Comprehensive Evaluation Of Financial Operation Of Ningxia County-level General Hospital Before And After The Reform Of Public Hospitals

BackgroundWith the implementation of the "Opinions on Deepening the Reform of the Medical and Health System",the medical policy of "allowing paid services" that has been running since 1989 in China has finally been abolished.The government has been committed to creating a new type of public hospital that is "people-centered",emphasizing the public welfare and non-profit of public hospitals.The hospital has changed from focusing on scale expansion to connotation-based construction,fundamentally solving the problem of residents seeing a doctor and seeing a doctor.The problem is to ease the burden on the masses.From the new medical reform in 2009 to the reform of public hospitals in 2012,the government began to reform the public hospitals from drugs to medical treatment,such as implementing zero price difference for drugs,price adjustment policy for medical services,graded diagnosis and treatment,and value by disease.A series of policy measures,such as payment,fundamentally broke the mechanism of medical supplementation in public hospitals,and reduced the inspection and inspection prices of medical consumables and large medical equipment.However,this has increased the operational pressure of public hospitals to a certain extent.It is necessary to maintain its own development in a highly competitive market economy and to exert its public welfare spirit.When public hospitals face such a huge change,hospital finance,as the most important part of economic operations,will face all unknown risks.Evaluating the financial operation of the hospital not only enhances the hospital’s ability to resist risks,but also provides decision-making basis for improving management and promoting optimization.Therefore,the impact of public hospital reform on thefinancial operation of county-level public hospitals remains to be further empirical research.ObjectivesCompare the financial revenue and expenditure status,asset structure,asset operation,solvency,cost management and internal composition of Ningxia county-level general hospital before and after the reform of public hospitals,and scientifically select financial operation evaluation indicators by establishing existing research results.The financial operation evaluation index system compares and analyzes the financial operation of Ningxia county-level general hospital before and after the reform of public hospitals.The problems in the financial operation of Ningxia County General Hospital were found to provide policy recommendations for promoting the sound development of county-level general hospitals.MethodsThe literature review method and descriptive analysis method are used to analyze the related concepts of financial operation in public hospitals and the new requirements of public hospital reform for hospital finance.The comparative analysis and trend analysis methods are used to analyze the financial revenue and expenditure status and asset structure of hospitals before and after public hospital reform.,asset operation,solvency,cost management and internal composition changes;the Delphi method is used to construct the financial operation evaluation index system of public hospitals,and the Analytic Hierarchy Process(AHP)assigns weight coefficients to each indicator;finally,the utility coefficient method is used to publicize Comprehensive evaluation and comparative analysis of financial operations of county-level hospitals before and after hospital reform.Results1.Index system constructionThrough the Delphi method,through two rounds of expert consultation,the framework of the first-level indicator system is: economic benefit index layer and social benefit index layer,and five secondary indicators and 19 third-level indicators under the economic benefit index layer;social benefit indicators There are 3 secondary indicators and 10 tertiary indicators under the layer.The final total: 2 first-level indicators,9 second-level indicators,29 third-level indicators.Using the Analytic Hierarchy Process(AHP)to assign corresponding weights to the final indicator system,economic benefits: balance and risk management(15.06%),asset management layer(11.99%),cost management layer(14.69%),revenue and expenditure structure layer(12.15%),development capacity layer(10.25%);social benefits: service capability layer(14.54%),patient cost control layer(9.69%),medical efficiency layer(11.43%).Among them,the most important is the balance and risk management,the lowest is the patient cost control layer,and the important level will also affect the final comprehensive evaluation results.2.Sample hospital financial benefitsThe financial operation results show that the asset-liability ratio of 11 sample hospitals in2009-2016 is increasing year by year,among which the highest annual asset-liability ratio is C hospital(60.34%),the lowest is D hospital(28.98%);11 samples The total hospital revenue is less than the total expenditure,the balance of business revenue and expenditure is negative,and the balance of income and expenditure is getting lower and lower.The balance of business revenue and expenditure before the reform of public hospitals is-13.10%,and the number of public hospitals is reduced to-14.49% after the reform;the total asset turnover rate The overall operation was good.The average annual turnover rate after the reform of public hospitals reached1.12 times;the proportion of personnel expenditure increased from 31.29% before the reform to46.63% after the reform,up 49.25% from the previous month;the hospital revenue accounted for26% annually.The overall trend is slowly increasing year by year;the proportion of pharmaceutical income declines year by year,from 37.34% in 2009 to 28.27% in 2016,the decline is more obvious,indicating that the public hospital reform implementation has a significant effect on eliminating the drug addition policy.3.Sample hospital social benefitsThe results of social benefit operation showed that the average daily burden ofhospitalization for the 11 sample hospitals in the public hospitals decreased from 1.11 before the reform to 1.06;the average fixed assets per bed fell from 1044.99 yuan before the reform to the reform.The decline of 839.77 yuan was relatively large;the per capita hospitalization expenses and the average cost of emergency patients in Ningxia county hospitals increased year by year during 2009-2016,and the per capita hospitalization expenses increased from 3,195.53 yuan before the reform to 4,781.8 yuan after the reform.The average hospitalization time of patients decreased slightly,from 11.24 days before the reform to 10.56 days after the reform;the bed utilization rate was from 107.48% before the reform to 119.93% after the reform,an increase of11.58% from the previous month.4.Comprehensive evaluation of financial operation of sample hospitalsBy comparing the total scores of 11 sample hospitals and the scores of the second-level indicators in the period from 2009 to 2016,it was found that the financial operation ability of each hospital after the reform of public hospitals was improved;the scores of the second-level indicators of the same hospital were different.There are also differences in the same indicator in different years.This is mainly due to the fact that the scale of hospital assets is expanding and the development speed is accelerating.It is more difficult for managers to control hospital costs,which ultimately leads to hospital risk and balance management.The difficulty is increased.Overall,the average annual score before the reform was 79.11,and the average annual score after reform was 80.63.After the reform of the public hospital,the hospital’s financial operation efficiency coefficient score was better than that before the public hospital reform.Recommendations1.Control the scale of hospital debt and broaden the channels for fund raising2.Strengthen hospital cost accounting and budget management3.Adjust the price of medical services and increase the enthusiasm of medical staff4.Improve the quality of financial personnel and strengthen the risk awareness of all employees5.Increase government financial input and reduce the pressure on hospital funds...