| Research objective:Since the new medical reform,favorable policies at the national level to encourage the society to run medical services have appeared frequently,especially the supply-side structural reforms launched in 2015,which have further ushered in good development opportunities for private hospitals.In this context,Chongqing actively responded to the call of the state and issued a series of policies to encourage and guide social capital to open private hospitals.However,after more than ten years of medical reform practice,has the enthusiasm and investment vitality of Chongqing’s society to run medical services stimulated? What is the service capacity of private hospitals? Are people willing to go to private hospitals for treatment? Have the resources of private hospitals been used rationally and effectively?What are the factors that affect people’s willingness to seek medical treatment and service utilization in private hospitals? This study conducts an in-depth study of these issues based on the perspective of supply-side structural reforms.Research method:1.Literature search: Adopt appropriate retrieval methods to collect relevant books,periodicals,survey reports,government reports and documents of private hospitals at home and abroad.After extensively reading relevant literature,in-depth analysis of the research results of the development of private hospitals at home and abroad,and refine the influencing factors related to the willingness of residents to seek medical treatment and service utilization in private hospitals.2.Expert consultation: Chooses to engage in research work in social medicine,health management,hospital management,health law,health statistics,etc.with a bachelor’s degree or above,associate senior or higher titles,and more than 10 years of work experience in the health field.Provide suggestions for the selection of service utilization indicators,the design of questionnaires and interview outlines,and conduct consultation and argumentation on the selection of survey objects and subsequent strategic measures.3.Questionnaire survey: Combining research purposes and literature data,self-designed questionnaires,revised after repeated discussions and pre-investigations by the research group,and finally determined the "Questionnaire of Resident Private Hospitals in Chongqing".Using the convenience sampling method,from november to december 2019,the residents of the 7 communities in the main urban area of Chongqing were conveniently selected as the research objects..The inclusion criteria of the research subjects:(1)The permanent population in the jurisdiction,including the registered population and the floating population who have lived for more than half a year;(2)Age ≥ 18 years;(3)Community residents who have no mental illness and are willing to cooperate with the survey.The questionnaires will be distributed and collected at the community site by uniformly trained investigators.The survey mainly includes three aspects:(1)Basic information of residents,such as gender,age,marital status,occupation,education level,family monthly income,self-assessed health status and insurance participation;(2)Whether they are willing to choose a private enterprise hospitals;(3)Reasons why residents are unwilling to seek medical treatment in private hospitals(multiple choices).4.In-depth interview: Based on the research content designs a semi-structured interview outline,and selects residents in the main urban area of Chongqing,the presidents or key management personnel of representative private general hospitals and private specialized hospitals to conduct in-depth interviews in order to gain a deeper understanding of the private hospitals.The willingness to seek medical attention,residents’ medical service needs,residents’ private hospital service utilization and its influencing factors,etc.Residents’ choice: 4 community residents of different ages,occupations and income levels were randomly selected from7 communities in the questionnaire survey of residents’ private hospitals to seek medical care for in-depth interviews.The content of the interview mainly involved residents’ cognition or views on private hospitals,the willingness of residents to seek medical treatment in private hospitals,the reasons why residents are willing or unwilling to seek medical treatment in private hospitals,and the residents’ choice of private hospitals when suffering from different diseases.Selection of the person in charge of the hospital: Three representative private general hospitals and private specialist hospitals with different scales and different business scopes were selected for in-depth interviews.The content of the interview mainly included the basic situation of the hospital,the situation of personnel and equipment,and the situation of service utilization.5.Normative analysis: Based on the collected interview data and literature,use the relevant theories of supply-side structural reform to make logical inferences,combine the actual situation of Chongqing and domestic and foreign experience,explore strategies and measures to increase the willingness of residents to seek medical treatment in private hospitals and to promote the utilization of residents in private hospitals.Results:1.Chongqing residents’ private hospitals’ willingness to seek medical treatment.1950 valid questionnaires were collected in this survey,with an effective response rate of 99.0%.The vast majority(77.9%)of the residents surveyed indicated that they were unwilling to seek medical treatment in private hospitals.The main reasons for their reluctance to seek medical treatment in private hospitals were “distrust private hospitals”(23.8%),“self-seeking habits”(15.1%),private hospitals have "high cost"(13.6%)and "low technical level"(10.7%).2.Influencing factors of residents’ willingness to seek medical treatment in private hospitals.There were statistically significant differences among residents of different ages,marital status,occupations,education levels,family monthly income per capital,and types of insurance participation in choosing private hospitals for medical treatment(P<0.05).The results of multivariate analysis showed that the educational level was above junior college(OR=0.542,P=0.019,95%CI: 0.324～0.905),and the family monthly income per capital was 5001 ～ 7000 yuan(OR=0.453,P=0.000,95%CI: 0.310 ～ 0.662)and ≥7001 yuan(OR=0.527,P=0.004,95%CI: 0.342 ～ 0.812)were the main influencing factors of residents’ willingness to choose private hospitals.According to interviews,residents were reluctant to seek medical treatment in private hospitals.On the one hand,private hospitals exaggerate false medical advertisements,resulting in a lack of understanding and insufficient awareness of the real situation of the hospital,which affects their willingness to seek medical treatment;on the other hand,due to at present,Chongqing’s private hospitals are generally small-scale,low-level,and repeatedly set up.Problems such as the lack of medical and health personnel and the weak medical technology are protruding,resulting in insufficient service supply capacity and difficulty in ensuring the level of medical technology and service quality.Furthermore,it is difficult to obtain a good reputation,and it is difficult to attract people to seek medical treatment.3.Chongqing resident private hospital service utilization.The entropy TOPSIS evaluation analysis results showed that the comprehensive evaluation index of service utilization of private hospitals in Chongqing increased year by year from 2010 to 2018;the descriptive comparative analysis of the service utilization of private hospitals and public hospitals showed that as of 2018,Chongqing private hospitals the number of people,the number of admissions,the number of discharges,and the number of inpatient operations each accounted for less than 28.0% of the four types of service people in the city’s hospitals,while the public hospitals over the same period exceeded 72.0%,and the number of consultations and admissions in private hospitals were all,the number of discharges and the number of inpatient operations were only 21,000,2,000,2,000,and 10,000 respectively.In the same period,the average number of public hospitals with relatively small number of institutions exceeded the average number of private hospitals,which were 244,000,14,000,14,000,and 4,000 respectively.4.The development status of Chongqing’s private hospitals and the influencing factors of residents’ utilization of private hospital services.As of 2018,the number of private hospitals in Chongqing reached 555,accounted for 69.4% of the total number of hospitals in the city,but most of them were general hospitals(53.9%),and the number of specialized hospitals was very small(23.4%);ungraded hospitals and first-level hospitals Hospitals account for the vast majority(89.7%),with only a handful of second-and third-level hospitals(10.3%);private hospitals accounted for only 33.4% of the city’s hospital beds,with an average of only 97.9 beds;health technicians and practitioners(assistant)physicians and registered nurses in the three types of health human resources in the city’s hospitals were less than 28.0%,and the average number of the three types of health human resources in the hospital was only 67.3,21.0,and34.2 respectively.The number of equipment above 10000 yuan only accounted for 17.9% of the total number of hospital equipment,and the number of equipment above 10000 yuan per hospital was only 40.9.From the analysis of the weights and influencing factors in the comprehensive evaluation of the service utilization of residential private hospitals,it can be seen that the sum of the weights of the number of admissions in private hospitals,the number of discharges from private hospitals,and the annual hospitalization rate of residents in private hospitals accounted for 52.7% of the total weight of the 11 indicators.Combining the current development of Chongqing’s private hospitals and the interview data of private hospital directors and key management personnel,in-depth analysis of the influencing factors of residents’ use of private hospitals mainly comes from three levels: one is the government level.First of all,due to the lack of a comprehensive social medical access plan,the government has no compulsory and detailed requirements for private hospitals established by social capital in terms of hospital scale,number of personnel,number of beds,number of wards,and the number of equipment.Extensive growth is only shown in quantity,rather than connotative expansion.The hospital as a whole is still in a "low-level,low-grade,and small-scale" development state,which makes private hospitals insufficiently competitive on the medical supply side and provides treatment for the public.Insufficient attractiveness;secondly,government departments have weak links in the supervision of private hospitals,and frequent chaos has led to insufficient social credibility of private hospitals;finally,some policies are not perfect or implemented,which affects the improvement of private hospitals’ service capabilities and reduces people’s attractiveness for medical treatment and service utilization.The second is the level of private hospitals.First of all,private specialized hospitals are underdeveloped and market competitiveness is weak.Private hospitals dominated by general hospitals cannot compete with public hospitals with advantages such as innate technology.Small-scale,low-level private specialized hospitals cannot adapt to the current people.The demand for special and high-end medical services is obviously insufficient in the competitiveness of the medical supply side,which to a certain extent leads to its insufficient appeal to the public for medical treatment;secondly,some private hospitals have bad medical practices,which damage the image of the industry and reduce credibility;and finally,lack of health professionals and weak technical capabilities have reduced the attractiveness of medical treatment to the public.The third is the social level.Due to the misunderstanding of the public’s perception of private hospitals,the public has a long-term psychological stereotype,and there is a preference for medical treatment of "publicity over private".Conclusion:1.Residents’ private hospitals in the main urban area of Chongqing are not willing to seek medical treatment and their recognition is low.The results of the study showed that: among the residents surveyed(77.9%),they were unwilling to seek medical treatment in private hospitals.The main reason for their unwillingness to seek medical treatment in private hospitals was "distrust private hospitals."2.Education level,family economic income,residents’ cognition and hospital reputation,technical level,and service quality affect residents’ willingness to seek medical treatment in private hospitals.Residents with higher education level and higher family income are less willing to choose to go to private hospitals for medical treatment.Compared with those with an education level below elementary school,residents with a college education level or above(OR=0.542)are more reluctant to go to private hospitals for medical treatment.Compared with households whose monthly income per capital is less than or equal to 3,000 yuan,residents with an income of 5001 to 7,000 yuan(OR=0.453)and those with an income of more than 7001 yuan(OR=0.527)are less willing to go to private hospitals for medical treatment.It can be seen that the higher the education level 1.Residents with higher family income are less willing to choose to go to private hospitals for medical treatment.In addition,according to interviews,it was learned that residents’ cognition,reputation of private hospitals,technical level,and service quality are important factors influencing residents’ willingness to seek medical treatment in private hospitals.3.Chongqing residents generally under-utilize the services of private hospitals.According to the entropy TOPSIS evaluation and analysis results of the service utilization of residents’ private hospitals and the descriptive comparative analysis results of the service utilization of private hospitals and public hospitals,it can be seen that the service utilization of private hospitals by Chongqing residents has increased year by year,but the overall service utilization is insufficient.4.The number of private hospitals in Chongqing occupies an absolute advantage in the medical supply side,and general hospitals occupy the dominant position in the private medical market;the overall level of hospitals is low,and there are very few hospitals above the second level;the overall scale of the hospital is small,the shortage of health personnel,and large-scale equipment insufficient configuration.Therefore,the market competitiveness and service supply capacity of private hospitals are insufficient.The number of admissions in private hospitals,the number of discharges from private hospitals,and the annual hospitalization rate of residents in private hospitals are key indicators in the comprehensive evaluation of the service utilization of residents in private hospitals,and they are also the main factors affecting the utilization of private hospitals.Based on the in-depth analysis of the interview data of the deans and key managers of private hospitals,the factors that affect residents’ utilization of private hospitals mainly come from three levels: one is the government level;the other is the private hospital level;the third is the social level.Policy suggestion:In order to enhance residents’ willingness to seek medical treatment in private hospitals,promote the utilization of private hospital services,this study combines the relevant theories of supply-side structural reforms,and provides three aspects for the above-mentioned influencing factors.Out of strategic recommendations:1.At the government level innovate the market access mechanis m,guide the rational setting and layout of private hospitals;innovatethe social medical supervision mechanism,strengthen the supervisionand management of private hospitals;the government accelerates theimprovement of the top-level design of social medical services,and promotes the improvement of private hospital service capabilities.2.Private hospital level play the role of market innovation mech anism and take the path of specialty development;consciously operat e in good faith,play the advantages of market mechanism,and estab lish a good industry image;focus on the introduction and training oftalents,and improve service capabilities.3.At the social level the joint effect of the government and the market enhances the public’s awareness of private hospitals. |
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