Research On The Common Governance Of Public Hospital From The Perspective Of Public Interest

Health insurance is the basic right of life which the citizens should enjoy. The public hospital, as the leading medical and health supplier, should play a key role in providing medical and health services. With the transition from the planned economy to the market economy system, health care policies have been adjusted. The conflict of interest between public hospitals and public is becoming more and more serious. The public interest of public hospital is desalination. The problem that medical treatment is difficult and expensive is becoming increasingly prominent. Based on the analysis of the background of medical and health development, the first chapter thinks that the study problem is how to build a suitable governance model for the public hospital in order to achieve public interest, and demonstrates the theoretical and practical significance of this study. The theoretical significance lies in developing and perfecting the stakeholder theory, expanding the governance theory of public hospital, and deepening the common governance theory. The practical significance lies in promoting public interest desalination of public hospital, providing theoretical guidance for the practice of public hospital reform, and expanding the application field of governance theory. Based on the review of domestic and overseas hospital governance, this chapter analyzes the shortcomings of the research and presents the research innovation. The previous studies couldn’t make clear on the specificity of public hospital organization and public interest orientation, and did not take the way to establish the suitable governance model. This study follows the research ideas of problem, analysis and solving. As to the study problem, this chapter proposes the research ideas, framework and main content, analyzes the difficulties of the study, and presents the research methods. For the convenience of research, this study presents the key concepts such as public hospital, stakeholder, public interest, common governance.Any research needs to have theoretical foundation. Because public hospital governance relates to public administration, economics and political science, the second chapter studies the public hospital governance from the interdisciplinary perspective. These theories include the good governance theory, game theory, public goods theory, stakeholder theory, the tragedy of the commons theory, principal-agent theory, public management theory and other related theories. These theories provide theoretical support and reference for the public hospital governance. For example, the use of resolution mechanism of tragedy of the commons can apply to public hospital governance. These theories become the theoretical foundation of common governance of public hospital.Public interest of public hospital is the root of its existence, but its public interest goal deviates from the reality. Of course the reasons are many. It is necessary to analyze the main reasons of the public interest desalination from the point of empirical and practical view. The feature of this study is multiple empirical analysis. This study can objectively determine the main reasons of the public interest desalination of public hospital, and provide a realistic basis for the establishment of public hospital governance model. The third chapter analyzes the necessity of the evaluation of the public interest of public hospital, establishes the evaluation index system with three grades by Delphi method. According to the index system design of the questionnaire, the study establishes a database, analyzes the date by the method of TOPSIS, and evaluates objectively the public interest of12public hospitals. The results of this empirical study show that the public evaluation index of public hospitals is low. This study uses the public interest evaluation index and carries on the questionnaire for the government, market and public hospitals in order to study the main reasons of public interest desalination of public hospital. Through the SPSS17.0software this study analyzes the questionnaire data and does comparative analysis to further verify the investigation. On the basis of investigation and research, the study analyzes the public interest desalination of government failure, market failure and incorrect behavior of public hospital from the point of reality.On the two points of theoretical and realistic support, this study further constructs practical experience point of the common governance model of public hospital. The highlights are to summary and classify the governance models of domestic and overseas hospitals. The fourth chapter analyzes the hospital governance of the United States of America, Britain, Germany and Suqian, Shenmu and Wuxi. Bases on the hospital governance reform practice, this study makes these governace models divided into government-led governance, market-led governance and mixed type governance. These governance models can improve efficiency, quality and fairness. The valuse is also consistent with the public hospital reform in China at present. But in the reform practice, the reform achievements of public hospital mainly focus on the efficiency, and the social benefits is not enough. The deep reason is that the design of public hospital governance model and machine system can’t be combined with the public interest goa. Based on the analysis of the advantages and disadvantages of existing governance and reform, this study thinks that the main reasons of governance failure include three aspects. For example, the governance system itself is complexity, subject participation is not enough, and governance value goals among the main subjects are inverse.In the context of the market economy, any reform involves the adjustment of interest. The public hospital reform is no exception. This study introduces the stakeholder theory and game theory. The study characteristic is to analyze the relationship among the public hospital stakeholders’interests from the perspective of empirical and theoretical in order to realize the needs of integration of public hospital governance. In the fifth chapter, this study confirms and classifies the stakeholders in the form of questionnaire survey among public hospital stakeholders, including public hospital administrators, medical staff, patients, pharmaceutical companies, health care institutions, government departments, public, social organizations, other ownership hospitals. Due to the different interest pursuits for the various stakeholders, another investigation is carried on to analyze the interest pursuits of the stakeholders. On the basis of this analysis, this study analyzes the game between public hospitals and their stakeholders. At present, the hospital, the doctor and the government is in the leading position. But the interest of other stakeholders can not accept enough consideration, and the social benefits can not be highlighted. This study suggests that the game between the public hospital stakeholders is not the zero-sum game, but the cooperative game. It needs to coordinate the interests through the power of market, government and society. Good interest coordination mechanism benefits to reach game equilibrium between stakeholders and promote the public interest.Cooperative game of stakeholders needs to establish a good common governance model and mechanism. This study is the first time to study the public hospital governance with common governance and public interest from the point of the system. The sixth chapter analyzes the necessity of common governance of public hospital, and thinks this governance can reduce agency costs, realize social responsibility and public interest, balance and coordinate the internal and external power, maintain internal and external relations stable and long-term performance. The principles of common governance include fairness and efficiency, taking into account the interests and welfare, internal and external governance combined, residual control right and residual claim right symmetric distribution. Stakeholders participate in the public hospital governance with relatively equal right. In the common governance, according to the system, the common governance of public hospitals is divided into internal and external governance. The internal governance is internal participatory governance. According to the contract theory, the external governance is divided into contractual governance and public contract management. Internal and external governance of public hospital governance is interactive. Stakeholders can participate in different governance mechanisms and play their role at the same time.The effectiveness of the common governance model depends on the implementation of specific path, and combines the realization path with the public interest goal closely. This study analyzes the main problems existing in the realization path, and puts forward the corresponding countermeasures. The innovations inlcude improving the effectiveness of governance regulation, establishing information disclosure mechanism and public interst evaluation mechanism. The seventh chapter puts forward the realization paths of the common governance of public hospital. The realization paths of internal participatory governance are the establishment of the common governance structure, a sound internal control system, establishment of flexible personnel management mechanism and a reasonable salary incentive system. The realization paths of trading contract governance are the perfect price formation, the establishment of new medical security model and the reform of the pharmaceutical production and circulation system. The realization paths of public contractual governance are the reconstruction of government regulation system, improving the external supervision mechanism, establishing the information disclosure mechanism, reforming decision-making mechanism of public hospital, establishing public interest evaluation mechanism and strengthening the ethical mechanism. The government should lead the coordination from the system level, integrates the paths of governance to ensure the realization of the public interest of public hospital governance. The eighth chapter summaries the common governance of public hospital and the future research prospects.