| Since the reform and opening up,China's medical and health services have made great progress,the people's health status has improved significantly,and the government has always made improving the quality of medical services the key content of the reform of the medical system.Especially since the 18th National Congress of the Communist Party of China,China's comprehensive medical and health development has developed rapidly,the reform of the medical and health system has entered the deep water area,the comprehensive medical service capacity of public hospitals at all levels has been significantly improved,and the supervision of the pharmaceutical market has made great progress.The improvement in the quality of medical services is a direct manifestation of the 77 years of life expectancy of urban and rural residents in China,and a marked decline in maternal and infant mortality.These are the direct results of deepening the reform of medical and health system in China and the obvious increase in the quality of medical services.However,the effect of China's medical and health system reform is not immediate,the people's burden of medical treatment is still relatively serious.At the national level,as of 2018,the average hospital outpatient expenses in China were 274.1 yuan,up 6.7%YoY,and the per capita hospitalization costs were 9291.9 yuan,up 4.5%YoY.At the grass-roots level,the average outpatient costs of community health service centers and township hospitals in 2018 were 132.3 yuan and 71.5 yuan,respectively,an increase of 13.1%and 7.5%in accordance with the comparable prices of the year,while the per capita hospitalization costs of community health service centers were 1834.2 yuan,up 6.8%.The per capita hospitalization cost of township hospitals was 730.7 yuan,a decrease of 2.4 percentage points.It can be seen that the quality of medical services increased at the same time,the people's group of medical burden has not been effectively reduced.At the national level and at the grass-roots level,china's per capita outpatient costs and per capita hospitalization costs have increased significantly.In a word,the quality of medical service in China has been greatly developed,but it is also facing great challenges.Therefore,on the basis of the above-mentioned status quo,this paper systematically evaluates the impact of government's economic regulation on the quality of medical service.This paper first introduces the research background and significance of this paper,and further carries out the definition of concept and literature review,and secondly,this paper analyzes the historical evolution and development of medical service regulation in China,and divides it into several historical stages for systematic analysis.Moreover,the impact of medical service price regulation,medical service access regulation and economic regulation on the quality of medical service is the effect of the empirical level.Finally,the conclusion and prospect of the study are put forwardSpecifically,this article is mainly from the following seven chapters,the content is arranged as followsThe first chapter,the introduction.In this part,the article explains the relevant background of this study,and analyzes the value and significance of its existence from the theoretical and practical level.This part summarizes the existing research review,and examines it from the point of contention,the theory of regulation theory and the study of regulatory effect.Then the research content,technical road map and research framework of this paper to make a further overview,explain the research methods used in this book,extract the innovation point of this paper.The second chapter,the relevant concepts and theoretical basis.The article first introduces and explains the basic concepts and related theories of regulation,and elaborates the relevant concepts and meanings of economic regulation,price regulation,access regulation and medical service quality.And in-depth analysis of the basic theory of regulation,from the regulatory economics,normative regulation theory and the development of regulatory theory,the follow-up empirical analysis of this paper is precisely on these theoretical basis of the development and extensionThe third chapter is the history and development of China's medical service regulation This part mainly discusses the historical context and stage of development of the research topic.From the planned economy era(1949-1983),the market-oriented exploration stage after the reform and opening-up(1983-1997),the reflection stage of government medical service regulation(1997-2009),and the reconstruction of medical service regulation in the context of new medical reform(2009-present)four levels.Chapter four is the impact of medical service price regulation on the quality of medical services.In the specific study,the proportion of capital and labor used in medical service institutions was chosen as the agent variable of price regulation(pregu).Through the evaluation of the effect of the price regulation of government medical services,the effect of China's medical and health system reform is evaluated.Based on the feasibility of the study,this paper mainly selects the inpatient mortality rate(inhdr),maternal mortality(prdr),the number of family health services(fas for short),the second-rate outpatient expense(hsp),per capita in-patient out-of-pocket expenses(inhsp)five indicators to measure the technical quality of medical services,Operational efficiency and output results.In the selection of data,the original data mainly come from the statistical yearbook of provinces,autonomous regions and municipalities directly under the Central Government,China Health Statistics Yearbook,China Industrial Statistics Yearbook,EPS Global Statistical Analysis Platform,China Economic And Trade Network Statistical Database and Wind database,with 2004-2016 as the sample interval.This is a good foundation for this study.on the model,the endogenous problem of estimation results can be effectively controlled by building the dynamic panel model.Chapter V is the impact of medical service access regulation on the quality of medical services.The data in part of this paper is the same as the data sourceIn chapter FOUR,in the definition of medical service access regulation,this paper selects the total social investment of the relevant industry,the total output value ratio of non-public medical institutions and the ratio of the total output value of public medical institutions to the ratio of total assets of non-public medical institutions to the total assets of public medical institutions(Xiao Xingzhi,2011;Guo Lei,2016)to measure specifically.The construction of medical service quality index is the same as in chapter four.In the empirical analysis,this part mainly takes the dynamic panel broad moment estimation(GMM)method to carry on the empirical analysis,and further demonstrates it by the robustness test.Chapter Six is the mechanism analysis of the effect of economic regulation on the quality of medical services.The purpose of economic regulation is mainly price and quality,which is realized through price access,and its mechanism is realized through the behavior selection of medical institutions,including whether there is excessive diagnosis and treatment,whether to reduce costs,so as to achieve the goal of improving the quality of medical services.This chapter of data is based on the 2003-2017 China National Bureau of Statistics,the National Health and Family Planning Commission,the State Administration of Traditional Chinese Medicine and other departments,published on the medical aspects of the annual time series data,based on empirical analysis.Empirically,it mainly comes from two aspects,namely,the empirical analysis of the policy effect of price regulation and the analysis of the policy effect of access regulationChapter Seven is conclusions,suggestions and prospects.Based on the literature analysis method,the theoretical analysis method and the empirical analysis method,this paper studies that the government medical service price regulation has a certain influence on the quality of medical service.However,the influence of price regulation lag period on related variables has the effect of non-conformity,which shows that the positive effect of price regulation does not show long-term soundness and consistency.Access regulation has a negative impact on the quality of medical services.The behavior of diagnosis and treatment in the medical process has a conductive effect on the relationship between the price regulation of medical service and the quality of medical service.On the basis of the conclusion of the study,a series of policy recommendations are put forward,and the future research prospect is put forward in the light of the specific research situationThis article includes four main innovation pointsFirst,based on the theory of government regulation,this paper discusses the influence of the policy regulation of medical services on the quality of medical services in our country,which is different from the theoretical normative study which only focuses on the government regulation policy of medical service in the past,and the actual policy effect of medical service price regulation and access regulation is more systematic.The analysis view of the previous theoretical literature only emphasizes the necessity or form of government regulation is expandedSecondly,through empirical research,this paper shows that the price regulation of medical services has an immediate policy effect.This has the same characteristics as the government's administrative tools,and the mandatory of administrative instructions often has a significant effect in the short term.In the short term,the price regulation of medical services can be brought into play more quickly to control the cost of medical services,increase the supply of medical services,and the impact on the quality of outpatient medical services,if we do not consider the behavior of medical service policy circumvention that regulation may cause,the price regulation of medical services has a positive impact on the quality of medical services.However,there is inconsistency between the short-term and long-term effects of medical service price regulation on the quality-related indicators of medical services.In the short term,Price regulation has an immediate effect on patients medical service expenses,but in the long term,price regulation may increase the cost of patient medical services.This makes a reasonable verification of the validity of the government's medical service price regulation policy,enriches the relevant research on the effect of medical service price regulation,and provides some explanation for the rationality and necessity of the medical service price regulation policy,which also provides some explanation for the government's medical service price regulation situation.Openup a new theoretical perspective about how to define the scope and boundary of regulation,how to more effectively regulate.Third,the paper found that the price regulation of medical services did not cause the increase in the per capita cost of medicines in outpatient clinics,but it led to an increase in the cost of outpatient examinations,the cost of outpatient medical treatment increased;There has been no significant increase in expenditure on items such as surgery,which suggests that "over-treatment" is more reflected in unnecessary "over-examination" in outpatient care,and that "over-treatment" is achieved through unnecessary medication and examination in the course of inpatient medical services.This provides a new theoretical basis for examining the occurrence mechanism of "overdiagnosis" and the profit-making behavior of medical service subjects,and controlling the unreasonable growth of medical costs.At the same time,this paper finds that there is a transmission mechanism of the government's medical service price regulation policy on the quality of medical service.The main provider sits in medical services,including hospitals and other medical institutions,and the government suppresses the excessive growth of medical service expenses through the price regulation policy of medical services,which causes the change of medical service behavior.This conduction mechanism is reflected in the behavior of medical institutions,medical institutions may reduce the supply of medical services,increase the use of non-regulatory programs,or increase more non-essential medical services.The policy of unreasonable price regulation will cause the behavior of in-patient medical service in medical institutions to distort behavior and have a negative impact on the patient's health.This provides a new research perspective for objective analysis of the relationship between government-hospital-patients and the origin of the contradiction between doctors and patients.Fourth,the article points out that the govemment's market access regulation of medical services also has no long-term effective positive impact on the quality of medical services.The main purpose of market access regulation policy is to allow subjects who meet the conditions of practice medicine and have the ability to supply services to enter the medical service market through administrative regulations or systems.However,from the actual situation,the market access regulation of medical services not only did not increase the supply of social medical services,but also did not effectively improve the quality of medical services.Instead,it has become a rent-seeking tool for some sectors,and it has inhibited the competitiveness and dynamism of the medical market.This shows that the existing medical service access regulation policy,in the process of formulation and implementation of the target deviation and regulatory failure,which provides a new direction for the government medical service supply market reform.At the same time,this paper finds that the access regulation of medical services has an impact on the relationship between price regulation policy and medical service quality.This regulatory effect is more obvious in the process of patient inpatient medical service.In the process of reforming the access regulation of government medical services,the higher the market access,the more significant the positive effect of the price regulation of inpatient medical service on the quality of medical service.That is,the higher the market access of private capital,the stronger the positive influence of the price regulation of in-patient medical service on the quality of medical service.This not only reflects the need of the reform of the government access regulation of medical services,through further relaxing the regulation of access,improve the level of medical service marketization.It also reflects the reasonable and scientific level of medical service marketization is of great significance to optimize the allocation of medical service market resources and improve the quality of medical service.This provides a strong empirical basis for studying the diversified supply of medical services and the reform of medical and health system. |
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