Organizational Ecology Based Study On The Impact Mechanism Of Evolution Of Public And Non-public Healthcare Institutes

[Purpose]Integrating decentralized policies and managing multi-systems gradually from a holistic point of view are the basic ideas for the formulation and implementation of China's healthcare and health policy.Focused on practical management of the development and reform of the two core components of the health service delivery system:public and non-public healthcare institutions,this study aimed to analyse the connotation of the evolution of public and private healthcare institutions,and to develop their evolution impact mechanism model guided by organizational ecology theory.This research further aimed to use the model as a research framework to analyze the evolution of public and private healthcare institutions in China,to explore the key influencing mechanism in the evolution,and to put forward policy recommendations for the development and management of public and private healthcare institutions from the organizational ecology perspective.[Methods]The content of the study was divided into two parts,and the qualitative and quantitative methods were adopted to study the research objectives.Firstly,the theory of organizational ecology applied to institutional management were combed through literature review,the framework of evolutionary impact mechanism of public and private healthcare institutions was proposed,the conceptual model of evolutionary impact mechanism of public and private healthcare institutions based on the characteristics of institutional evolution and the analysis of the interaction between them was put forward.Secondly,the evolutionary trajectories of various subsystems in public and private healthcare institutions from 2002 to 2017 were described and counted by dynamic time warping algorithm(DTW).Thirdly,the influencing factors and interaction of the two types of population evolution in the past 15 years were estimated by using the tracking data regression method and Lotka-Volterra interspecific competition model based on the conceptual model of public and private healthcare institutions' evolutionary impact mechanism.Finally,the evolutionary impact mechanism of public and private healthcare institutions in the eastern,central and western regions of China were refined through expert interviews guided by the idea of model realisation.[Results](1)Constructing the conceptual model of the influence mechanism of the evolution of public and private healthcare institutions: the complexity,integrity and synergy of public and private healthcare institutions were confirmed to coincide with the objectives and characteristics of the analysis of organizational ecology,and the theories of organizational ecology were applicable in this study;population,economy,resources and output were defined as the four characteristics of the evolution of the organization;designing the interaction coefficient to the evolution of species was designed to e used as the method of measuring the strength of group interaction;the model was situationalized and the extraction plan of influencing mechanism combined with geographical characteristics was established.(2)Research on the Evolution Trajectory of Public and Private Healthcare Institutions(2002-2017): On the whole,the legitimate needs of public healthcare institutions,also refered to as the degree of social awareness was on the verge of saturation,competition will become the dominant evolutionary organizational relationship,the speed of new organizations establishment will slow down;non-public healthcare institutions were still in the stage of demand-led legitimation,and the speed of new organizations establishment will continue to accelerate.Among them,the evolution trend of hospital population was basically the same as that of healthcare institutions;the population size of public primary healthcare institutions were growing continuously,but the growth rate was slowing down gradually;the population size of non-public primary healthcare institutions had stopped growing since 2014;the population size of public and non-public professional public health institutions was growing,and the growth rate of the former is stable.The latter grew slowly before 2015 and rapidly since 2015.Public sanatoriums were in the stage of procedural organizational death,which had the risk of triggering ALLEE effect and leading to extinction.The population growth of non-public sanatoriums was unstable,and the volume was insufficient to simulate accurate prediction(3)Influencing factors of the evolution of public and private healthcare institutions: the number of discharged persons in the whole country(P < 0.01)and in the East(P < 0.01),the middle(P < 0.01)and the West(P < 0.01)had significant positive effects on the population size;the number of healthcare staff in the whole country(P < 0.01)and in the East(P < 0.01),the middle(P < 0.01)and the West(P < 0.01)had significant positive effects on the population size,and the average length of stay in the East(P < 0.05)and the western region(P < 0.05)had a significant positive impact on population size.The utilization rate of sickbeds had a significant negative impact on population size in the whole country(P < 0.01)and the central region(P < 0.01),and the western region(P < 0.05).The number of elderly population had a significant positive impact on population size in the western region(P < 0.01).The per capita healthcare care expenditure of urban residents in the western region(P < 0.01)had a significant negative impact on population size.(4)Interaction between public and private healthcare institutions in evolution: Public healthcare institutions and non-public healthcare institutions were symbiotic in the measured 15 years,and their population size increased at the same time.On the premise of limiting the maximum environmental carrying capacity,the two populations showed a mutually inhibiting relationship in the symbiotic state,which had a certain degree of inhibition on the growth of the population size of each other.The inhibition effect of the former on the latter(inhibition coefficient=-0.009581)is weaker than that of the latter on the former(inhibition coefficient=-2.737).Assuming the environmental carrying capacity was unlimited,under the condition of symbiosis,the two populations showed predatory competition.The former inhibits the latter population size,while the latter promoted the former population size.The degree of inhibiting effect of the existence of public healthcare institutions on the population size of non-public healthcare institutions(inhibition coefficient=-0.4947)was higher than that of the latter on the former(inhibition coefficient = 0.1289).Among them,the restraint effect of non-public healthcare institutions on the scale growth of public healthcare institutions in the eastern and central regions was stronger,while in the western regions the opposite situation was presented.[Conclusions]Public healthcare institutions and non-public healthcare institutions,which were the core components of the healthcare service delivery system,had been in a state of fragmentation for a long time.At the policy level,there was a lack of top-level design for the co-ordinated management of the two populations.The establishment of a consortium of multiple management departments and the monitoring and analysis of population evolution could help policy makers to grasp the trend of population development,and could aid to achive a cooperative development of institutional population.In the next steps of health care reform,taking into account the differences of influencing factors of public and private healthcare institutions' evolution in different regions of China,and to formulate and implement appropriate policies in accordance with different environmental carrying capacity could be necessary.A research system could be set up in an evidence-based method for the index design of environmental carrying capacity.Enhancing competitiveness could be the intervention actions of public healthcare institutions at present,and development direction guidance could be the focus of intervention actions for non-public healthcare institutions.Guidance to a benign interaction status via establishing a system of sharing advantages and obstacles could be the key to promote the transformation of public and private healthcare institutions from mutual restraint to mutually beneficial symbiosis.To establish a negotiation and cooperation mechanism between public and private healthcare institutions to enhance their ability to overcome the main obstacles of evolution could be the short-term goal of policy implementation,to promote the coordinated development of the two groups by promoting the participation of non-public healthcare institutions in the construction of healthcare consortium could be medium-term and long-term goal.The competitive advantages and disadvantages of the public and private healthcare institutions in the evolution could be taken into account for the design of the policy.While the size control of public healthcare institutions were strengthened,improving their service capacity and efficiency could also be focus on;whle the staff system competitiveness of non-public healthcare institutions were improved,their participation in public service could also be increased.[Innovation and Deficiency]Innovations:(1)Based on the theory of organizational ecology,this study proposed an evolutionary impact mechanism model,which broadened the application scope of organizational ecology and enriched the theoretical basis of health policy,and health management discipline.(2)In this study,the interaction and interaction intensity in the evolution of public and private healthcare institutions were measured by the bio-competition model,which provided a quantitative measurement tool for the state of public and private healthcare institutions in the evolution,and qualitatively refined the evolutionary impact mechanism combined with regional differences.This has universal guiding significance for policy makers in different regions to manage the two types of institutions as a whole.Deficiencies:(1)Based on the improvement of data accessibility,the trajectory study of the evolution of two populations could be more detailed.(2)The analysis of the factors affecting the evolution of the two populations could be further optimized.The idea of empirical research in this study could be used to carry out more empirical research in the future and provide further clarified results..