The Study On Government Held Public Hospitals Scale And Financial Compensation

Background and PurposeRight to health is the fundamental right of every citizen. Providing basic medical and health services and guaranteeing the right to health is the inescapable responsibilities and obligations of government. The hospital service system that built after the founding of the nation, comparing to some developing countries, is more thorough, specific and effective in terms of guaranteeing every citizen to enjoy basic medical and health services. But it still have greater disparity with the efficiency of hospital service system of the western countries. The object of study would be the hospitals which conducted by Hunan government in this paper. By studying the aim, quantity, construction and network layout, cost and social effects of the hospitals managed by government, I will clarify the social functions of the action, predict the quantity and scale of the hospitals which will be establishing by Hunan government in the future five years as well as putting forward policy hospitals in the next five years in Hunan area according to the requirements and the dynamic changes of the disease. Based on it, I put forward the new idea of government financial input to the hospital, estimating the level of financial input to the government of Hunan province to the hospital in the next five years and making policy Suggestions about establishing relatively perfect hospital finance compensation. and providing reliable reference frame for regional health plan in Hunan province.MethodsThrough the study and summary of the historical documents, this research build a new research framework; According to the factors affecting the current social function implementation of public hospital, we reclassified classification positioning of the social function of public hospitals; we designed of the public hospital information collection form, and made a sample survey of more than35secondary public hospitals to get the basic data of operating information in Excel to create original database; Using the quadratic exponential smoothing model and single sequence first-order grey dynamic model GM (1,1) forecast residents demand for medical services; Using literature and expert consultation method to determine data envelopment analysis (DEA) evaluation index of public hospitals in Hunan Province, at the same time using DEA CCR model and BCC model of relative efficiency evaluation sample hospitals, and the sort of situation according to the results of the evaluation to determine the proper size value of various types of public hospitals at all levels in Hunan Province; Using quadratic exponential smoothing model and DEA CCR model and BCC model to predict public hospital financial compensation level of Hunan Province in2013.Contents and Results1The theoretical and practical foundation of the suitable scale and financial indemnity mechanism of the public hospitalFirst, I discussed some basic concepts related to this research, such as reinterpreting the connotation and extension of public hospital. From the perspective of public administration, I reexamine the connotation and extension of’public’in the’public hospital’, believing that the emphasis of’public’in the’public hospital’should rest on the achievement of public interest or common interest instead of struggling too much on the subject of public hospital. No matter who conduct the public hospitals, any non-profit hospital aiming at public interest can be called as public hospital. In other words, public hospitals are those non-profit health care organizations held by different social subject, aiming at serving social public interest. Such a definition has broken through the traditional conception of public hospital, expanding its connotation and extension. The interpretation of the appropriate scale of hospital, not only considering the analysis of suitability degree on monomer hospital vertically and horizontally, but also discussing the suitability degree of public hospital vertically and horizontally on the basis of regional health service planning. At the same time, based on the appropriate scale of public hospital, public hospital added the content of financial compensation. For an instance, the financial compensation to hospitals should include not only direct input, but also policybenefits.Second, theoretical basis for government to establish hospitals are teased out and the boundary of social responsibility of it are confirmed on the basis of the analysis of practical difficulties. There are three theoretical basis for government to establish hospitals:firstly, social contract theory which based on guaranteeing the rights of life and health of citizens; secondly, the public goods theory which based on the basic requirement on health care products for citizens; thirdly, the human capital theory which based on the demand of capital accumulation for national development. Although it is the responsibility for government to establish hospital, there are four problems faced when our government are trying to do its job:the first problem would be the ambiguity of the social functions for government operating hospitals, which directly result in that the public welfare nature go away; the second problem is that too little financial investment and financing channels caused that the operation for hospital realizing its public welfare nature lacks enough funds; and the third challenge is that excessive mercerization lead to the tendency of clustering and chasing interests under the circumstances of the inadequate development of market economy; the last problem is that government plays two roles at the same time-athlete and judge, which makes the hospitals lack of effective supervision. There for, the boundary of responsibilities for government establishing hospitals should include: locating the social functions of public hospitals, channeling social capital into public hospitals, confirming the suitable scale and the network layout of public hospitals, and reinforcing the construction of supervision system of public hospitals. Third, systematically elaborate the theory of the scale of public hospital. the scale of public hospital is divided into two aspects, lengthways scale and the horizontal scale. The main theoretical basis of setting the lengthways scale is transaction costs theory, while the horizontal scale setting basis is scale economy and scope economy theory.The last but not the least, describe the theoretical and practical basis of the construction of public hospital financial compensation mechanism. The property of health care products show that under the circumstance of market economy, only government using its strong financial resources can satisfy the need of people for pure public health service products. The products could be offered by different subjects, entirely by government, totally by market, even both. But what is worth noticing is that no matter offered by government or by market, both exist the possibility of invalidity. The reality proved that there exist serious problems about the pattern, level and mechanism of financial compensation that our government provide to hospitals, which force the government undertake comprehensive reform to hospital system.2The Social Functional Orientation of Public HospitalThe existence value of public hospital lies in its social function that their own ability of supplying medical services and market regulation can have positive effects through meeting people’s needs of medical treatment and health services. In other words, one of the functions of public hospital is manufacturing and supplying public medical treatment and health services. On the social function of public hospital, the public hospital’s social function has been divided into four or five parts by some domestic scholars from the perspective of its public nature and service function. However, the main problem is that the realization of its social function doesn’t depend on its overall positioning. Since different public hospital has different structure and composition, thus, they have shown different features and functions. Under the premise of upholding the overall function of public hospital, according to the sprint of our national health care reform, combined withdifferent kinds and levels of public hospital’ sactualsupply capacityandpeople’s actual needs ofpublichealth services, this study reconstructs public hospital’s function by category and level. For instance, the first-class hospital is mainly responsible for the diagnosis, treatment and prevention of general population; the second-class hospital is responsible for High-risk groups’diagnosis and treatment; the third-class hospital is responsible for special populations’ treatment.3Analyses on the Appropriate Development Scale of Public Hospital in Hunan ProvinceHunanProvince, as a predominantly agricultural province in central china, not only its Level of economic development (GDP) and total population are Always in the forefront of the six central provinces but its residents’demand for medical services is equally at the forefront of the six central provinces and even the whole country. Therefore, TakingHunanProvince as an exampleto studythe suitability of the scale of government-run hospitals and their financial compensation mechanism is representative. In face of its people’s huge demand for medical services, how should governments at all levels of Hunan Province do to ease the contradiction between people’s demand for medical services and public hospital’s supply? From the view of management, there are lots of effective solutions to solve this contradiction and to expand or reduce the production of hospital is considered to be one of the most effective actions under the condition of market economy. Thus, this section makesa prediction on public hospitals in HunanProvince on its scale efficiency and the scalewhich the next five years they should reach. The study shows that the growth of total number of public hospital in HunanProvince is going to be up to92%from2010to2015. That is to say, the average annual growth is about15%. Among them, the number of third-class hospital can still be increased about53; the total required number of registered nurses of public hospital is approximately97,591; the registered physician number is about50,582-55,179; the actual demand for pharmacists, technicians and other technical staff is about16,296.16,296.18332.40; thetotal number of beds of nonprofit hospitals (here mainly refers to the public hospital) will reach338,869.In order to prove the above growth of public hospital and The suitability of a single hospital size, this research uses sample survey on28public hospitalsin Hunan Province of their relativeeffectswith dataenvelopment analysis (DEA). We find that among all the19general hospitals (TCM hospitals included),7hospitals’DEA is ineffective or inefficient, accounting for36.8%; of all9specialty hospitals,6hospitals only get1in their overall efficiency, pure technical efficiency and scale efficiency values, accounting for66.7%;2hospitals’returns to scale is increasing and the remaining1hospital’s return to scale is decreasing. Through the input redundancy analysis on all these DEA ineffective and inefficient hospitals, we find thatdemand for various input(human, finance, material) of the hospital is expanded in varying degrees. Meanwhile, according to the scale efficiency value of hospitals of different classes and levels, we predict the appropriate numerical range of scale efficiency value of general hospitals and specialist hospitals in areas suitable scale value in the next five years:the beds number of comprehensive tertiary hospital should be controlled below1200; the appropriate beds number of comprehensive second-class hospital should be controlled at the range of300to500and it may not be able to work if the number is More than500or less than300.In order to verify the reliability of the results, this study also predicts the residents’ total demand for medical services (the patient amount of the4county hospitals) of4county hospitals (the second-class hospital) in Zhuzhou city, a reform pilot point, from2013to2017by use ofthe data processing system (DPS). The prediction shows that the4counties’total demand for medical services and the suitability of hospital scale development in HunanProvinceare generally consistent with the previous forecast. From2013to2017, the total patient number of the4county hospitals will be479,756、510,716、582,331、664,058and757,312. 4Researches on Financial Compensation of Public Hospitals under the Context of the New Medical ReformGenerally, lack of financial investment in public hospitals and unreasonable"drug-maintaining-medicine"compensation mechanism are considered to be important reasons of the contradiction between medical services and supply. This unreasonable system can be traced back to wrong understanding. At the beginning of reform and opening up, our country’s concept of financial investment in public hospital is "efficiency is priority and the justice should also be taken into consideration"(at this time, justice equals equality), however, the contradiction between service and supply have not been solved even under the guidance of this concept. There is still a lot of difficulty in satisfying Chinese medical demands and hinderthe sustainable developmentof public hospitaland achievement of fair medical care. Through the philosophy analysis on the relationship among fairness、 equality and efficiency (equity and efficiency are required to and able to achieve the high degree of unity in philosophy, while, if we try to achieve the high unity of fairness and efficiency in philosophy, we will realize that it’s only our moral ideal. Sincethere is a hugegapbetweensubjective and objective in reality), combined with the analysis on our government’s financial investment concept of "Efficiency is priority and the justice should also be taken into consideration" in public hospital, this study comes up with a new concept of financial investment in public hospital: justice is priority and the fairness should also be taken into consideration.Under the guidance of the above concept, this research makes a sample survey of financial investment of572comprehensive public hospitals of Hunan Province; with the help of time seriesanalysis andDEAsuper-efficiency slack-based evaluation model and according to the positioning of the social function of public hospitals and the current country’s project of financial compensation to public hospital, takingthe amount of medical services in hospital, namely, the volume of Outpatient, emergency and hospital, as the dependent variable and taking the expense of manufacturing and providing public medical service goods(The so-called Policy expenditure)as the independent variable, this essay estimates the compensation amount of the so-called policy loss of public medical hospital in Hunan Province. Besides, take the retirees fees and expense on hospital infrastructure and large-scale investment in equipment purchase and input in the construction of key disciplines、 the public health grants which hospitals undertake、the fee onEmergency treatment, foreign aid, agriculture aid and frontier aid, etc which government prescribed, this essay calculates that the total amount of financial compensation in public hospitals of Hunan Province in2013will likely reach10billion Yuan.Conclusions1. Holding public hospital is government’s responsibilities, and to fix on the periphery of government’s accountability is of vital importance to improve benefit of government held hospitals.2. The value of public hospital exists in its social function, and classifying of public hospitals’social function is one of the important elements to keep up public hospitals’public benefit.3. In the next five years, the suitable scale of tertiary public hospital in Hunan Province should be controlled about at1200beds, which is300-500beds concerning with secondary public hospital.4. The concept of justice is priority and the fairness should be the new guidance of financial investment in public hospital of Hunan Province.5. The total amount of financial compensation in public hospitals of Hunan Province in2013will likely reach10billion Yuan, so the local government should strengthen financial investment to public hospital.