Research On Harmonious Doctor-patient Relationship Mode In Public Hospitals From The Perspective Of Institutional Changes

Since China’s reform and opening up,along with the medical reform in our country,especially in 1989,promulgated by the State Council "about expanding health service’s opinions on relevant issues,further defined the direction of the marketization of medical reform,the medical service market efficiency greatly,and public welfare of public hospitals is abate,cause unfair social resource allocation,public hospitals increasingly strained doctor-patient relationship and medical disputes emerge in endlessly,all kinds of" medical alarm "and violence injury medical events frequently on social problems,caused the social from all walks of life pay close attention to and profound reflection on the doctor-patient relationship.After the implementation of the new medical reform in 2009,the doctor-patient relationship has been eased to some extent,but the weakened commonality of public hospitals has not improved,and there are still contradictions between doctors and patients.At present,the multiple and complex contradiction between doctors and patients in China has become a very difficult social problem for local governments to deepen the reform of the medical and health system,optimize the allocation of health resources and promote the scientific development of health undertakings,hindering the healthy development of medical and health undertakings and the prosperity and stability of the economy and society.Based on this,under the background of the new era,continuing to study the doctor-patient relationship system has not only academic value,but also strong practical significance.In this paper,based on the existing research results,with the basic theory of institutional economics as analysis framework,based on the perspective of institutional change theory in public hospitals in our country the doctor-patient relationship pattern of historical evolution,using the theory of public choice theory and evolutionary game theory,economics and methods of analyzing our country public hospital doctor-patient relationship pattern evolution of the system behavior characteristics in the choice of main body in the patient-doctor relationship system mode and system,and provide countermeasures of cracking system trouble,the ultimate goal is to improve public hospitals doctor-patient relationship model,promote the patient-doctor relationship more harmonious.The doctor-patient relationship in this paper refers to the special contractual relationship and principal-agent relationship formed by the two sides in medical activities.It is also the interest game relationship between the interest subjects of the two sides and a doctor-patient risk-sharing relationship maintained under certain institutional and social moral constraints.Doctor-patient relationship model refers to a set of management system,operation mechanism and legal standard system used by the government to regulate the medical service behavior of both doctors and patients in the process of building a harmonious doctor-patient relationship.Under the planned economy,socialist public ownership is practiced,and arrangements for the unified social management system are made by the central government.Under the market economy,the basic economic system with public ownership as the main body and multiple forms of ownership developing side by side is practiced,and the market plays a decisive role in the allocation of resources.In the reform of medical marketization,public hospitals operate in a corporate way,which weakens the public welfare.Although the efficiency of medical services is improved,the allocation of medical resources is unfair,resulting in frequent doctor-patient conflicts and bringing security risks to social harmony and stability.In building a harmonious doctor-patient relationship system,the government plays a decisive role and should bear the corresponding institutional responsibility,legal responsibility,financial responsibility and regulatory responsibility.Since the founding of the People’s Republic of China,the historical evolution of the doctor-patient relationship model in China’s public hospitals can be roughly divided into three periods,forming three types of doctor-patient relationship model :(1)the harmonious and stable doctor-patient relationship model in the planned economy period.China has a single medical and health system,a stable doctor-patient relationship,public hospitals with a prominent public-welfare nature,and a low level of medical security for all.There is no conflict of economic interests between doctors and patients,and the doctor-patient relationship is relatively harmonious and stable.Due to the inefficiency of the planned economy system,the serious waste of medical resources and funds for medical security,and the heavy financial burden on the country,the reform of the doctor-patient relationship system has been put on the agenda.(2)the conflicted doctor-patient relationship model before the reform and opening up to the new medical reform.With the deepening of the medical market reform,public hospitals have implemented corporate operation and improved the efficiency of medical services.However,public hospitals have become less public welfare,with uneven allocation of medical resources,heavy burden of patients’ medical expenses,and the problem of "difficult to see a doctor and expensive to see a doctor" becoming increasingly prominent among ordinary people,resulting in intensified conflicts of interest between doctors and patients.In 2009,the central government launched a new round of reform of the doctor-patient relationship system.(3)the multiple and complex doctor-patient relationship model since the new medical reform.The government has increased its investment in medical and health care.While paying attention to the efficiency of medical services,it has also paid attention to social equity,increasing the commonweal nature of public hospitals,and trying to improve the doctor-patient relationship in public hospitals.The central government has encouraged local governments to actively explore,and formed such joint mechanisms as the "ningbo solution" in ningbo,zhejiang province,the "three-doctor linkage" in sanming,fujian province,and the third-party people’s mediation and medical liability insurance in guangdong province,which have achieved certain results,eased the doctor-patient conflict,and improved the quality of medical service.At present,the public hospitals in our country the doctor-patient relationship pattern evolution process,the presence of central and local government in the medical market reform "entrust-agent" dilemma,public hospital doctor-patient relationship model system of the main body(population)in patients with local government,medical groups,evolutionary game "prisoner’s dilemma" model of institutional changes and the doctor-patient relationship system of "path dependence" and so on.In view of the above difficulties,the optimal path for institutional change of the harmonious doctor-patient relationship model is worked out.The second is to establish the prevention mechanism of medical disputes and properly deal with medical disputes.The third is to implement the third party medical dispute mediation mechanism to resolve the contradiction between doctors and patients.Fourth,establish and improve the medical liability insurance mechanism,improve the medical service system;Fifth,establish and improve medical laws and regulations to protect the basic rights and interests of doctors and patients.The innovation of this study :(1)the research perspective is innovative.Based on the perspective of institutional change theory,this paper analyzes the institutional change of thedoctor-patient relationship model in China’s public hospitals,which enriches the research on the doctor-patient relationship model.(2)the theoretical application is innovative.From institutional economics theory as the analytical framework,this paper based on the perspective of institutional change theory in public hospitals in our country the historical evolution of the doctor-patient relationship system modes,with the public choice theory and evolutionary game theory to analyze the difficulties and the reasons of the evolution of the doctor-patient relationship system model to deepen the study on the model of the doctor-patient relationship system,enrich the research content of institutional economics,the economic subject has a certain academic value.Based on the study of the harmonious doctor-patient relationship model in China’s public hospitals,its theoretical analysis can provide a theoretical basis for the construction of a harmonious doctor-patient relationship model in the new era of China,and its policy Suggestions can provide a reference for the government to formulate policies related to the harmonious doctor-patient relationship.