The Development And Studies On Patients' Trust Index System Based On Medial Quality Management

With the development of market competition brought about byChinese reform and opening, china has experienced a process ofdeepening economic reform and health system reform, promoting,making great achievements in health course and improvement ofpeople's life standard.However, there are also serious problems on the health service likeother countries in the world, such as consistently rising of the statehealth care spending and absolute input value on health care year by year,"seeking doctors is difficult and expensive," especially seriousdeterioration of physician-patient relationship which has become animportant issue currently.Since issuing and implementation of "Regulations on MedicalAccidents Handling" on1st, September in2002, the incidence of medicaldisputes increased by22.9%average year. It was seen that fromShanghai Municipal Health Bureau in survey medical disputes rised at arate of11%since2003and in2009330medical malpractice complaints were received by the medical dispute-treating office in a district healthbureau, of which230were complaints with an outstanding increasecompared to ones in the last year.Faced with this situation, our country issued some targetedmeasures in the new medical reform programs to ease doctor-patientrelationship, reconstruct physician images and patients' trust. Therefore,how to continue to promote successfully implementation of healthreform programs, improve the medical quality of medical services andbetter the doctor-patient relationship so as to fight against the commonenemy-disease is particularly important in the context where newmedical reform plans and scientific concept of development strategy arebeing implemented for reality of a harmonious society.According to previous studies,we found that, compared withpatient satisfaction, patient trust is a new concept which has typical ofsubjective and forward-looking ability that can match the patient'sassessment. So, it is natural to establish trust as the evaluation standardon quality of patient-doctor relationship and medical services. After,many literature reviews about trust abroad, it is found that there are littlemeasurement indicators on medical services compared to the patents'satisfaction instrument. Therefore, it is both important and challengingto combine research on patients' trust with health care quality to bridgethe gap between the doctor-patient relationship and medical reform plans being implemented currently in our country.In this study, On the basis of the previous studies Liuweis' studies,firstly a patient's trust index system based on medial qualitymanagement and a hierarchical model of health service quality weredeveloped to study relationships among patient's trust, health servicequality, perceived health service quality, satisfaction and behavioralintensions and confirm the theory that a patient trust correlated his healthoutcomes. Secondly, the process on developing a patient's trust in aphysician was analyzed with method of incomplete information dynamicgame theory and found the importance of a physician's trustworthiness.Finally, by use of information economics and welfare economics theory,the level of investment on patients' trust for a public hospital and thevalue of reimbursement for the government were optimized given theintroduction of competition force in the health market to give a referencefor government to rationally allocate health resource, for a medicalinstitute to positively play a role in promoting patients' trust, bothresulting in a increase of social welfare.Main research work and results of this article can be categorized asfollows:(1)Reviewing and summarizing literatures collected on patients'trust and health service quality. By reviewing the literatures onperception, measurement, dimensions and assessment indicators of health service and issues correlating patients' trust, we found that:compared to patients 'satisfaction, patients' trust is a new concept that islittle studied in china. To combine research on patients' trust with healthcare quality is in the light of doctor-patient relationship and health policystudy. Meanwhile, reviewing a lot of literatures has built a theoreticalfoundation to develop an evaluation index system on patients' trustbased medial quality management.(2)Developing, validating and empirically evaluating a patient'strust index system based on medical quality management. Based onprevious studies, developing a first patient's trust scale appropriate forChinese population with methods of translation plus back-translationand two rounds of Delphi expert review and validating it with factoranalysis and correlation analysis, finding that this scale with6interpretable factors: Responsiveness, technical competence,Benevolence, care quality, communication skills and global trust, total24items has good reliability and validity, which could be used ameasure for further research of trust in China population. Data from481eligible inpatients were used to empirically evaluate and rankpatient trust in four hospitals in Shanghai.(3)Developing and validating a hierarchical model of patients' trustassessment on health service quality. An empirical study has been doneamong patients' trust index system, health service quality, perceived health service quality, patient satisfaction and behavioral intention. Theresearch results showed that:Patients base their perceptions of healthservice quality on four primary dimensions: environment quality,technical quality, interpersonal quality and administrative quality, whichantecede their satisfaction and behavioral intensions. Perceived healthservice quality has significant effect on patents' satisfaction andbehavioral intentions；and patents' satisfaction effects on their behavioralintentions；dimensions of health service quality has a significant indirectimpact on patients' behavioral intentions through their perceived healthservice quality．That is, it is concluded that the process from the patients'trust to medical quality, patient satisfaction and patient behavior is theone that from patients' subjective perception to their objective outcomes(satisfaction and behavioral intentions). Finally some suggestion relatedto how to assess perceived medical quality, improve patients' satisfactionand promote positive behavioral intensions has been given.(4) Doing empirical analysis about the effect of patients' trust ontheir health outcomes. There are many qualitative articles aboutrelationship between patients' trust and their health outcomes abroad,while little quantitative studies are found and could confirm theassumption that patients' trust has effect on their health outcomes.Empirical studies were carried out to analyze the mechanism process ofthe effect, and it is found that patents' trust effects positively on their behavioral intentions; patients' behaviors effect positively on life qualityand clinical outcomes; patients' trust has a positive significant effect ontheir life quality and clinical outcomes；Patient behaviors mediate fullythe relationship between trust and life quality, and partially between trustand clinical outcomes. According these results, some implementation todevelop patients' trust and change patient behaviors for health outcomesis put forward.(5)Emphasizing the importance of a physician's trustworthiness inimproving patients' trust based on the incomplete information dynamicgame theory. A signal game model physicians and patients is constructedto analyze the trust-building process when a patient seeing the physician.The results found the equilibrium conditions when a physician'strustworthiness reflects effectively his true type. Some suggestion onhow to improve patients' trust from a physician's perspective wasdiscussed finally.(6)With medical market models Deriving the equilibrium level ofinvestment on patients' trust and maximum social welfare for publichospitals based on the theory of information economics and welfareeconomics. It is an important issue for public hospitals to improvingpatients' trust investment to better the relationship between patients anddoctors when a dilemma exists that public hospitals are characterized asmonopoly and just-profit-seeking currently. Three medical market models were set to optimize the trust investment and the value ofgovernment reimbursement. Two for market-oriented and monopolymarket and one for social welfare environment. Research results showthat alternative services between public hospitals due to competition donot necessarily bring about enhancing level of patients' trust investment,but increasing numbers of hospitals do. The equilibrium level ofinvestment on patients' trust in social welfare status increases anddecreases with transportation cost for medical service higher and themarginal cost of medical investment higher respectively, while both thenumber of hospitals and hospital "altruism" have no effects on thisequilibrium trust level。Furthermore, a specified value of governmentreimbursement is determined which can increase the level of investmenton patients' trust after the introduction of competition in public hospitals.Finally, some recommendation which can make competitive mechanismplay a positive effect on improving the investment on patients' trust forpublic hospitals was proposedThe primary innovations of this paper are as follows:(1)Innovation in research ideas: Based on previous studies,thisarticle designed some operations, including the development of thepatient's trust index system based on medial quality management and thehierarchical model of patients' trust assessment on health service qualityand confirmation of the effect of patients' trust on their health outcomes, etc. Expanding the scope of the sample, with inclusion of objectives insome community-based health services to generalize the implications ofconclusion discussed in the paper. Analyzing firstly the antecedents andconsequences of patients' trust with modeling studying method to makespolicy recommendations more persuasive.(2)Innovation in research contents: Developing a first patient's trustindex system based on medial quality management and its correspondenthierarchical model; confirming the effect of patients' trust on their healthoutcomes; introducing the factors of competition, reimbursement andsocial welfare to intemperate patients' trust appropriate forcharacteristics of the current health care market and the new medicalreform plans, expanding the content of trust.(3)Innovation in methodology: The research methods lie in thecombination of theoretical study and empirical study, qualitative studyand quantitative study. Specific research methods include Literaturereview, Empirical analysis, Structural Equation Modeling, Game Theory,Equilibrium analysis and Static Comparative analysis, all of which arealways used in Economics and are comparative mutual methods, whilefew used in Health Economics, particularly in Chinese study on patients'trust. This paper is a trial of applying Game Theory, InformationEconomics, and Social Welfare economics methods to study of Chinesepatients' trust, which break the routine theoretical methods and enrich the study of Health Economics and trust in China.