A Breakthrough Study On The Dilemma Of Small And Medium-sized Private Medical Institutions Participating In The Construction Of Urban Medical Service System

With the release of the Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical and Health Care System in 2009,a new round of medical reform in China was officially launched.In order to establish an integrated medical service system with a complete system,clear division of labor,complementary functions,close collaboration and efficient operation.The Outline of the Healthy China 2030 Plan points out that it is necessary to establish a hierarchical and categorized medical service system for all types of medical services,establish a synergistic mechanism for work with clear goals and responsibilities,and improve the service network,operation mechanism and incentive mechanism,so as to make primary healthcare institutions the "gatekeepers" of the people.However,primary medical and health-care institutions,especially small-and medium-sized private medical institutions,still suffer from a lack of capacity and a lack of clarity in the functions of their medical services,resulting in a lack of continuity and uniformity in medical services,which is also the biggest problem in the development of the current medical service system.Small and medium-sized private medical institutions are an important mainstay of the urban medical and health-care service system in meeting people’s diversified and multilevel medical service needs;in particular,the proliferation of small and mediumsized private medical institutions of a for-profit nature can enrich the structure of the mainstay of medical and health-care provision,and is an important supplement to nonprofit medical and health-care institutions.The government seeks to create a favorable environment for the development of small and medium-sized private medical institutions through the construction of laws and regulations and policy guidance.It encourages the development of new forms of medical and health care services,and improves the capacity and level of primary medical and health care service provision.In order to implement the government’s responsibility in the supervision and provision of medical and health services,etc.,and to give full play to the role of the market mechanism in the allocation of resources and medical services,etc.,and to innovate the system and mechanism of running medical services by social forces,we will satisfy the people’s demand for diversified and multilevel medical services.This paper tries to find the realistic dilemmas of small and medium-sized private medical institutions in the process of participating in the construction of urban medical and healthcare system,and analyze the results of the research in C city of J province,so as to provide more effective paths and countermeasures for small and medium-sized private medical institutions to better participate in this process.In order to realize the goal of building a fair and efficient medical and health service system that is compatible with China’s economic and social development and health needs by 2030.This paper found through the literature combing: domestic literature mainly from the study of social medical system,the development of urban medical service system research,private medical institutions how to participate in the urban medical service system and participation in the process of government and market relations in the study of the four aspects of the research.The development of foreign medical service system is more perfect,mostly from the privatization of medical services,medical service system division of labor framework and participation in the form of research.However,there is no targeted research on the role of small and medium-sized private medical institutions in the urban medical service system,therefore,this paper is committed to seeking the reasons for the dilemma of the participation of small and medium-sized private medical institutions in the urban medical service system with the help of the perspective of the government regulation theory,and to find a breakthrough in the dilemma of the method.This paper takes City C of Province J as a case study,and focuses on the research method of questionnaire survey and semi-structured interview.Through the research study,it is found that: the average years of establishment of small and medium-sized private medical institutions is 10.5 years,with an average of 3 practicing doctors,the daily reception of patients is 19.9,the departments are mainly set up for internal medicine and traditional Chinese medicine,88.4% of the small and medium-sized private medical institutions are unable to use the payment of medical insurance,and 72%of small and medium-sized private medical institutions have a monthly business income of less than 30000 yuan.88.4% of small and medium-sized private medical institutions can not use medical insurance payment,72% of small and medium-sized private medical institutions have a monthly business income of less than 30,000 yuan,small and medium-sized private institutions have become an important main body in the construction of urban health care system.By analyzing the results of the interviews,this paper classifies the 30 small and medium-sized private medical institutions participating in the in-depth interviews into three types according to their different willingness to participate: active participation,neutral participation and passive participation.At the same time,the results of the questionnaire were analyzed to show that the main factors affecting the participation of small and medium-sized private medical institutions in the urban healthcare service system are: system supply,talent development pathway,and government purchasing service.Among them,most of the influencing factors are regulatory policies.In the process of participation of small and medium-sized private medical institutions in the urban medical service system,due to the influence of the nature of profit-seeking,the government overemphasizes the hard regulation and lacks the flexible guidance policy.The study found that the main dilemma of actively participating medical institutions is the external trust dilemma under the dominance of public hospitals,and the main reason for the dilemma is that public hospitals play a dominant role in the current health care system,and in the social environment of public hospitals squeezing,it makes the public’s cognition of the service level of public hospitals and small and medium-sized private medical institutions seriously biased,which leads to a decrease in the trust level of the society towards small and medium-sized private medical institutions.The main dilemma of neutral participating medical institutions is: the dilemma of their own talents under the multi-practice,the main reason for the dilemma is that due to the strict control of public hospitals for the talents,it is difficult to implement the policy of multi-practice,and it has become a slogan on paper,leading to the overall low level of practice of small and medium-sized private medical institutions,which makes it difficult to improve the level of service of the public hospitals and small and medium-sized private medical institutions.The main dilemma of the passive participation type medical institutions is: the pursuit of short-term returns under the predicament of their own planning,the main reason for the predicament is that the person in charge of this type of medical institutions for the implementation and implementation of the policy of the enthusiasm is not high,due to the uncertainty of the future development of the expected,resulting in the lack of long-term planning of the organization’s future development,mostly focusing on the current situation,and the long-term planning of the future development of the organization.Due to the uncertainty of the expected future development,they often lack long-term planning for the future development of the organization,and mostly focus on the short-term benefits and returns of the present.Ultimately,it was found that the most fundamental reason is due to the profit-seeking attributes of small and medium-sized private medical institutions,which led to a series of government regulations in order to avoid overmarketization,in order to better participate in the urban health care system will inevitably be subject to more stringent government regulations,which will have a certain impact on the freedom of small and medium-sized private health care institutions to make profits.The solution to this dilemma can be taken to strong regulation to strong guidance transformation,improve the participation of small and medium-sized private medical institutions enthusiasm,under the premise of guaranteeing the profitability of small and medium-sized private medical institutions,reasonable guidance,in order to make the small and medium-sized private medical institutions to better participate in the urban medical service system.Based on the above analysis,countermeasure suggestions are proposed for the breakthrough of the predicament.First,under the premise of regulatory,it is necessary to strengthen the policy guidance for small and medium-sized private medical institutions,such as the management level and guidance level to put forward more specific development direction and development path;second,the external environment optimization strategy under the guidance of the government to guide and create a conducive to the development of the small and medium-sized private medical institutions of the external environment,to improve the degree of trust of small and medium-sized private medical institutions,and the introduction of a third party for supervision;third,to guide the Third,guide small and medium-sized private medical institutions to build a reasonable talent development mechanism,look for breakthroughs in small and medium-sized private medical institutions,pay attention to internal planning,especially talent development planning,build a perfect talent training mechanism,establish talent attraction and incentive mechanism,and pay attention to the creation of talent early warning mechanism,improve the function of medical and health care service system,and innovate the medical service management system.Fourth,on this basis,guide small and medium-sized private medical institutions to carry out reasonable and long-term future planning with the prospect of win-win cooperation.By upgrading primary healthcare services and improving the supply-side structure of the healthcare service system,we are trying to explore an effective path for the construction of a close-knit healthcare service system under the regulation and guidance of a reasonable government.