recommendations:1,To better reflect public welfare, public hospital must execute the separate regulatory function, strengthening the supervisor of government, lowering the self management of hospital, implement the unity management of hospital right, set up the administering system of legal person.2,Classify management of different levels in public hospitals, conduct structural adjustment to the medical institutions of the government-run, and establish a compensation mechanism based "procurement of services" by government, highlighting the government's investment in medical services in public welfare.3,Enhance monitoring on performance of Nonprofit public hospitals, improve the financial compensation accounting system, establish the financial statements of public hospitals CPA audit system, the larger public hospitals can set up a hospital chief accountant position, appointment system can also used in the public hospitals(the implementation of rotation system).4,A public disclosure of hospital information system should be established, to increase the efficiency of public welfare investment evaluation and disclosure of investment of public resources including land, fixed assets, all kinds of government subsidies, tax concessions and other intangible assets etc. These elements are all included in cost accounting and reporting system, as to give public health task special subsidy or single row, and distinguish the direct input and indirect inputs which government give the hospital.5,Public hospitals have to focus on medical services at a reasonable price, and provide the free provision of public welfare services for the general public as the primary content. Public hospitals also should assume corresponding responsibility when disasters and public health emergencies happened in the medical assistance, it also should provide free health education and the concept of public hospitals would be more considerate, Rational drug use and standardized examination are widely recognized in public hospitals, in order to establish the public welfare image of public hospitals.6,The Establishment of the medical indigence compensation mechanisms have great significance on Major accidents, natural disasters and particularly poor patients'medical arrears, the mechanism should be shared by the "Government in recovery Fund", "Medical Relief Fund," and various forms of funding sources. It was created to reduce the system losses that caused by the inhuman, to achieve the full coverage of the public welfare.7,We should broaden the channels of public hospital funding, medical aid foundation set up by charity organizations to help raise money and drugs, and to mobilize community participation, the establishment of the autonomy of public hospitals, long-term fund-raising mechanism for public hospitals, medical assistance to carry out public activities provide adequate funding8,Wage and salary positions performance system with integrated distribution system should be implemented and effective incentive and comprehensive evaluation mechanism should be established, improve medical staff initiatively, to enable medical personnel to income and ability, post, responsibilities, workloads, quality linking, generate profits procedures is no longer assessed separately or principally.9,When public hospitals operating mechanism built the hospital's survival and development should not be considered only, it is more important to achieve the social function of public hospitals, to ensure the bottom line of the provision of basic social functions of public welfare, that the people in groups such as living alone, destitute subsistence allowances rescue people and the supporting object of Department of Civil Affairs can enjoy low-cost or free medical treatment with evidence in order to fully reflect the hospital's public welfare.10,The establishment of the external assessment mechanism public welfare public hospitals may be led by the health administrative departments under the NPC, CPPCC,with the supervision of a third party evaluation. We need to develop public hospital performance appraisal program, design a detailed scientific assessment system, so as to assess the public welfare of the public hospital comparative objectively and impartially.