| 1. BackgroundThere is market failure and government failure in the medical service market At the same time. Because of information asymmetry, health care providers play a strong and active role in the relationship with the patient, which cause induced demand and social welfare loss. In addition, due to historical background, government support, mass preference and advanced technique, public hospitals earn certain monopoly, leading to market failure, manifested in the rapid rise in costs and poor efficiency of health care services and other issues. And also, the process of excessive government intervention for public hospitals could exacerbated the market failure, due to power rent-seeking, corruption and such acts, which could lead to government failure. Therefore, to develop the social capital medical institutions is one of the significance ways to address market failure and government failure.The insufficient health resources and imbalanced configuration is one of the main problems in health care system in China. With the increase of social economy development and improvement of universal health insurance system, public health care demands is released, and present a multilevel and diverse characteristics. Conflict between the supply and demand of medical services is highlighted increasingly. To increase the proportion of social capital medical institutions in medical and health services, and to construct a pattern of medical and health services with diverse sources and style of social capital investment, could increase the medical and health source in total, expand services supply, satisfy diverse and multilevel medical demand of people. On the other hand, it could introduce competition mechanism, break the monopoly of public hospitals, activated catfish effect and sequence theory to reallocate medical resources and operate system efficiently, which would create a situation that social capital medical institutions and public hospitals promoted and developed mutually.To compare the figure of 2012 and 2008 before the new health reform started the development of social capital medical institutions shows in four growths. Number of institutions grew. The number of non-public medical and health institutions reached 447,000, accounting for 47% of total national health care institutions; including non-public hospitals 9786, accounting for 42% of the total national hospital, with an average annual growth of 16%. Number of beds increased. The total number of beds in non-public hospitals is 582,200, which increased from 9.5% to 14%. Number of labor increased. Staff from Non-public medical institutions reached 161.97 million, accounting for 18% of the total number of health workers, an increase of 44.6 million, accounting for 38%. Medical service increased. Non-public hospital visits reached 253 million, accounting for 10% of the total, an increase of 120 million (up 90.9 percent).However, social capital medical institutions are still facing problems in the scale and quality of development. There is no larger-scale and higher-level development trend in the industry. Problems like small-scale institutions, low industry concentration and lack of behavior regulation is highlighted. Other problems like qualified personnel, lack of team building and long-term development strategy, lack of integrity would slow down the development. Relevant policies and measures have not fully implemented, present as "spring gate" and "Glass Door" phenomenon occurs and insufficient industry regulation. According current figure of medical service, there is huge gap to reach the goal of non-public medical institutions, beds and services account for 20% in total by 2015, which was set up in State department’s <Health Reform Plan and Implement Project in "Twelfth Five-Year" Period>. In order to create a good development internal and external environment and accelerate the pace of development of social capital medical institutions, and promote a diversified medical pattern, this research aimed at addressing problems in social capital medical institutions development, such like the main problems, the key and starting point of solving these problems and support strategies of the development in social capital medical services.2. PurposesAccelerating the new formation of diversified medical pattern with public sector as the main and non-public medical institutions as complement, is the desirability of improve the medical services system, increase the medical resources supply, satisfy public multilevel and diverse medical demands, and also achieve the purpose of new health reform. According to the main problem of social capital medical industry development, support strategies would be presented in this study, which would be significance for the development of the industry. This research aims to analyze the main problems of social capital medical industry development, targeted to propose solutions to the problem, break the policy barriers, the main strategy to support the development of the industry, to promote the development of social capital medical industry, provide policy recommendations.3. ContentsThere are 4 aspects included in this research.3.1 Current circumstance of social capital medical industry3.2 Main problem and policy barriers of social capital medical industry3.3 International applications and experiences of social capital medical industry development3.4 International support strategies and characters of social capital medical industry development4. Method4.1 Literature review:via CNKI, Vip, WANFANG DATA, Pubmed, Proquest, Medline, etc database, collect relevant literature and policy documents of capital medical industry from domestic and international.4.2 Field SurveyComplete survey was conducted in Guangdong, Shandong and Yunnanabout the information of public and non-public medical sectors circumstances.Stakeholder’s questionnaire was designed to measure their awareness and order of the problems and policy barriers of social capital medical industry to identify the problem.Interviewing stakeholders and quality analysis would help to identify the problems and improve the policy.4.3 Typical cases analysisFrom different levels,choosing provinces,cities and social capital institutions as typical cases.Analysing the developing status and main support policies. Guang Dong Province,Yu Nan Province, Shen Zhen City,Wen Zhou City, Tongren hospital of Nanjing and Wuhan Asial Cardiac Disease Hospital are the typical cases.4.4 Data analysisData is input and check logic inference with EpiData. Data is analyzed with SPSS 19.0.Descriptive analysis of quantitative data:Analyze indicators reflected the circumstances and operation characters of social capital medical industry, such as number of institutions, beds, staff, service efficiency and medical cost.Ordinal scale method:using an ordinal scale to evaluate stakeholders’awareness of barriers in the development of the social capital medical industry.Statistical method:Using Chi-square test analyze the attitude and recommendations of stakeholders on policies of tax, health insurance access, scientific research and professional title promotion, personnel training, and internal administration and supervision.5. Result5.1 The number of social capital medical institutions is increasing rapidly.In general the average increasing ratio is 22.65%。5.2 Social capital is focus on relatively lower level hospital. There are less large-scale and high-level hospitals from private sectors. In 2009, the ratio of the third-grade and second -grade private hospitals of Shandong, Guangdong and Yun nan is 9.18%、6.25% and 5.21%, lowerthan public hospitals.in 2011,the ratio are 5.80%.4.67and3.31%.5.3 The amount of human resources of social capital medical industry is increasing rapidly, the average increasing rate are 20.30%and 28.63%,while accounting percentage is still low. In 2009,the doctors percentage is between10.49%-14.93%, in 2011 is between 11.39%-19.70%. in the same time, the nurses percentage are 9.94%-15.06% and 11.30%-19.58%.5.4 Although the services volume of social capital medical institutions is growing rapidly, the average increasing rate is 25.16%. But still account for a lower proportion. In 2009,the average proportionof three provinces is 9.29%, in 2011 is 11.11%.5.5 Different development trend in different area are mainly related to local support policies.5.6There are multi factors would influence on the social capital medical industry. Government and hospital administrators, doctors and nurses put the barriers of the social capital medical industry In the order of the shortage of human resource, restriction of local health development planning, over protection of public hospital from the government, the public prejudice, monopoly of public hospital, relatively lower return rate of investment, supervision policies, scientific research application, professional title promotion, health insurance access, medical technique, equipment access, land policy and tax burden.5.7 At present, the development of social capital medical industry faces five problems. Discrimination of system, policy and concept are barriers in the development of the industry. In the industry of health and medical services, we are insists on the policy that of diversified medical with public sector as the main pattern and non-public medical institutions as complement pattern, which cause the monopoly of public hospitals. And further, there are other discrimination of policy making, such as finance compensation, local health planning, personnel training, scientific research. Meanwhile, because the monopoly of public hospitals leads to the preference of patients’choice, patients trust public hospital because they are funded by the government, which lead to the discrimination of concept. Policy making problem include that the policy of developing social capital medical industry is distractive and macroscopic, and imperfect support policy caused difficulty in implantation. Due to the insufficiency and lagging of policy, the needs of social capital medical industry development could not be fulfilled. Policy implantation problem means although national regulations and policies specified that both public and non-public sectors are treated equally on planning access, health insurance access, professional title promotion, personnel training and academic environment, the effect of policy implantation was unsatisfactory. Non-public hospital self-development problem, such as lack of human resources is the problem of the main issue affecting the rapid development, which is acknowledged by all parties. External environment problem, such as patients preferred public hospitals, because unstandardized and false medical advertising has expanded patients’trust.6. RecommendationsFollowing content proposed hierarchical key strategies of national social capital medical industry development.6.1Classified management strategies established strict, specify, operational standard and process for non-profit organization, especially, scrutiny of property and profit allocation, the proportion of expenditure on staff wages and benefits, disposal of surplus assets should be enhanced. On the basis of strengthening the management of the qualification, specify tax-free accreditation standards, certification process, tax-free income range of non-profit medical institution, regulatory measures and penalties.Comprehensive strict regulations changing properties of medical institutions should be researched and developed, which provided a clear regulatory authority departments, regulatory content, change procedures, asset valuation methods, such as asset disposal options. In order to protect the existence and development of social capital medical industry, legal system construction should be promoted.6.2 The macro-control strategiesPlanning:Rational development of Regional health planning and medical institutions planning should be developed rationally, to eliminate "glass door and spring door" in social capital access to medical industry. Continue using plan as an significant tool to adjust and optimize health care resource by increase the scientificity, feasibility and mandatory of the plan, in order to guide social capital to invest prior in scarce areas of health care resources and the special-needed care areas, such as specialized subject and rising health care services. And also, the unlimited scale increase of monomer public hospitals should be controlled.Finance, taxation and price policy:In term of finance support, we suggest government at all levels set up special fund to support the discipline development of social capital medical institutions, equipment purchase, personnel training, and to support social capital medical institutions with better reputation, lager scale and specialty. The tax-free policy for profit medical institutions should be extended to five years, and half the tax ever after. The tax policy of non-profit medical institutions should be improved. Non-public hospitals should be treated equally as public hospitals on the price of water, electricity, gas and credit card rate.Health insurance:The health insurance access of non-public hospitals should be fair and clear, and treated equally as public hospitals. Now, profit medical institutions should be considered to covered in appointed hospital of health insurance. As well as, basic healthcare insurance payment should be reformed by changing from according to treatment and proportion to diseases, improve negotiation ability of health insurance and strictly control paying price.Land policy:Local land policy should be guided and improved on national level, such as clear the standard of profit hospitals land application starting price and government agreement transfer price for local government to implement.6.3 Human resource strategies"The unit people" to "the community people":Gradually promote reform of the personnel system, and promote the identity of the doctors from the "unit" and the "social" change, while improving the physician to participate in social pension insurance and other related policies. Equal treatment should be provided as public hospital in social security, academic environment and job promotion. Personnel training policy should be improve in private medical sectors. Certain proportion of quota, such as general practitioner training, continuing professional education, job promotion, trade society members selected, should be obligated for social capital medical institutions.Improve physician multi-site practice. The policy of physician multi-site practice should be specified by clear and settle the relationship of right, responsibility and profit between the 1st,2nd and 3rd practice site by contract. At the same time, physician multi-site practice process and regulation should be established to achieve ordered multi-site practice under the industry and government supervision.Multi-site practiced doctors should be assessed regularly.Improve the insurance of physician multi-site practice.Strengthening of qualified personnel, increase endogenous motivation. Government support social capital medical institutions to increase efforts to attract talents, whom with high-level personnel should enjoy equal policies as local public hospitals in terms of housing, government subsidies, children education and research fundings.6.4 Organization culture development strategies:Medical industry characteristics determine that social capital medical institutions should insist on the premise of public-good and determine rational development model, to achieve rapid development. Following the develop trend of medical industry and insisting public-good character would be key criteria of the development of social capital medical industry, which means long-term return of investment.Seeking beneficial opportunities of misplace development:The development pattern should be determined base on actual circumstance. Misplace development strategies would be a better choice, such as hospital location could focus on urban developing area, suburb and satellite city, discipline could focus on Pediatrics, gynecology, geriatrics and other vulnerable areas and newly developed health services, such as long-term care, daycare, hospice and medical examination.Organization culture development should be enhanced:At the beginning of establishing social capital medical institutions, efforts should be made on the Organization culture development. Hospital should be managed by professional manager, so that physicians could concentrate on technique development.Medical quality and medical safety should be protected:To guarantee the quality of medical care and medical safety clearance, improve service, combine medicine, teaching and researching strength, are the strategies for sustainable development.Build brand integrity:In order to achieve sustainable development, social capital medical institutions should start with building brand integrity. Social capital medical institutions should focus on improve their services, quality and reputation, which should base on fund raisers and employees’self-control, insisting on moral line of healing, and maintaining medical industry as public welfare, to seek opportunities of long-term development.Creative marketing:Their marketing strategies should change from advertising dependency, health-oriented, mass-market-oriented to service-oriented gradually, relationship-oriented, market-oriented, and focus on creation of brand spread, service and relationship marketing.6.5 Support and supervision strategiesIt is recommended to enhance the communication of government departments to ensure supervision, such as medical service provide, quality and safety, and the use of premium income, on social capital medical institutions. In order to reduce the pressure of supervision, advanced informatization and creative supervision mechanism should be reinforced. Improving the exit mechanism to achieve "broad in and strict out" could further promote social capital medical institutions to regulate their medical practice. Health insurance agency should improve supervision as well. Industry associations, societies and other organizations should play important role in industry supervision to assist government departments. |
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