Performance Evaluation Of Fiscal Compensation For County Public Hospitals Based On The New Health Reform In China

China started new health reform at 2009.To ensure the public hospital keep public-interest,the hospital reform policies are canceling drug price addition policy,adjusting medical service price and increase fiscal compensation.2009-2013 year,the national budget have invested totaled more than 2242 billion yuan at health,accounting for the proportion of fiscal expenditure increased from 4.4%to 5.7%.The national budget has invested totaled more than 80 billion yuan.It is expected that the next ten years fiscal compensation will remain high investment trend.It is important to summarize the reform experience and evaluate county hospitals reform performance.Government can use the experience to guide next stage reforms.Based on the above background,this paper tries to solve the following problems:(1)the incentive of hospital to different payment mechanisms(2)to evaluate the effect of county public hospital reform and the fiscal compensation performance;(3)to construct the performance evaluation system.First,this paper reviews the literature of financial compensation and performance evaluation,assess the United States,Britain and Taiwan experience and look back Chinese hospital compensation policy change from 1949 to 2013.From the analysis,we conclude that pay for performance have become widespread in health care and have generated a great deal of enthusiasm in health policy circles and among legislators,despite limited evidence of their effectiveness.Pay for performance is new types of health care payment systems and has stimulated much new thinking about how to improve quality of care and reduce the costs of health care.So we would launch hospital performance assessment and carry out pay for performance to improve the effectiveness and efficiency of the fiscal compensation.Second,this paper demonstrates the incentive of high drug prices to health care providers is to choose the highest profit drugs or services,which lead to the distortion of medical behavior.No matter how accurate the price setting,the hospital can also try to push the high cost,the price regulation mechanism is failed.The reform focus from price regulation to payment reform.In order to solve the problem,this paper design 5 models:Model 1-5 are all payment models.Model 1 is "complete cost reimbursement model" which the social optimal payment amount is equal to the total cost of hospital.The model 3,4,5 are respectively post payment model,prospective payment,mix payment,when providers engage in multiple tasks,there is a tradeoff between quality and cost control.When the supply-side cost sharing is increase,the incentive to reduce cost is relevant increase,and the incentive to improve quality is decrease.Conceding incomplete information,the low quality and low cost of health care providers can imitate the high quality and high cost which The government has to pay rent to the imitator.The model 5 is the pay for performance model.Based on the total number of points in advance compensation,the performance evaluation score as the weight,found that hospital performance evaluation can effectively promote and supervise the hospital to improve service quality and reduce medical costs.Third,this paper constructs a performance evaluation framework,the performance of public hospitals separate into economic performance,efficiency and effectiveness respectively,to reflect the economy,efficiency and effectiveness.Evaluation index of performance evaluation by consulting experts.The hospitals performance indicators are objective and subjective,this paper using three stage data envelopment analysis to calculate the efficiency of each assessment unit,the relative efficiency of fuzzy cloud model calculation,and compared with those obtained by questionnaire survey data,to obtain the fuzzy comprehensive evaluation results.In this paper,this method provides a new research method for the comprehensive evaluation of complex systems with both objective and subjective factors.Forth,in order to evaluate the effect of public hospital reform and fiscal compensation,this paper focus on payment system reform in Henan province.Chose pilot county public hospital as the treatment group,the non-pilot hospital as the control group,using the difference-to-difference model to analysis the effect.A total of six years data of the Henan 332 county public hospitals are used to systematic and rigorous assess the reform policy effect.The results show that health policy not only has a positive effect on the single drug costs and inpatient health cost,but also on the health care quality.However it does not have a significant effect on treatment number.Based on the performance index system,the 30 county public hospitals in Henan province were selected as the sample(15 pilot hospitals,15 normal hospitals),the use of cloud model to evaluate the performance of 30 hospitals.according to the pay for performance model,calculate the payment amount of the sample hospital.This paper provides reference for the reform and enriches the performance management system.