Research On Ownership Structure Of Medical Institutions In Mixed Ownership

BackgroundOpinions on deepening the reform of medical and health system> put forward the reform direction and path of "The four beams eight columns", which were published by the CPC Central Committee and the State Council in 2009.It pointed the medical principles of non-profit medical institutions as the main body, for-profit medical institutions to supplement, public medical institutions as the leading and non-public medical institutions to develop together.Encouragement and guide social capital to do medicine from government could find a way out of a difficulty of insufficient government financial investment and contradictions in development of public hospitals. The introduction of market competition mechanism in the field of medical and health services could make public and non-public medical institutions to co-ordinate development.It contributed to the effective integration of resources, improved service efficiency and quality. The medical pattern of mutual competition, both promotion, collaborative development would be established and a healthy system of medical and health services could be fostered.Positive development of mixed ownership economy were pointed in<Decision on major issues concerning comprehensively deepening reform from the Central Committee of the Communist Party of China>,which issued at Party of the third Plenary Session of the 18th CPC Central Committee. Decision allowed more state-owned economy and other ownership economy to develop into a mixed ownership economy. With the introduction of the national encouraging policy, development of mixed ownership in the field of medical and health sparked heated debate in the academic circles and caused attention of hospital managers, medical investors.The development of mixed ownership of medical cooperation to do medical were explored in International Hospital of Peking University, Xuzhou Third People’s Hospital, Tumor Hospital of Hainan Province, The first people’s Hospital of Kunming, Kunming oral hospital and 3 public hospitals in Shanwei City. Their operating conditions and cooperation had different characteristics. The motivation, demands and goals in the process of cooperation of stakeholders are different. Social capital seeks capital expansion and enter the medical field through the mixed medical cooperation. Public hospitals seek development and growth. The government seek to ease the financing pressure. This is of great significance to study of the relevant policies and practices of the cooperative medical treatment. Research on the ownership structure of the mixed ownership medical institutions,and its impact on the operation of medical institutions may promote cooperation in the process of medical treatment.ObjectiveThe mixed ownership of medical institutions are performed as the research object. We analyze the feasibility and significance of exploring the mixed ownership of medical institutions. It is proposed to construct the running mode of the mixed ownership medical institutions from the perspective of ownership structure, one is to provide more theoretical reference for mixed ownership cooperation to do the medicine. The running situation of the representative mixed ownership medical institutions in China are analyzed. The ownership structure of all kinds of mixed ownership cooperation and the effect of ownership structure on governance structure, service capacity and operational efficiency are analyzed in particular. The operation model of the hybrid system based on ownership structure is put forward to provide more practical basis of medical cooperation for government departments. Third is to interview with domestic experts and scholars who concern mixed ownership of medical, understand their evaluation and suggestions of ownership structure of mixed ownership structure, put forward the running pattern of the mixed ownership of medical treatment. It can enrich the study and expand the idea of mixed ownership cooperation.Methods1. Literature researchWe consulted research of cooperation of medical, mixed ownership, public hospital property rights, ownership structure that were published at home and abroad. Research progress of cooperative medical theories were exploerd like Public choice, Market competition, Transaction cost, investment, Capital operation, Principal agent and Property rights.2. Comparative analysisThe comparative analysis of each research object is carried out to find relevant impact factors of ownership structure of mixed ownership medical institutions.3. Case studyThe representative mixed ownership of medical institutions were choosed as the study case. Focus on the set up of the ownership of all medical institutions mixed ownership,and the relationship among ownership structure,governance structure, operational efficiency and organizational goals.4. Stakeholder analysisPublic hospitals, social capital, government and other stakeholders were analyzed. We analyzed the attitudes on motivation of the mixed ownership from the interview or survey object and the influence of stock ownership on the interests.5. Structured interview and Questionnaire surveyStructured interviews were conducted with experts. The experts’ opinions were consulted by the mail questionnaire.6. PESTEL analysisPESTEL were used to analyze the macro environment of the medical cooperation of the mixed ownership, identify the factors influencing the development strategy of the mixed ownership medical institutions and explore the interaction between these macro factors.Results1. The results of case analysis(1) The ownership structure of the mixed ownership of medical institutions should not be too scattered. Ownership were relatively concentrated in mixed ownership of medical institutions.It may be conducive to avoid the conflict of organizational goals, minimize the excessive friction from scattered shareholders, so it can make the target of the shareholders more similar to the overall objectives of the organization, and to achieve organizational benefits with cooperation.(2) Social capital was more appropriate to the dominant position in the ownership structure of the mixed ownership of medical institutions. In order to break the existing rigid management system of public hospitals, social capital with absolute control could make the cooperation quickly adjust operation strategy, implement management changes, Improve organization and operation efficiency by introducing the advanced management idea and method of the enterprise.(3) The adjustment of equity ratio should be adjusted dynamically according to the organization’s objectives. In order to promote the initiative and enthusiasm of human resources, the ownership structure should be dynamic change and adjust constantly. Recognition of the income right to the top management and the backbone of the medical business, dynamic adjustment of equity ratio is conducive to the the incentive and restraint role of ownership structure.(4) Ownership structure is the foundation of organization governance mechanism. Be different from enterprises, It is important to design the corporate governance mechanism in accordance with the mixed ownership of medical institutions using the relationship between ownership structure and corporate governance for medical institutions. The ownership structure of the mixed ownership structure of medical institutions determined the governance mechanism.It had a significant impact on the organization’s objectives and operations through the interaction between internal governance and external governance.(5) Equity ratio was the basis of the benefits distribution, but the benefits distribution should be in accordance with the laws of the medical market. Social capital required a return on capital. In order to ensure the health and sustainable operation of medical institutions, public hospitals and social capital can make an agreement that social capital extracted the development and construction funds of the hospital after a certain period of time. If it retained,they can dividends in a certain proportion or let the social capital legal interest through the hospital industry chain.2. Results of expert interviews(1) Division of labor cooperation mechanism between the market and the government should be clear, the role of government regulation should be played. The government should give the function of operation to the social capital, social capital introduced the enterprise management and managed reform using market mechanism. The government only reserves the function of "supervision". While the medical behavior of the mixed ownership medical institutions were regulated, a good environment for the development were created.(2) The evaluation system of the mixed ownership of medical institutions should be established, the access and exit mechanism should be improved. We must improve access standards and thresholds, make enterprises of capital abundant, mature, strong anti risk ability to enter, simplify the procedures and procedures for admission. The evaluation system of the mixed ownership of medical institutions should be established according to the requirements of public hospital grade assessment. Evaluation results can be an important reference for the equity adjustment and withdrawal of the mixed ownership of medical institutions.(3) The contradiction mediation mechanism of public hospitals and social capital would be established. The establishment of conflict mediation mechanism can make stakeholders seek common ground, work toward a common goal. Establish a corporate governance structure based on the separation of management and management, formate a corporate governance structure that to the main features of the board, the board of supervisors, the management, separation of ownership and management rights and power in mutual restriction.(4) Create a good public opinion environment for the growth of social capital.We can provide a good public opinion environment for the cooperation in the form of mixed ownership in multi way. It may provide comprehensive information of introduction and development of cooperation in supporting policies for the government.(5) Optimize policy environment for social capital cooperation to do medical. Government administrative departments should break departmental barriers. The management of mixed ownership of medical institutions and public hospitals could be coordinate in financial compensation, land, taxation, health care, talent growth and multi point practice. So as to provide more support for the social capital.Conclusion1.Establisha scientific transaction system of property right. First, the property rights of public hospitals shoul be defined Clearly. The state should establish the assets investors system of public hospital as soon as possible.Second, Assets appraisal performed in science. A set of assets evaluation system of public hospitals should be established. Appraisal work can be carried out by the professional asset appraisal organization.Third, circulation of property rights. The interests of property owners were allowed to change transfer and withdrawal in accordance with their own interests.2. Set up an effective equity incentive mechanism. First, the hospital’s equity incentive from the board to directors on the management should be clear. Reasonable control could be given to management. The personnel management, operation rights given to the president. Assessment of the contract were strengthened and restraint mechanism would be build. Control of managers would be capitalized. Stock ownership can be an incentive measures. Second, Management have to stimulate the enthusiasm of the staff to do business, construct the hospital staff career planning system of staff and workers.3.Design a reasonable return path. For-profit mixed ownership of medical institutions can be in accordance with the proportion of equity profits dividends. Non profit mixed ownership medical institution, social capital can obtain appropriate economic returns at agreed proportion of investment based on sufficient funds on career development.4.Properly handle the placement of employees. The placement of employees should be given different choices of path. In the process of cooperative medical, we must give appropriate compensation to employees with benefit damaged. The hospital should properly handle the placement of employees in identity change and retirement pension.5.Establish the trading market of talent flow. Medical institutions with mixed ownership can continue to enhance their own brand and core competitiveness through Multi physician practice, doctors group, equity incentives, attracting medical personnel. The appointment of the director shall be selected by the board of directors or the board of directors. The position of the president in promoting the development of hospital reform should be recognized with appropriate return on equity.6.Supporting policies should be equivalent of public hospitals. First, implemented tax reform. Increase policy tilt to social capital in tax policy. Second, Open policy on health insurance. Opportunity to become qualified health insurance would be equal.Third, they should have a certain financial compensation.Innovation and contribution1.Theoretical innovation. First, the content of cooperation between public hospitals and social capital to do medicine were enriched. This paper expounds the feasibility and significance of exploring the medical institutions with mixed ownership.Second, the theoretical study of the medical institutions with mixed ownership were enriched and we try to make an analysis of the current controversy of the mixed ownership medical institutions.Third,it is the first time to analysis of mixed ownership of medical institutions from the perspective of ownership structure,which focus on the impact of ownership structure on the operation of mixed ownership institutions.2.Practice innovation. This paper can provide reference for the government departments in the introduction of cooperative medical rules and make the policy or rules meet with the actual needs.It can improve the operability and guidance of the policy and help government to promote social capital and public hospitals to reach a consensus. The target conflict will be reduced and quality medical services would be provided.