Study On The Policy Of Separating Accounting And Management For Medical And Pharmaceutical Of Public Hospitals And The Compensation Mechanism Based On System Dynamics

The new medical reform directs the emphasis of reform at the stubborn illness of"Support Medical by Pharmaceutical, Supplement Medical by Pharmaceutical", determines the clear direction of reform of the policy of separating accounting and management for medical and pharmaceutical(SAMMP), and specifically points out that it is necessary to push forward the reform of compensation mechanism of public hospitals, carry out governmental subsidy policy for public hospitals, impel the policy of SAMMP, gradually abolish hospital drug price addition and actively explore various efficacious forms for SAMMP. The reform strives to achieve a breakthrough and obtain tangible results.There are considerable exploration paths for SAMMP reform throughout the country. However, the reform effect of"Support Medical by Pharmaceutical"should be extremely little. This dissertation, from the perspective of an independent researcher, through an objective survey of the statement of SAMMP put forward by the new medical reform, studies the SAMMP system thoroughly, meticulously and specifically, rationally analyzes the connotation and path of SAMMP reform, and constructs the system model of SAMMP compensation mechanism, simulates and analyzes various kinds of compensation measures and strategies, by adopting the theory and method of system dynamics, and proposes specific integrated scheme and relative values. The dissertation enriches the SAMMP reform content in the medical and health system reform, and also provides corresponding policy reference and scientific advice for reforming pilot projects of public hospitals.First of all, the dissertation put forward a gradual and comprehensive path for SAMMP on the basis of the research summary of domestic and foreign literatures. It points out that the"Medical"needs to quit economically from collusion of medical and pharmaceutical, and the excessive drug price addition (not zero slip) under the administrative protection of public hospitals. It also points out that the pharmacies of out-patient departments and in-patient departments should implement lower drug deduction, at the same time, sufferer's right of receiving prescription and option of prescription dispensing sites should be fulfilled;"Pharmaceutical"should be independent from the subsidiary status of"Medical", i.e., the independence and role play of pharmacist professional will provide double inspection and guarantee from physicians and pharmacists for prescription and public medication, and therefore the quality of public medication will be improved continuously.Secondly, this dissertation constructs a drug supply-demand equilibrium model for hospitals before and after SAMMP and a relationship model for the careers choice and income of physicians, and analyzes the economic effect of SAMMP and its impact upon the physician incentive mechanism. It points out that the high degree of risk and technical difficulties, as well as other factors of the medical service industry should be sufficiently considered, after SAMMP, to establish scientific and effective compensation mechanism for public hospitals and incentive mechanism for mobilizing the enthusiasm of medical staff, hence to ensure the accessibility and affordability of high-quality medical services.Lastly, this dissertation constructs SD model for SAMMP compensation mechanism for public hospitals by utilizing the theory and method of complex system and modeling technique of system dynamic. Through SD model, it simulates various emulation results of the operational and development circumstances of public hospitals before and after SAMMP, analyzes the emulation results of various compensation measures and strategies for the reduction of reasonable revenues by virtue of implementing SAMMP, and provides specific integrated measures, schemes and relative values.