| Objective:as the main medical service organizations of a country, public-run hospitals assume the responsibility of basic social medical service protection and public health service, therefore they are social welfare enterprise with certain public interest and welfare oriented works. The existing public-run hospital management system in our country was established and developed under the system of planned economy. With the increasing advancement of health institutional reform, the institutional flaws in public-run hospitals have become more and more acute, some contradictions of deep level in actual practice are gradually exposed. It can be said that the reform on public-run hospitals has become one of most concerned topics in the current China social reform. The success or failure of public-run hospital reform decides the fate of Chinese health institutional reform to a great extent, and will also produce profound influence to the long-term development of health and medical enterprise in our country. Based on the recent public hospital management institutional reform in Shanghai, Zhejiang, and Jiangsu as cases, this study attempts to propose the theoretical foundation for public-run hospital management institutional reform from a macroscopic perspective, to streamline the evolution process of public-run hospital management institutional reform in our country, to launch empirical studies on public-run hospital management institutional reform, to explore the value orientation of public-run hospital management institutional reform, to construct a preliminary frame for new-type public-run hospital management institutional reform that adapts to socialist market economic system and the national conditions of China.Methodology:(1) Literature research. Mainly collect research literature of recent years on domestic and foreign public-run hospital reform for reference after analysis and re-treatment. (2) field investigation. Mainly use preliminarily-designed data-gathering tool to collect relevant data; design interview outlines and adopt individual and group interview method for interview. (3) Qualitative investigation. Mainly carry on qualitative analysis on the materials collected from interviews. (4) Empirical analysis. The public-run hospital reform practices in Shanghai, Zhejiang and Jiangsu are used as the key cases in this study. To analyze and evaluate on the basis of investigation and study of Shanghai mode, Suzhou mode, Wuxi mode, Jinhua mode, and Suqian mode.Results:(1) since the reform and open policy, the gap between the actual behavior goal and social policy goal of public-run hospitals can be not only attributed to macroscopic political and economic reasons, but also to their own management and structural reasons of hospitals. (2) Due to their special professional characteristics, attempts of reform in public-run hospitals lags behind the overall reform of society, politics, and economy. (3) Governments should run public-run hospitals and should create favorable institutions and conditions for them so that they can play a leading role in the medical and health institutional reform and play a pivotal role in medical and health services.Conclusion:(1) fairness and efficiency are not completely opposing. We should seek the best-balanced point between each other. Public hospitals should take "fairness first, efficiency improvement" as the value orientation of their management institutional reform, namely to solve the fairness problem through governmental function transformation and social supervision strengthening, to solve the efficiency problem through introducing market mechanism and innovating hospital operational mechanism. (2) public-run hospital management institutional reform is not only the need from governmental function transformation, but also the need from scientific development of public-run hospitals, and more the need from public health reform. The theoretical anticipation of public-run hospital management institutional reform should be the separation of government from enterprise, of government from capital, of regulation from operation, as well as innovations in regulation structure, organizational structure, management mechanism, and theory. (3) public-run hospital institutional reform is not only subject to governmental supervision, external environment and institutional influence, but also subject to the influence of various interest parties. A reform with satisfactory effects should be all-dimensional from the perspectives of government, market, hospital, and society.Suggestions:(1) at the level of governments:functional transformation; playing prominent role; optimizing professional policy environment; improving compensation mechanism; perfecting hospital services structure; implementing entire professional regulation and supervision. (2) At the level of markets:Introducing market mechanism should not depart from the basic public welfare goal; preventing the conflict between organizational benefit and public benefit; the market mechanism should be unified with the hospital categorization and classification management; effective movement of modern market economy cannot dispense with the positive role of governments. (3) At the level of hospitals:innovating hospital management ideology; establishing legal person management structure; reforming hospital management structure. (4) at the level of society:establishing channels by which each interest party of the society can fully express their view; capitalizing on the function of social capital; cultivating third party and professional intermediaries; strengthening social regulation and supervision. Innovations:(1) proposes the goal orientation of public hospital management institutional reform:fairness and efficiency are not completely opposing, reforms should positively seek the best-balanced point between each other so as to fully increase efficiency through the reform, and at the same time, to fully ensure fairness and to emphasize government's guiding responsibility and guarantee the main body status of public hospitals. (2) proposes the goal pattern of public hospital management institutional reform, and based on this, puts forward for the first time political suggestions on public hospital management institutional reform from the levels of government, market, hospital, and society. |
