Research On The Effect Of Government Regulation Of Chinese Medical Service Industry

After more than 40 years of reform and opening up,China's economy and society have undergone profound transformations,and made major achievements.The total economic volume has stabilized the world's second largest,and the great goal of building a moderately prosperous society in all respects is almost completed.At the same time,China's medical service industry has also made remarkable achievements.Since the launch of a new round of medical system reform in 2009,government regulations in China's medical service industry have been continuously adjusted and optimized,which has improved the accessibility and fairness of medical and health services,and has significantly improved the health level and life expectancy of Chinese residents,and has won wide recognition from the international society.However,with the continuous development of Chinese society and economy,the "contradiction between the people's growing need for a better life and the unbalanced and inadequate development" in the field of medical services has become increasingly prominent.At this time,the study of government regulations including the implementation effect of China's medical services industry has important theoretical and practical significance for deepening the reform of the medical system and realizing the highquality development of the medical service industry.Domestic and foreign literatures have shown that medical institutions are often regarded as micro-research objects,and valuable empirical studies have been conducted on specific hospital clusters in related fields and regions,here considerable progress has been made.However,this type of research also has following shortcomings: First,it seldom adopts standardized methods to discuss the medical service industry in a multi-disciplinary system,especially the insufficiency of the induction and analysis of the industrial economics characteristics of the medical service,and it has not yet formed a theoretical framework with multi-disciplinary cross-analysis.Second,the historical evolution,regulatory content,regulatory tools,and regulatory agencies of China's medical service industry government regulation are not sufficiently sorted out,and the current situation of government regulation in China's medical service industry has not been comprehensively summarized.Third,there are a lack of logical analysis based on regulatory requirements,regulatory evolution and regulatory evaluation,and a lack of empirical research on systematically measuring the total factor productivity of the medical service industry and systematically verifying the effects of government regulations.Based on this,in response to the actual needs of adjusting government regulations and optimizing China's medical service industry,an analysis and research framework of "regulation demand-regulation evolution-regulation evaluation" has been established.Regulation demand is related to the motivation for designing and implementing government regulations to promote the development of China's medical service industry.It needs to be studied from both theoretical and practical aspects in combination with the characteristics of the medical service industry.Regulation evolution is an analysis of the process of changes in government regulations in China's medical service industry over time,place,and conditions.It is necessary to combine the development context of China's medical service industry to summarize the change processes and internal mechanisms of the industry's related regulatory goals,regulatory content,and regulatory agency.Regulation evaluation aims to answer the question whether government regulations in China's medical service industry are effective.This requires systematic verification of government regulations through quantitative analysis on the basis of measuring the efficiency of the industry as the basis for evaluating the effect of government regulations.The main research content of the thesis is summarized as follows:First part of the thesis is the research on the necessity of government regulation to promote the development of the medical service industry.Firstly,re-understand the medical service industry and government regulation through the literature research method and inductive and deductive method,discuss and summarize the basic definitions of the medical service industry,government regulation and regulation effects,and review the existing research on requirements,content and effect evaluation of government regulation in the medical service industry as the research basis of the thesis.Through literature research method,inductive deduction method and statistical analysis method,it analyzes the industrial characteristics of China's medical service industry,such as the attributes,operation characteristics,supply and demand characteristics,and government positioning.The theoretical basis of government regulation in China's medical service industry is discussed in combination with public interest regulation theory,interest group regulation theory and incentive regulation theory.The practical necessity of government regulation to promote the development of China's medical service industry is discussed from the perspective of improving the social benefits of the industry and the balanced development of supply.Finally,through the inductive and deductive method,a longitudinal analysis of the government regulation of China's medical service industry since the reform and opening up is carried out,and the characteristics and problems of each evolution stage of the industry are summarized,and the content and goals of the government regulation at this stage are summarized.Second part of the thesis is the research on the effectiveness of government regulation in China's medical service industry.Firstly,the improvement evaluation of the total factor productivity of China's medical service industry through statistical analysis and comparative research methods is made,combined with the current government regulation goals,considering the importance of social benefits,the reconstruction includes the quantity of medical services,the quality of medical care,and the safety of medical care.The total factor productivity evaluation system,including output indicators such as the burden of patients and the patient's burden,uses a three-stage DEA model based on the Malmquist index to conduct empirical testing and structural analysis of the industry's total factor productivity,which serves as the efficiency evaluation standard for government regulation;The multiple regression method evaluates the effect of the government regulation of China's medical service industry segmentation.The relevant data of the medical service industry in different provinces in different years are systematically collected,and the Tobit regression model is used to empirically test the influencing factors of the industry's total factor productivity.The government regulation is made as the adjustment variable of the influencing factors of the industry to test the regulation effect of the government regulation on the industry's total factor productivity.The third part of the thesis put forward suggestions for optimization of the government regulation in China's medical service industry.Firstly,through the case study method and the literature research method,the current situation,characteristics and problems of the medical service industry in Germany,the United Kingdom and the United States are summarized,and the status quo and reform focus of the three countries' government regulations are summarized;then combined with the new medical service industry in China demands,the effect of current government regulation implementation and typical national medical service industry government regulation experience,several suggestions to improve the industry's government regulation system and promote the healthy development of the industry are put forward.The main research conclusions are summarized as follows:First,China's medical service industry faces new challenges.Firstly,due to factors such as population aging,chronic non-communicable diseases,and unhealthy lifestyles,the health of the Chinese population is facing tremendous threats.Secondly,with the improvement of China's social and economic development level,the demand for medical services continues to increase.Thirdly,with the slowdown of China's economic growth,it is difficult to maintain sustained growth in the current level of health expenditure.China's medical service industry needs to deal with many challenges through a series of reforms.Second,government regulation has theoretical basis and realistic basis for promoting the development of the medical service industry.The medical service industry has three attributes: public,social and economic attributes,which determines that it is subject to both general economic laws and other related laws.The supply of medical services is professional and the demand for medical services is compulsory.The results of medical services are irreversible,leading to the inherent profit-seeking mechanism of the economic entities of the medical service industry,which may lead to moral hazard and adverse selection problems,which may lead to market failures and the government failure,which occurs alone or at the same time.The evolution of China's medical service industry is related to public interest regulation theory,interest group regulation theory,and incentive regulation theory.Related theories are an important basis for this article to study the effect of government regulation in the medical service industry,and also provide a solid theoretical basis for further improving government regulation.At the same time,through combing through the development history of China's medical service industry,it is found that government regulations have played a vital role in solving the problems of medical service demand,supply and expenditure.Third,the effect of the evolution of government regulation in the medical service industry remains is to be tested.Since the founding of the People's Republic of China,the government regulation of China's medical service industry has gone through three stages with the changes in the economic system.From comprehensive regulation to deregulation and incentive regulation,government regulation has continued to evolve with the development of society and economy.Although government regulations have played an important role in different stages,it must be noted that the industry still has many problems in the accessibility,fairness,and public welfare of medical services.Since the new medical reform,although China's medical service industry has initially formed a relatively comprehensive government regulation system,a mechanism for evaluating the implementation effects of various government regulations has not yet been established.Fourth,the improved total factor productivity of the medical service industry can be used as an evaluation criterion for the effect of government regulation.The original intention of implementing government regulation in this industry is to improve efficiency and fairness.Industrial efficiency evaluation that combines the characteristics of the industry and the goals of government regulation is an important criterion for evaluating the effect of government regulation.Traditional efficiency evaluations mostly use quantitative indicators of medical services,and it is difficult to fully reflect the current government regulation orientation.Therefore,the improved efficiency evaluation system proposed in this thesis should also include indicators such as medical service quality,safety,and burden.The results of calculations using this system show that the total factor productivity of China's medical service industry will cause significant changes with the addition of undesired output.The efficiency is increased in the context of only considering the quantitative indicators of medical output,but the efficiency is decreased in the context of increasing the undesired output indicators such as medical quality,patient burden,and medical safety.It shows that the effect evaluation standard of government regulation in this industry needs to select the improvement efficiency that meets the regulatory goal,and the improvement efficiency can be used as the evaluation standard of the government regulation effect.In addition,the calculation of the system also shows that the total factor productivity of the industry in the seven major regions of China is showing a downward trend,but the total factor productivity of 15 provinces is gradually increasing,indicating that since the new medical reform,the medical service industry in a small number of regions in China has well implemented the current regulatory goals and the quantity,quality,safety and accessibility of medical services have been improved.The medical service industry in more regions still needs attention to the simultaneous improvement of economic and social benefits.Fifth,there are differences in the effects of different government regulations in the medical service industry,and government regulations need to be further optimized and improved.Government regulation is an important factor that affects the total factor productivity of the medical service industry,but it often does not directly affect the changes in the industry's efficiency,but indirectly affects the changes in the industry's efficiency through internal and external factors that affect the industry.The empirical results show that:(1)In terms of internal factors that affect the total factor productivity of the medical service industry,the increase in the salary of medical institutions and the utilization rate of hospital beds has significantly increased the total factor productivity of the industry,while the growth rate of medical and health expenditure has significantly reduced the total factor productivity of the industry.In terms of the individual external factors that affect the total factor productivity of the medical service industry,the coverage rate of basic insurance significantly reduces the total factor productivity of the industry;in terms of the common external factors that affect the total factor productivity of the medical service industry,the increase of the growth rate of per capita GDP can significantly increase the total factor productivity of the industry,and the increase in the proportion of outpatient visits in public hospitals,which represents the degree of market competition,has significantly reduced the total factor productivity of the industry.(2)Drug price regulation has achieved the goal of improving the efficiency of the medical service industry by positively regulating the growth rate of medical and health expenditure;hospital admission regulation has achieved the goal of improving the efficiency of the medical service industry by positively regulating the proportion of outpatient visits in public hospitals;the regulation of the flow of doctors achieves the goal of improving the efficiency of the medical service industry by positively regulating the salaries of medical institutions;hospital management regulations achieve the goal of improving the efficiency of the medical service industry by positively adjusting the utilization rate of hospital beds.In terms of the evaluation of the effect of government social regulation,medical equity regulation failed to achieve the goal of improving industrial efficiency through the proportion of medical insurance;medical safety regulation achieved the goal of improving the efficiency of the medical service industry through positive adjustment of the number of health supervisors.Sixth,the government regulation of the medical service industry in Germany,the United Kingdom and the United States has reference significance.There are government regulations in the medical service industry of the three countries,but the differences in social,economic and political systems have led to differences in the goals,methods and content of government regulation.However,their government regulations on the medical service industry are in the same direction,and they all adopt the method which combines the government regulations and the market mechanisms in the development the medical service industry.At this stage,the government regulation of China's medical service industry needs to learn from experience of relevant countries based on own domestic situation,explore the functional mechanism of building medical insurance institutions to promote the new development of the industry,improve the internal market competition mechanism of medical service institutions,and improve the quality of medical services,the safety management system and other institutional mechanisms,urge medical institutions to pay more attention to the effective improvement of medical quality,patient burden and medical safety,guide the balanced development of the industry between regions,prevent the generation of supplyinduced demand for medical services,and ultimately achieve the industry's government regulatory goals.Based on the above research findings and conclusions,this thesis puts forward policy recommendations on optimizing the medical service industry regulatory system and improving the medical service industry system: one is to clarify the boundaries and connotation of China's medical service industry;the second is to clarify the role of the government and the market in the development of China's medical service industry;the third is to establish a unified and independent government regulatory agency;the fourth is to establish an industry performance evaluation system that fully reflects the regulatory goals;the fifth is to actively explore the construction of incentive government regulations in the medical service industry;the sixth is to regularly evaluate the implementation effect of the government regulations in the medical service industry.