Management Model Study Of Managed Hospital In The Context Of The Medical And Health System Reform

Since the reform and opening up, China’s medical and health sector has made tremendous progress, the level of medical care and service levels has been improved steadily, but the phenomenon of difficulty and expensive of medical treatment has become increasingly prominent. One of the main reasons is that with the rapid development of its economy and great improvement of people’s living standards, the demand for healthcare and medicalservices increased significantly, whereas the reality of healthcare resources in general is not sufficient and the layout is not reasonable. So the government regarded promoting the efficient allocation of health resources as one of the critical strategiesin all medical and health system reform.Public hospital has a dominant position in the health care system in China. So reform of public hospitals has been the focus and difficulties of medical and health system reform. Asthe views of the CPC Central Committee and State Council on deepening the reform of the medical and health system(hereinafter referred to as "Views"), promulgated in April2009,pointed out, five priorities can be the critical tasks in carrying out the medical and health system in the new situation, one of which is" to promotethe reform pilot of public hospitals". In February2010, five ministries and commissions, the Ministry of Health, Central Personnel Office, the National Development and Reform Commission, jointly issued the Notice for publication of the guidance on reform pilot of public hospitals (hereinafter referred to as "Notice"), proposing the "overall configuration of health care resources between urban and rural, and among different regions"as a focus of the reform of public hospitals. This strategy makes the combinationof the public hospital reform and the promotion of health care resources. In addition, the "Views" and the "Notice" both present that, large available hospitals could promote the rational flow of medical resources by means of managed mode or restructuring, in accordance with the regional health planning requirements. It makes managed mode,one practice of public hospitals reform, has a clear guide at the national policy level, and also has been given a new meaning.Hospital trusteeshipmeans that the property owners of the hospital authorize the hospital with strong business management capabilities and experiences to manage it by business cooperation. According to cooperation contracts, the trustees conditionally manage its assets, keeping and increasing its value. In other words, the nature of thospital trusteeship is the separation of ownership and management rights.But as the strengthasymmetry of the two hospitals, as well as the restrictions of government policies, it brings some difficulties to this form of cooperation. Hospital managersneed have the wise choices and operations to establish the own model of management, and hence to achieve their final objectives, which embodies its management level.This study researches the case of Guangdong Yanling Hospital’s trusteeshipby NanfangHospital against the background of the new health system reform,and analyzeshow Nanfang Hospital build a hospital trusteeship management modelunder the influence of various internal and external factors. To retrospectively summarize and diagnose the management model applied to NanfangYanling Hospital in the past2years, we analyzes the model combined with trusteeship management effects and the measures taken by Nanfang Hospital, so as to propose targeted advice of perfecting management model for Nanfang Yanling Hospital. Analysisof advantages, deficiencies, and internal and external factors of the model provides provide a template of trusteeshipmanagement for other hospital, but also providesreference for formulating supporting policies of public hospitals reform.According to the research objectives and subjects, different research methods have been used:literature research helps to collect information on practical and theoretical status of trusteeshipmanagement in other domestic hospitals, as well as the management model concepts and hospital management model; gray literatures such as demonstration report before trusteeship,trusteeship agreement, and all documents and data reports after trusteeship are also made use of; opportunities, challenges, advantages and disadvantages of Nanfang Hospital and response measures taken in past2years are analyzed by brainstorming, one-on-one interviews and questionnaire survey among experts who deeply involved in thetrusteeship; as for thequestionnaire survey, resultsespecially shortcomings and reasons of measuresis analyzed by SWOT analysis method,which provides targeted views to improve the management model for NanfangYanling hospital.The study found that the quality and quantity of medical servicein Yanling Hospitalhas been significantly improved, as well as its economy conditions in the2years, mainly in:(1) service quality, amount of outpatient and emergency, inpatient volume has greatly improved, and proportion of patients admitted critically ill patients has also increased, indicating that in addition to increased volume of business, medical treatment capability ofmajor diseaseshas also been strengthened;(2) medical efficiency has improved significantly,and occupancy rate, bed turnover, outpatient and emergency department volume of each doctor and discharged patients have increased greatly. Meanwhile,average length of stay raised at first, then decreased, which may result from the inpatient structural change--increasing critically ill patients;(3) financial statushas improved significantly:health care revenue increased by401.50%, per bed income has increased by3002%growth, and per capita costs of outpatients and inpatientshave respectively increased by39.81%and24.22%, which may be influenced by patients changes in structure (increasingcritically ill patients).Based on SWOT matrix analysis, Nanfang Hospital is mainly affectedby following internal and external factors in the entrusting:(1) opportunities:the dominant position of major public hospitals has been further strengthened because of health care reform; entrusting accords with the direction of public hospital reform in the context of health reform; lots of practical examples of hospital trusteeship in China are available for reference; support from both sides’ superiors (Southern Medical University and Guangdong Provincial Land Reclamation Bureau); both of them are located in the prosperous Pearl RiverDelta; large medical demand; strict technical guidelines and Medicare-wide coverage provides good opportunities for hospitals’ enlargement.(2) threats:corporate hospitals and large public hospitals vary in functionalorientation, so government departments have reservations about the entrusting; imperfect supporting policies on trusteeship, such as two-way referral, healthcarepolicy, physiciansmulti-sited license,approval of medical subjects, large-scale device configuration permit; there are a large number of high-level medical institutions with rapid developmentin Guangzhou; fierce competition in health industry; obvious differences in management and culture exist between Yanling hospital and Nanfang Hospital, which leads to disaccord of entrusting among staff and improper management mechanism; limited investment to Yanling hospital from Land Reclamation Bureau, its superior department;poor infrastructure and technology of Yanling hospital is a barrier.(3) advantages:high brand awareness and reputation; complete disciplines setting and potent comprehensive strength; full support by leadership; professional management and technical staff; broad connection with the government; some medical departments have high enthusiasm about external expansion; excellent logistics supporting capability, disadvantages: lack of trusteeshipexperience and related talents; few management personnel and academic leaders with both perfect management ability and enthusiasm; employees’sense of competition, crisis and coordination need to be further improved; innovation system cannot match with development ofthe hospital; only a small number of subjects with both large-scale and high technology; few experts with high reputation among health industry and the masses; medical services andcharacteristictechnologies lag behind customers expectation.On the basis of current situation and trusteeship experience about NanfangYanling Hospital in the past2years,the paper sums up key points of the NanfangYanling Hospital Management Model as follows.On the one hand, fiduciary Hospital, Nanfang Hospital, has assigned experienced personnel toNanfangYanling Hospital.On the other hand, the integration of medical resource is realized by pairing-assistance between two similar medical departments.Enabling factors can be analyzed from two aspects. To begin with, the former Guangdong Yanling Hospital is in weak bases. Secondly,Nanfang Hospital has strong general strength,brand and reputation. Last but not least, short distance between these two hospitals decides also contributes to the trusteeship.The study then makes analysis on advantages and problems of NanfangYangling hospital management model. Advantages:(1) it promotes the effective release of high-quality resources from tertiary-level hospitals and rapid development of professional technologies in the managed hospital;(2)departments’enthusiasm of trusteeship in the tertiary-level hospital can be enhanced obviously;(3) the tertiary-level hospital only needs to deal with small negative effects. Every medal has two sides. There might be problems at the same time:(1) deviated orientation in the managed hospital can result in difficulties in operation;(2) improper management can be caused by vaguemanagement authority;(3) both sides may be unwilling to devote ifprospects are not clear;(4)obviouspolicy limit;(5)the managed hospital has a heavytechnical dependence on the main hospital.In the view of analyses above, recommendations on adjustmentofthe NanfangYanling hospital management model are put forward:(1) overcome the negative effects of care for immediate interests;(2) completely rationalize the management mechanism, including further clarify the competence of both sides to ensure the real separation of management and ownership, and adjust management departments inNanfangYanling Hospital;(3) adjust developing strategies of NanfangYanling hospital in time;(4) establish an effective mechanism for strengthening upgrading ability in Yanling Hospital. In general, results of the study are of great practical guiding significance inperfecting the management model and strengthening the management of NanfangYanlinghospital in the next period. The study also provides a reference in management model designing and development strategies makingfor other managed hospitals.Moreover, some reasonable viewpoints may be appropriate for governments in the formulation of complementary public hospitalsreform policies.