| [Purpose]The establishment of mixed ownership hospital is one effective way to drive the public hospitals reform in China. And it is helpful to found the mechanism of resources sharing, risk sharing and balanced interests.This research is based on the theory of property rights, corporate governance theory and game theory, to design the decision-making theory model of risk sharing and revenue distributing of mixed ownership hospital. Meanwhile, this research defines and explains the concept of Public Hospital Restruction, Hospital PPP Mode and Mixed Ownership Hospital, according to our national conditions. Then, this study evaluates the efficiency of sample hospitals using the DEA model, after descriptive analyzing and summarizing the patterns of mixed ownership hospital in China. Based on above, it clarifies the policy barriers and institutional defects on developing mixed ownership hospitals, and puts forward the pertinence policies and guarantee mechanism. In a word, this study is aimed to provide scientific theoretical basis and empirical reference for the designers at the top, in order to establish and develop the mixed ownership hospital in China.[Methods](1) Literature Analysis:This study discusses the research situation and the application in various fields of theory of property rights, corporate governance theory and game theory, through the domestic and foreign relevant literature database retrieval. Which is the basis of theory research on development mode of the mixed ownership hospital in China. Meanwhile, this study defines and explains the concept of Public Hospital Transformation, Hospital PPP Mode and Mixed Ownership Hospital, and presents the differences and relations of them.(2) Empirical Study:This study collects the data and material of the seven hospitals which explore to establish the mixed ownership, in Hubei province, Henan province and Shandong province, by the method of typical case studies with questionnaire survey, symposium and individual interview. Then, describe the status quo, in order to study the practice experience and existing modes of development of the mixed ownership hospital in China.(3) Data Analysis:This study adopts the method of Data Envelopment Analysis, and selects contrast hospitals similar to the scale of sample hospitals, in order to build the DEA evaluation model of hospital efficiency. Through comparing analysis of the experimental group and control group, this study makes out results of the relative efficiency evaluation.[Results](1) Relevant concept definition and theoretical analysis.The existing public hospital restruction is the restructuring in the broad sense. It is a complex dynamic process of adjustment and change of property right, management system, the internal operating mechanism and function of the hospital. Although, the result of public hospital restruction is the establishment of hospital share-holding system, it may not involve both of the "public" and "private" capital.Hospital PPP mode means that government and social capital cooperate to construct and operate the public service facilities, to provide public services, in financing and management. It must involve both of the "public" and "private" capital, but it may not occur property right change.Mixed ownership hospital is one kind of the hospital PPP modes. It must involve both of the "public" and "private" capital, and occur property right change.What's more, this study discussed the related theory, in order to lay a theoretical foundation for establishing the mixed ownership hospital.(2) The analysis of development causes of hospital PPP modeThe administration management system results in inefficiency of public hospital governance. The mixed position of medical service institutions results in severe waste of medical resources. Public hospitals monopolize the medical service market, making the private hospitals developing difficultly. Various funds drive investment in medical industry. The structural reforms of supply side of the medical service. The government possessed clear consciousness of reform and frequently unveiled relevant policy.(3) Study on the decision-making theory model of mixed ownership hospital.This study has built the theory model of risk sharing based on game theory, and the decision-making theory model of revenue distributing based on utility function. The theory models could make some conclusions:the public capital is on behalf the government and possesses the dominant position in decision-making. When foreseeable benefits are growing, the public capital will increase its investment to the hospital, so as to gain more benefits. With the increase of the total investment amount of the hospital, public capital will gradually decrease its investment proportion, while the private capital's stake would be increased with the increase of hospital construction costs. This is because that, with the expansion of investment, considering their risk tolerance and capital quantity, the public capital tends to improve the private capital's holdings. Although the direct revenue of public capital will reduce, more social benefits will be transformed into indirect revenue of public capital, brought by the further development of the hospital. At the same time, it also transfer the bulk of the risk. Thus, it is a win-win for both public and private.(4) Typical case study on mixed ownership hospital.This study listed some examples of the four types of hospital PPP models and made typical case analysis with the fifth kind model types, shareholding system restruction. On the basis of site investigation results of the empirical analysis, this study summed up three patterns of hospital sample:the workers shareholding mode; the privatization model; the mixed ownership model. They all are the results of shareholding system restruction.(5) Evaluation of the efficiency of mixed ownership hospital based on DEAAccording to the contrastive study of the experimental group and control group, this study selected compared seven public hospitals without reform of property rights system, based on the scale and location conditions of the seven samples hospitals. Using the DEA model analyze the total efficiency, pure technical efficiency and scale efficiency of these 14 hospitals.Combination the results of descriptive analysis, comparative analysis and paired t test analysis of DEA efficiency evaluation, this study made some conclusions:under the condition of existing sample, it could be thought that the efficiency of all the investigated hospital was rising with time changing, as a whole. Meanwhile, the overall efficiency of hospitals experienced property right system reform changed relatively significantly, than the overall efficiency of hospitals without property system reform. Which is statistically significance. While, it is not yet illustrative that there was significant difference between the pure technical efficiency and scale efficiency of hospitals experienced property right system reform and the hospitals without property system reform.(6) Study on the obstacles and strategies of establishing mixed ownership hospital in China.Combining with theoretical analysis and empirical analysis, this study discussed the existing policy barriers and institutional defects of establishing and developing mixed ownership hospital in China, from the concept, policies and regulations and institutional security system. Then, this study analyzed the macro and micro situation of developing mixed ownership hospital from the political, economic, social and technology, based on SWOT-PEST model. At last, this study put forward the pertinence policies and guarantee mechanism, including three aspects:clearing target orientation and grasping the basic principles, making laws and regulations and perfecting the related policy, strengthen the institutional guarantee and the effective measures.[Conclusions]Firstly, both the theory of property rights and corporate governance theory emphasized introduction of private capital into the public service, clarity of property rights, establishment of the corporate governance and balanced the interests of all parties, in order to improve efficiency and enhance competitiveness.Secondly, on the occasion of certain risk sharing proportion of the public and private, the public capital will increase its investment to the hospital with the increase of hospital's benefits. Then, when the construction costs need to expand, the private capital, with a higher risk tolerance, will choose to increase its investment proportion. Which will result in the increase of endowment of the hospital.Thirdly, the public capital could dynamically select the optimal investment proportion with specific conditions. When the overall development risk of the hospital is small, the public capital will choose to raise investment proportion and gradually recover the stock rights of the hospital. When the overall development risk of the hospital is high, the public capital will choose to transfer the risk to the private capital with a higher risk tolerance and attract private capital to participate in establishing mixed ownership hospital, through policy guidance to create good conditionsFourthly, the existing hospital PPP is one exploration step to try to establish the mixed ownership hospital, under the background of unclear policies in China.Fifthly, this study considered mixed ownership hospital as a mature form of ownership restruction. On the basis of site investigation results of the empirical analysis, this study summed up three patterns of hospital sample. No one is perfect, each of them has advantages and disadvantages, as well as its applied conditions and principles.Sixthly, under the background of unclear policies, the strong financial support for private enterprises has a great attraction to develop mixed ownership hospital, especially nonprofit hospital. But it is just based on public welfare and charity purpose of the private capital. To maintain sustainable development of mixed ownership hospital, it should establish and improve the relevant laws and regulations and policy system, in order to maintaining the legitimate interests of the private capital, on the basis of ensuring value efficiency of state-owned assets.[Creativity and Inadequate](1) Theoretical creativity:This study makes out the principle, the reasons and factors of evaluation of Hospital PPP. And this study has built the theory model of risk sharing based on game theory, and the decision-making theory model of revenue distributing based on utility function. Meanwhile, this study defines and explains the concept of Public Hospital Transformation, Hospital PPP Mode and Mixed Ownership Hospital, and presents the differences and relations of them. Which are theoretical innovation.(2) Research design:By adopting the combination of theoretical analysis and empirical research method, this study makes typical case analysis with mixed ownership hospital and sums up three patterns of hospital on the basis of site investigation results of the empirical analysis. According to the contrastive study of the experimental group and control group, this study selected compared seven public hospitals without reform of property rights system, based on the scale and location conditions of the seven samples hospitals. Using the DEA model to analyze the efficiency of these hospitals. Which are innovation.(3) Political value:Combining with theoretical analysis and empirical analysis, this study discussed the existing policy barriers and institutional defects of establishing and developing mixed ownership hospital in China, and put forward the pertinence policies and guarantee mechanism. Which are political valuable.(4) Limitations:Firstly, the guiding significance of the decision-making theory model of risk sharing and revenue distributing is still insufficient. Secondly, it remains to be further strengthened for the representative of construction and development of mixed ownership hospital model. Lastly, the difficulty and the lack of data collection become the problem of this study. |
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