Examining The Influence Of Medical Informatization On Hospital Satisfaction And Income Cost Ratio

On August 19th,2016,China held the highest level of "Health Congress" since the beginning of this century,taking Tiered diagnosis and medical treatment system(TDMTS)as the priority of the five basic medical and health systems,and promoting the gradual formation of the medical treatment model "first treatment at the basic hospital,or turn to higher-level hospitals,emergency patients and chronic patients treated separately,combined treatment of basic hospitals and higher-level hospitals".The proposal of TDMTS is based on the historical background that is difficult and expensive for Chinese people to seek medical treatments and draws lessons from the foreign family doctor system to put forward a major strategy for the health reform.In order to create a better operating environment for TDMTS,many scholars have studied the drivers of TDMTS,such as medical information and medical insurance level while most of these studies only based on phenomenon observation and result judgment.Empirical studies linking information technologies and TDMTS based on the viewpoints of information resources and resource dependence are lacking.Meanwhile,as the citizens' gradual understandings of the social attributes of public medical institutions,their satisfactions of medical institutions have become the focus of industry-related research.From the perspective of stakeholder theory,there is a great debate in academics about the citizens' satisfaction with the hospitals' services since the implementation of TDMTS.As this system has been newly implemented,there was no systematic and comprehensive empirical study to explore the impact of TDMTS on satisfaction.In addition,the public medical institution should treat the ordinary operation of public welfare as the foundation.The implementation of TDMTS could motivate patients to be back to the countryside hospitals,which provides an opportunity to increase financial incomes of these institutions.Therefore,based on resource-based theory,resource dependence theory,and stakeholder theory,this study investigates the mediating role of TDMTS on the relationship between informationization level and hospital satisfaction and income cost rate.In addition,this study higlights the critical role of top hospital managers in the processes of implementation of TDMTS,realization of hospital informationization,improving hospital satisfaction,and control of hospital balance.In other words,top hospital managers should create a consensus toward hospital reform and development to realize the goals of TDMTS.However,difficulties exist as the development of public medical institutions in the countyside lags behind the large-scale tertiary hospitals and the levels of management skills are uneven.To fill these gaps,based on resource-based theory,resource dependence theory and stakeholder theory,this study proposes a conceptual framework in which medial infomationization level impacts hospital satisfaction(i.e.,medical staffs' and patients' satisfaction)and income cost rate via TDMTS's implementation.This study further investigates the moderating role of top management supports on the relationship between medical informationization level and TDMTS.The content of this research is composed of the following four parts: The first part,the introduction,is the first chapter of this article.The content mainly includes the research background,significance,goals,research plan,research characteristics and innovation,and the chapter structure of this research.The second part,including the theoretical framework and the research hypothesis,is composed of the second and third chapters of this article.The content mainly includes the theoretical basis,literature review,model construction and hypothesis.The third part consists of the fourth and fifth chapters of this article.The content mainly includes empirical research design,data analysis and hypothesis testing.The fourth part is the sixth chapter of this article.The content mainly includes conclusions,suggestions and prospects.Sichuan Province,which started its implementation of TDMTS in October 2014,is the first province with large population in China.Treating the public medical institutions(including county public hospitals and basic health institutions)in 87 counties(cities and districts)of Sichuan Province as the sample frame,this study collected the objective data of medical informationization,TDMTS,hospital satisfaction,and income cost ratio and the subjective data of senior management support via survey methods.This study firstly defines the relevant studies variables,identifies the measurement dimensions and items of medical informationization level and TDMTS,and determines the relevant categories of hospital satisfaction and income cost rate via experts' consultant.Then,this study collected the objective data collected from different health administrative departments on these variables from 87 counties(cities and districts).This study further adapts and modifies the measurement items of top management support from the past studies.A questionnaire survey was conducted among 601 senior managers in these 87 counties(cities and districts).422 valid samples were collected with the response rate of 70.21%.After matching the ojective data with the survy data,this study examined the construct reliability and convergent validity and calculated the correlation matrix using the software of SPSS 22.0 version.The software Smart PLS 3.0 was used to test the convergent validity and calculated the factor loadings and weights of each items of the studied variables.This study then used Smart PLS 3.0 to test the proposed hypotheses including main effects,the mediating effect,and the moderating effect followed by results discussion.To conclude,on the background of medical reform and development,this study combined indepth interview with quantitative method and discussed the impact of medical informationization level on counties' TDMTS on their relevant outcomes.The contributions of this study are elaborated as following four aspects.First,from the analysis level and based on resource-based theory,resource dependence theory,and stakeholder theory,this study constructed a region-level framework of "medical informationization level – TDMTS – hospital satisfaction(i.e.,medical staff satisfaction and patient satisfaction)– income cost rate".The current literature on resource-based theory and resource dependence theory mainly discusses firms' operation mechanisms and their performance enhancement from the organizational level while neglect the importance of a relatively macro level.From the perspective of regional development and based on the medical service industry,this study focused on the impact of counties' medical informationization level on their TDMTS,which in turns impacts their hospitals' satisfaction and income cost rate.Doing so,this study extended the study boundary of resource-based theory and resource dependent theory.Second,from the content of the research,this study took 87 counties' medical and health institutions in Sichuan Province as the main research object to explore and analyze the antecedents and consquences of TDMTS.Past research on TDMTS has mainly focused on the obstacles and difficulties that are hindering the implementation of the TDMTS from a qualitative viewpoint and inconsistent views and conclusions exist.Empirical studies in the context of Chinese special habits on medical services are needed to better understand TDMTS's antecedents and consequences.This study treated TDMTS and hospital satisfaction as two mediating variables to uncover the internal mechanism how counties' medical informationization level affects their income cost ratio.In addition,this study also explored and confirmed that top management support plays a moderating role between the level of medical informationiazation and the implementation of TDMTS.Thus,this study verifies the importance of improving top management support in promoting the implementation of TDMTS and improving the level of medical informationization.Third,from the perspective of research methods,this study applied the multiple sources and multiple informant method to collect data and test the hypotheses.Specifically,this used the longitudinal time series data to test the antecedents and consequences of TDMTS which is conducive to the test of causality of variables.In addition,the data of this study came from four different sources which are digital hospital grade evaluation platform,health information statistics platform,hospital satisfaction comprehensive survey and direct questionnaire survey.Doing so could also reduce the concern of common method variance and accurately reflect the “true” relationship between the studied variables.Furthermore,statistical analysis softwares(i.e.,SPSS22.0 and Smart PLS3.0)were used in this study to carry out data processing and model verification.Through these procedures,the quality of data and the effect of inspection were effectively improved.Fourth,from the measurement of variables,to my understanding,this study is the first one to empirically explore the concept of TDMTS.The previous research on TDMTS mainly focused on the analysis of the policy,as well as the advantages and disadvantages of its implementation and the existing problems.There is no quantitative exploration of the concept of TDMTS.This study put forward the measurement dimension of TDMTS based on theory investigation and real practices,providing implications for empirical research related to TDMTS in the future.To conclude,this study proposed the framework of "counties' medical informationization level – TDMTS – hospital satisfaction(i.e.,medical staff satisfaction and patient satisfaction)– income cost rate" and puts forward the moderating role of top management support on this framwork.During the processes of model development and hypotheses testing,I tried to follow rigorous scientific research paradigm and fit the selected theoretical connotation.Limitations also exist and are mainly reflected on the aspects of the sampling and the research structure.Therefore,in future research,a more comprehensive research form and content will be used to carry out a more in-depth study of the antecedents and consequences of the implementation of TDMTS.