Research On The Reform Of The Chinese Public Hospital

Health is one of the eternal pursuit of the goal of human society, but also a basic human right, for the development and progress of society have an important role. The hospital is the main body to treat diseases provides health and other services, is of great significance for the maintenance of people’s life and health, to promote the stability and development of the whole society. Development of medical career not only reflects the strength of a country’s level of economic development, science and technology fields. As a quasi-public goods, but also to a large extent reflects the level of a country’s ability to supply welfare and public services.In the1960s and1970s, China is seen as a "developing country miracle" has become the country with the most comprehensive medical care in the world. But today,20years later, China is facing an embarrassing situation, the existing labor health care system, public health system-based health care system gradually disintegrated, the government gradually reduced the investment in the health sector, the public hospitals increased from Government gradually led into "self-financing", resulting in the gradual public sector welfare missing achieve normal operation of the hospital patients by inducing spending or raise the price of drugs and other means. Therefore, it appears in the course of medical treatment "expensive, medical treatment is difficult" issue, a serious impact on people’s medical needs are met, the field of medical and health welfare and fairness missing, the public hospital system is particularly necessary and urgent.For the problem of medical and health system, the state began to reform the health sector. March17,2009, the CPC Central Committee of the State Council "on deepening medical and health system"(hereinafter referred to as "Opinion") issued, marking the official launch of the new medical reform, which proposed reform of public hospitals. March18, the State Council issued the "recent focus on medical and health system implementation plan (2009-2011)"(hereinafter referred to as the "program"), this programmatic document for the new health care reform pointed out the direction, beginning in nationwide carried out. As a key and difficult health care reform, reform of public hospitals is the key to the entire health care reform, the establishment of the implementation of all policies and other supporting systems are dependent on the successful reform of public hospitals. However, after years of reform, China’s reform of public hospitals are still many problems, the community generally required to solve "difficult and expensive" problem.From the current point of view, the reform of public hospitals all over the country during the show the following characteristics:First, throughout the public hospital reform measures basically follow " on the reform of public hospitals guidance", follow the affairs separate, separate management from operation, medicine apart, separate profit and non-profit principle, return to public welfare, be innovative institutional mechanisms to reform be harvested. Which focuses on the reform of legal mechanisms are more concentrated in hospitals, compensation mechanisms, and regulatory mechanisms to strengthen the hospital’s management? Second, establish public hospital corporate governance mechanisms conducive to the modernization of the hospital’s internal operations and management. Beijing, for example, the establishment of the Council in the pilot inside the hospital, the Council became the hospital’s decision-making body responsible for decision-making hospitals. Council appointed by the Executive President, Executive President in charge of the hospital in accordance with the Council’s decision-making is responsible for specific operational management, the Council accepted the assessment. Through the Council, the Executive President and the Board of Supervisors,"separation of powers", respectively, assume decision-making, execution and supervision functions to form the corporate governance structure of public hospitals. Third, the compensation mechanism for exploring public hospitals, mainly in order to solve the long-standing "drug dependent doctors "of the state. In Beijing, Shenzhen has explored, by eliminating drug addition to the purchase price of the sale of drugs, hospital profits to service from drugs. From the last three major revenue sources:medical, pharmaceutical, health care subsidies and subsidies turned two revenue streams.Based on game theory, the theory of public goods, corporate governance structure theory, stakeholder theory, incentive theory, property rights theory, the theory of market failure, government failure theory theoretical basis, a systematic review of the development process of China’s reform of public hospitals, this process will be independent of organized medicine is divided into four stages of market-oriented reform, in-depth, new medical reform, etc., and to Shanghai, Shenzhen, Suqian, Beijing and other cities, for example, sums up the recent health care reform over the course of the existence of the practice issues and experiences. Based on the above analysis, we believe that the presence of the main public hospital reform in the medical field market, from regulation to government regulation, make supply-side oriented, public return several main features of existing public hospital service system needs improvement, management system and regulatory system needs reform, hospital compensation mechanism, corporate governance and internal operating system needs major reform and other issues.Secondly, the reform of public hospitals Motives analysis shows effectiveness in government regulation and public hospitals and the implementation process of the overflow and information asymmetry, leading to a double low administrative efficiency and health effects; institutional factors, such as not behavioral regulation and value-oriented guidance, bad balance is difficult to shake, which is a public hospital reform process touched the most difficult patient relationship, and therefore require a great effort. Government and medical patient interaction and contact among government departments due to the tendency of emotional cases exist, so the design decisions made and compensation mechanisms may be part of the best and not the global optimum. This affects the fairness and social attitude to some extent. Reform of public hospitals need to have targeted institutional reorganization and not just for some.Thirdly, this paper based on principal-agent model to analyze the relationship between the government and the Commission on behalf of the public hospitals and public hospitals and multi-stage patients with repeated game theory. Meanwhile, also from the institutional, stakeholder perspectives on China’s reform of public hospitals to inspect the motivation, in-depth analysis of the internal mechanism of public hospital reform. This paper argues that the current final draft of public hospitals, public deletion mainly institutional constraints are missing macro and micro aspects of the system of constraints and moral constraints. These constraints caused by the current lack of public hospitals due to the " profit is greater than the public interest " and went to reform the current situation. Come to examine the relationship between influencing factors in a public hospital reform need to address with stakeholders to mobilize the enthusiasm of all parties involved in the reform push for reform.Fourthly, the paper carried out the reform of public hospitals, public policy evaluation, from the policy of macro-examine, evaluate trends, assess the results of three perspectives, assessment of China’s public hospital reform government comprehensive protection phase, independent of organized medicine stage, market-oriented reforms stages of the development process. And the current phase of the new health care reform focused analysis, we believe that the new health reform process in the public sector, there are still remains irrational allocation of resources, the slow process of return to public welfare, government investment instability mechanism, the effect does not control health care costs obviously other issues.Fifthly, the background and development status of foreign public hospital reform reviewed, and in typical UK, South Africa, Germany, France, Singapore, Russia and other countries, for example, analysis of public health care services model, social health insurance model, at their own expense medical insurance model, provide a model of public health services such as health care reform on our reference and inspiration.Finally, based on the theory and practice analysis, this paper points out the guiding ideology and basic principles of public hospital reform, put forward policy recommendations to accelerate the reform of public hospitals from the government, hospitals, three levels of society, this paper argues, from the perspective of government, the future of China’s public hospital reform process should pay more attention to adhere to the government’s dominant position, changes in hospital compensation mechanism, improve the health care system, health information system construction, optimization industry external environment, the implementation of industry-wide supervision; from the hospital perspective should be more comprehensive hospital corporate governance reform hospital accounting system, establish and improve the examination and evaluation system, the establishment of high-quality medical team, advocated "people-oriented" service concept, strengthen professional ethics and hospitals; from a social perspective, it should be more focus groups to fully express their willingness to play the role of social capital, fostering professional management companies and industry associations to strengthen social supervision.The innovation lies in this article may:summarizes the approximate path around the course and the main pilot reform of public hospitals, draw the approximate route of a reform, and reform is divided into four stages, it is obvious to see the various stages of mutual undertaking, and the process of continuous innovation. Meanwhile, this paper summarizes the five kinds of reform path, a different analysis of the main ways the reform path, clear to see their strengths and weaknesses, to provide a reference for the policy recommendations. Secondly, the use of multi-stage dynamic game theory external factors affecting the motivation of public hospital reform, and reform of public hospitals are facing from the macro-policy environment and internal environment analysis, describing the dynamic process of reform of public hospitals.