Research For The Management System Reform Of The County-level Public Hospitals In Jiangxi Province

In the process of deepening the reform of the public medical and health system in China,the "fairness" and "public welfare" of public medical resources have been one of the main objectives of the reform.To realize the "fairness" of public health care resources is an effective way to effectively solve the long-term problem of "difficult to have medical treatment and expensive medicine" in China.For the county-level public hospitals,the main goal of the reform of the management system is to improve the efficiency of the medical service in the county public hospitals,and in the meantime to ensure the effective embodiment of the medical public welfare.To realize the "fairness" and "public welfare" of the public medical resources at the grass-roots level in China,solve the plight of "difficult to have medical treatment and expensive medicine" and promote the process of deepening the reform of the medical and health system in China and the local areas.This paper focuses on how the county-level public hospitals achieve the goal of "fairness" and "public welfare"reform through the management system reform to carry out the research from three aspects:performance salary management system,compensation mechanism and supervision mechanism of county-level public hospital management system in Jiangxi Province.Through the methods of comparative analysis,comprehensive analysis and qualitative analysis,the process,status and content of the reform of the management system of county-level public hospitals in Jiangxi province are expounded and analyzed.Then,according to AHP analysis method and TOPSIS analysis method,the medical service effect and public welfare of management system reform of county-level public hospitals in Jiangxi Province is assessed and analyzed to evaluate the effect of "fairness" and "public welfare" of the basic medical and health resources through reform of the management system,to find out the existing problems and analyze the causes,so as to put forward effective policy suggestions for deepening the management system reform of the county-level public hospitals in Jiangxi province.In terms of the performance salary system reform of county-level public hospitals in Jiangxi province,this paper chooses the performance salary assessment system in the People's Hospital of Yudu county,Jiangxi province as a typical case for study.The paper conducts an analysis of the strengths and weaknesses of the existing performance salary management system of county-level public hospitals in Jiangxi province by comparatively studying the performance salary assessment systems in the People's Hospital of Yudu county,Jiangxi and that of RBRVS.It is found through analysis and study that the principle assessment patterns in the performance salary management system adopted in county-level public hospitals in Jiangxi province are the income and expenditure oriented bonus pattern,the workload determined performance pattern and the monthly rated base amount assessment pattern.Although the three patterns above are relatively simple to operate,and the assessment indicators can be easily obtained,they are lack of completeness and expansibility.In the present stage where thereform of county-level public hospitals in Jiangxi province are deepening gradually,the current performance salary management system has been insufficient for further arousing the work enthusiasm in medical staff and improving the efficiency of hospital operation.This paper puts forward policy recommendations on how to improve the performance salary management system of county-level public hospitals in Jiangxi province,as follows:optimize the design of the performance salary management system,and improve the fairness of performance salary management in county-level public hospitals;increase the salary expenditure proportion in the total expenditure in county-level public hospitals,and optimize the structure configuration of the total expenditure;introduce new types of performance salary management patterns,and improve the performance salary management system in county-level public hospitals;avoid taking financial indicators as guidance,and attach importance to the long-term development of county-level public hospitals;perfect cost management in the performance salary assessment pattern,and further reduce the consumption of hospital controllable cost.Regarding the reimbursement mechanism of management system reform of county-level public hospitals in Jiangxi province,in order to effectively understand the situation of reimbursement mechanism reform of county-level public hospitals in Jiangxi province,this paper,on the basis of the field survey data,selects 8 public medical institutes with sufficient data as the research object,which are from 4 counties and cities,namely,Ji'an county,Gan county,Jinggangshan city and Zixi county.Combining the relevant data from investigation,this paper adopts methods of data classification,statistical description and comparative analysis to analyze the 8 public hospitals as a whole,so as to explore the main characteristics and reform results of the compensation mechanism of the county-level public hospitals in Jiangxi province.In the research process,the compensation mechanism of the county-level public hospitals in Jiangxi province is analyzed through six aspects,which are operation,assets and liabilities,outpatients and inpatients,structure of total revenue,balance structure,and financial compensation.On the whole,the compensation mechanism of the county-level public hospitals in Jiangxi province still has following problems:the government financial compensation is still insufficient;the debts of county-level public hospitals should not be ignored;the price of medical service is not fully matched with the compensation mechanism.In view of the above problems,the policy recommendations for the compensation mechanism reform of county-level public hospitals in Jiangxi province are as follows:increase the government financial input and enhance the government's attention to the supervision of county-level public hospitals;implement the government investment and resolve the debts of county-level public hospitals;adjust service price dynamically and accelerate the payment reform of medical insurance;control costs scientifically and strengthen the management of assessment indicators of hospital expenses;deepen the personnel reform and improve the efficiency of medical service.In terms of the supervision mechanism for the management system reform of the county-level public hospitals in Jiangxi Province,the paper selects as the research object those county-level public hospitals with distinct features of and prominent achievements in the reform of county-level public hospital supervision mechanism in the pilot areas.Mainly through in-depth interviews with stakeholders,the paper gains an understanding of the existing situations,conditions,difficulties and problems during the implementation of county-level public hospital reform related to the supervision of county-level hospitals.The paper also puts forward proposals for further promoting the reform,and carries out a qualitative analysis of various factors that hinder the deepening reform.According to the research results,the paper finds out that some achievements have been made in the reform of supervision mechanism for the management system reform of county-level public hospitals in Jiangxi province,but some inadequacies remain.The medicare services still need to be strengthened,the authority and responsibility of the administrative committees of county-level public hospitals still need to be improved,and the working mechanism of authority and responsibility between the health bureau and the affiliated hospitals should be improved.In view of the above conclusions,the policy recommendations for the supervision mechanism reform of the county-level public hospitals in Jiangxi province are as follows:setting up the county territory health supervision mechanism and strengthening the supervision capabilities of the county-level public hospitals;intensifying the disciplinary punishment of the county-level public medical institutions and perfecting the supervision mechanism;strengthening fund supervision and management mechanism and establishing scientific performance evaluation mechanism;increasing the governmental compensation and raising the level of governmental attention to the county-level public hospitals.In the evaluation of medical service effectiveness of the management system reform of the county-level public hospitals in Jiangxi Province,based on the basic principles of science,orientation,representation and integrity for designing the evaluation system,this paper attempts to carry out scientific and comprehensive evaluation of the implementation of the county-level public health service system reform in Yudu county and Jinggangshan city of Jiangxi province.By contrasting the county-level public hospitals service system in Yudu county and Jinggangshan city,it is clear that the overall evaluation results of Jinggangshan city and Yudu county are basically consistent.The values of evaluation indexes in all aspects have been increased,indicating that some progress has been made on the whole in the reform of the county-level public hospital service system in Jiangxi province.But from the specific value of relative proximity,it can be found that Yudu county is better than Jinggangshan city as a whole in the progress of reform.It shows that public welfare has been much more enhanced in the process of reform in Yudu county.Because Yudu county stands at the leading level for health care reform at county-level in Jiangxi province,it also indicates that the overall progress and speed of county-level public hospital service system reform in Jiangxi province still need to be improved.To ensure the effective and efficient operation of the county-level public medical service system is the key to ensuring the healthy development of county-level public medical reform.The public medical system in the county territory should be scientifically designed,rationally distributed,and technically improved,so that people can see the doctor,afford the medical expenses and receive good treatment.In view of the above conclusions,the policy recommendations for the reform of the medical service effectiveness of the county-level public hospitals in Jiangxi province are proposed as follows:further improving the operational efficiency of the service system at the county-level public medical institutions;building scientific and effective medical service evaluation system.In regard to the public welfare evaluation in management system reform of the county-level public hospitals in Jiangxi Province,this paper refers to the field researches on a total of 14 public medical institutions in 7 counties and cities including Yudu county,Ji'an county,Jinggangshan city,Shangrao county,Zixi county,Ganxian county and Fuliang county in Jiangxi Province,to obtain the corresponding data materials for research and analysis,and to explore the phased achievements in the "return" of hospital public welfare service made during the process of the deepening of the reform in county-level public hospitals in Jiangxi.Based on the evaluation model of AHP analysis and TOPSIS method,the effectiveness of implementing public welfare reform in some county-level public hospitals during the period of 2014 to 2016 in Jiangxi province is evaluated and analyzed.On the whole,the level of internal and external public welfare,the quality of medical service and the efficiency of medical service in county-level public hospitals in Jiangxi province have increased during the period of pilot reform.Meanwhile,the costs of medical services also decreased.In the analysis of external public welfare evaluation of People's Hospital of Yudu County,it is found that the social medical service in the People's Hospital of Yudu County has been improved year by year.However,in the analysis of patient satisfaction data,it can be seen that the change in the satisfaction with each hospital department differed,and inpatients' satisfaction with clinical departments and the overall satisfaction of outpatients and emergency patients with hospitals in 2016 declined in comparison with 2015.The People's Hospital of Yudu County is one of the county-level public hospitals for pilot reform in Jiangxi province,and its achievements and problems in reform are representative.In order to deepen the reform of county-level public hospitals,fully reflect the public welfare of the public hospitals and solve the persistent ailments of "difficulty in receiving medical treatment and high medical expenses" for the common people,the paper puts forward the following suggestions:further enhancing internal public welfare of county-level public hospitals;improving patients' satisfaction with county-level public hospitals and deepening the reform of county-level public hospitals;building scientific and effective public welfare evaluation system.