Study On Relevance Of Institutional Environment, Institutional Arrangement And Performance Of Public Hospital

Objectives：Aimed at the issues in public hospital reform, this dissertation studied on thechange of three elements of the institutional environment and the management system,compensation mechanism and service system planning of public hospital and theperformance of hospital. It explained the relationship between the institutionalenvironment and hospital; the relevance among various institutional arrangements andthe influence between institution and performance of hospital. The objective of thisdissertation was to establish the overall framework of hospital reform based onperformance improvement.Methods:1. Literature research methodsSystematically reviewed and analyzed the related theory and empiricalresearches on institutional environment, institutional arrangement and hospitalperformance. Emphatically concerned the relevancy, the correlative mechanism andits results.2. Theoretical analysisBased on institutional economics and management theory, the systemcompatibility theory and the institutional change theory were used to analyses therelevancy of institutional environment, institutional arrangement and hospitalperformance. And the motivation theories was used to analyses the three factors ofincentive and restraint mechanism. Finally, establishing the incentive and restraintmechanism to improve hospital performance. 3. Empirical studyFirstly, expert interviews and seminar were combined to consult experts toknow the progress of hospital reform. At the same time, hospital performanceevaluation indicators were confirmed by14experts. Secondly, considered the typicaland continuity of the reform, Shanghai city,Wuhu city and Ma Anshan city wereselected to study the different institutional arrangement. Thirdly,10hospitals inWuhan city,7hospitals in Shanghai city and4hospitals in Ma Anshan city wereselected to study the performance.Result:1. The compatibility of institutional environment and institutional arrangement,the compatibility of institutional arrangement and hospital performance wereconfirmed theoretically.2. From government, market and legal three perspective to analyses currentinstitutional environment and confirm that this three aspects are playing importantrole in public hospital reform.3.Use three analysis tools of institutional relevance, these arehierarchy-systematic relevance, diachronic-synchrony relevance andinductive-compulsory relevance to analyses management system, compensationmechanism and service system planning.4. From hospital performance investigations in Ma Anshan, Shanghai andWuhan cities, we found that: four dimension of hospital performance have allimproved under service system planning reform in Ma Anshan city. Undermanagement system reform in Shanghai city, hospital performance has improved afterreform, however, compared with unreformed hospitals, the performance has nosignificant strength. Under compensation mechanism reform in Wuhan city,government increased the input to hospital each year, but it has not improved thecomprehensive performance.Conclusion:1. Current environment cannot meet the rapid development of hospital and evenlimit its development. Governmental function particularly has done an inadequate job in hospital’s development. Institutional environment and institutional arrangementare incompatible. Thus, optimizing institutional environment is the premise for publichospital reform.2. The various institutional arrangements are complementary and coordinating,but, the cohesion is bad. There are some defects in system design.3. Three institutional arrangements has affected hospital performance to varyingdegrees, but the results of comprehensive reform including management reform andplanning reform was superior to sole reform.4. Three essential factors of incentive and restraint mechanism wereinsufficient,the hospital incentive and restraint mechanism have not been formed.5. Based on above conclusions, public hospital institutions were proposed:Firstly, optimizing institutional environment measures include: the main direct ofgovernment function change, cultivate public hospital competitive market, improvelegal support. Secondly, institution design to improve hospital performance include:management system reform strategy, regional network service strategy, healthinsurance payment system reform strategy. Thirdly, Establishing public hospitalperformance evaluation system strategy.Innovations:1. This was the first time to use three analysis tools (hierarchy-systematicrelevance, diachronic-synchrony relevance and inductive-compulsory relevance) toanalyses public hospital institution and structure the theoretical analytical frameworkof institutional relevance.2. Previous research focused on the effect of single institution impact on hospitalperformance and ignored the mutual influence of institutions. While the key point ofthis study is to clarify the mutual relation of different systems and its function. It ismeet the shortfall of institution design.