Study On The Strategy To Carry Out Public Welfare Of Public Hospitals

Objective:On the basic of literature research, This study explored the connotation and denotation of public welfare in public hospitals, investigated implementation status of public welfare, analyzed the main reasons to downplay the public welfare and strengthening measures, then proposed the the implementation strategy for public welfare of public hospitals, so as to promote our the public welfare of public hospitals, improve the equity and accessibility of health services and to provide the basis for policy decision.Methods:1. Review the literature and analyze the information: Broadly access to the monographs, academic papers, professional magazines and online information retrieval literature about public welfare of domestic public hospitals, collect the relevant information about the status of public service,related system and the operational mechanism of public hospital at home and abroad.and by removing the literature of duplicate and irrelevant content,and no strong relevance,as well as without references, the literature of strong related to the connotation and extension of public welfare, and summary points about the main reason for public to play down in public hospitals;2.Questionnaire:Designed the questionnaire about perception separately for health care workers and patients about the situation public welfare in public hospitals, At 3 public hospitals, using the simple random sampled methods to take 150medical staff and 130patients in treatment(total 280 persons)from each sampled hospital ,make them write down questionnaire about the implementation of the manifestations in non-profit hospital and the cause for the downplay of public welfare; At the same time, design the agency questionnaire of public hospitals, Huimin hospital and respectively to investigate their fund-raising channels, revenues and expenditures, public welfare services and so on.3.Focus group discussion : Invited15 health management experts, hospital administrators, health department administration officials to study the reasons for downplay of non-profit public hospitals and discuss the embodiment form of public welfare.4 Analysis of a typical case: Selected one Huimin hospital, one public hospitals and one private hospitals, to analyze their operation status quo, including policy support, funding channels, the situation of public welfare activities and so on.5.Statistical method:By using spss12.0,the study make descriptive analysis of the cognitive of health care workers and patients about the embodiment of public welfare,the main reason to play down and enhance measures of public welfare , make comparative analysis of the relevance awareness between health care workers and patients about the the embodiment of public service,the main reason to play down of public welfare byχtest, and by the correspondence analysis,we analyze the corresponding relations between different socio-demographic groups and the embodiment of public welfare in public hospitals.Results:(1)Basic information of investigationwe collected three hospitals (including one Huimin Hospital, one comprehensive three-level hospitals, one private hospital) for a typical survey. Make site survey with 130 patients,including 60 male(46.5%),69 female(53.5%);15-25 years group 19 (14.7%),26-50 years group 67 (51.9), >50 years group 43(33.3%);and 150 health care workers including 31 male (20.8%), 118 female (79.2%);15-25 years group 12 (8.1%),26-50 years group 117 (78.5%), >50 years group 20 (13.4%).(2) The connotation and outreach of public hospitalsOn the basis of the literature reserach, policy analysis of the 3 hospitals combined with on-site survey result of 280 medical staff and patients. The results showed that 83.89% the medical staff in public hospitals that are embodied in the public at reasonable cost, the cost of vulnerable groups, poverty relief, emergency medical services; 89.92% patients in public hospitals that are embodied in the public interest for the sake of patients, reasonable price, the cost of poor relief, regulate and inspect the medication.The connotation of public hospitals is to maintain public health care services accessibility and fairness; and reasonable prices of medical services to vulnerable groups and poverty relief and the cost of public hospitals is the main manifestation of public welfare. However, On the connotation and extension of public welfare in the public hospitals ,in different stages, in different regions and different social roles with the different forms, so we need a comprehensive development perspective.(3) The typical case research on the status quo of public welfare in hospitals By the individual depth interviews and focus group discussions with the hospital administrators and the secondary data analysis ,we separately make typical case studies with one Huimin hospital, one comprehensive three-level hospital and one private hospital and the main results are as follows:By the government of adequate subsidies ,Huimin hospital can maintain the basic balance payments and expand the benefit target ,increase the benefit projects and measures to facilitate the broad masses for medical treatment, but due to the complexity procedures for funding application, the lack of the internal mechanism of performance appraisal and poor reform-minded of the staff, the wage pressures from retirees,such as reasons, the development of the Huimin hospital is being restricted;With the government subsidies,the balance of the comprehensive three-level hospital is negative, the hospital undertaken corresponding work, reflecting the public welfare, but with the lack of government investment as well as not very well reflect the labor value of the medicall staff, or lack of work enthusiasm, or find other ways to make up, so it can not maintain the long-term public welfare;Under the pressure of revenue, the private hospital make external marketing with the public welfare building and as an important means of brand building, carry out more public welfare activities, won the people's satisfaction, but due to lack of funds and personnel support, as well as lack of government guidance and publicity, the activities for public welfare is being restricted.(4)The analysis on main reason for downplay to public welfare and the enhance measures in public hospitalsBy the literature, policy analysis, integration of hospital staff and patients at the scene of the survey results show that health care workers and patients in public hospitals on the current understanding of the achievement of public welfare with no statistical difference (Z =- 1, P = 0.32) are of the view that the current public hospitals in the achievement of public welfare in general. Agreed that health care workers and patients in public hospitals is the main reason for public welfare: insufficient investment in the Government's hospital (χ2 = 3.05, P = 0.08), the excessive pursuit of economic interests of the hospital (χ2 = 0.89, P = 0.35), the Government's public hospitals inadequate supervision (χ2 = 1.6, P = 0.021), lack of public hospitals to strengthen their public service motivation (χ2 = 0.06, P = 0.8). By strengthening the responsibility of the Government to increase investment in and reform of the hospital to strengthen the operational mechanism of public service in public hospitals. 149 healthcare workers, 142 (95.3%) medical staff in public hospitals should be to strengthen the public welfare. Mainly that they can increase investment by the Government (39.6%), government policy (34.2%) and operational mechanisms of reform and the hospital (18.1%) to strengthen public service in public hospitals (Table 19); 129 patients, 128 (98.4 %) think that we should strengthen the public service in public hospitals. They think that the need for management measures related to government (32%), the Government increased funding in public hospitals (26.6%), strengthening the construction of medical ethics (24.2%) and the operational mechanisms of reform and the hospital (17.2%) to strengthen public hospitals the public welfare.Conclusions and Recommendations:1.Define the meaning and public outreach of public welfareThis study think the public welfare of public hospitals is embodied with the prices of medical services,and the society medical assistance for poverty and vulnerable groups.Government should define the meaning and public outreach of public welfare, and develop the standards, ordain the basic aspects of public welfare, and the formate the evaluation system for non-profit public hospitals to evaluate the achievement, put the evaluation results linked with the investment and social capital,so as to promote the realization of public welfare.2. Improve the operational mechanism of Huimin hospitalsGovernment need to optimize the process of financial assistance in Huimin hospital, simplifying the application procedures for funding, under the guidance from government, with the research institutions and health management,Huimin hospital develop performance appraisal mechanisms to stimulate the reform of the medical staff awareness and enthusiasm, while addressing retirees and pension issues. By improving the operational mechanism of Huimin hospitals, to play the advantage of Huimin hospital to facilitate medical treatment of poverty vulnerable groups ,and further explore in of the realization strategy for public welfare in other public hospitals.3. Increase funds for public health and social assistance compensationGovernment should compensate the social assistance and public health emergencies emergency medical and health services and adjust the compensation mechanism for public hospitals, the main compensation source of public hospitals should be transformed into the medical services,government investment and society finance;Government ensure the adequate compensation, at the same time it should be configured to carry out , reduce reasonably and appropriatly the investment of large-scale medical equipment and advanced technology, such as to increase the input for social assistance, public health services and emergency medical.4. By means of the strength of private hospitalsIn the process of exploring the strategy of public welfare, realization of,wecan learn from the practice of the United Kingdom and the United States,government can or handed over a number of public medical services products to private hospitals, then government buy the health care products .5. Strengthen the regulation functions of governmentGovernment's regulatory functions for public hospitals should be demonstrated as follows:the regional health planning; stricted the large medical equipment and the introduction of advanced medical technology, carry on the supervision and management of public hospitals in accordance with the law, punish the public hospitals with violation conduct.6. Bulid the reasonble assessment mechanisms and distribution mechanismBy the income distribution mechanism in public hospitals,the medical staff's salaries and the bonuses are linked to business income.Public hospitals, including including the Huimin hospitals are lack of a reasonable internal personnel management and distribution of performance evaluation mechanisms, also make greater use of personnel management approach in the planned economy era. Therefore, it should be in accordance with the nature of the work content and work to the workload of medical staff and the effectiveness and performance appraisal linked to norms of medical staff incentives, and put the public welfare as an important indicator into the performance appraisal system of the public hospital.