Study Of The Resource Allocation And Operational Mechanism Of Public Hospitals In Guangzhou

1.ObjectivesTo provide evidences to make the reform policy and plan in Guangzhou publichospitals, based on the status of the resource allocation of public hospitals inGuangzhou, medical service and balance in the hospital payment system, withanalyzing the problems in the policy reform of the public hospital in Guangzhou.2.Methods（1）Documentary research-Collecting information of the reform of publichospitals domestically and abroad while analyzing the internal and externalenvironments of the domestic reform of public hospitals.（2）General investigation-Using a pre-designed questionnaire to analyzing datavia descriptive analysis, the Gini coefficient method, data envelopment analysis asmeans to investigate human resources, the number of beds, medical services and thefinances of public hospitals in Guangzhou.（3）Focus group interviews–To design the outline of interviews and select10hospital presidents as a discussion group, collecting data from different departmentsof Guangzhou Municipal Health Bureau and Expert consultation.3.Results（1）The situation of health resource allocation of public hospitals in Guangzhou:aspects of total resources, public hospitals indicated a growing trend of healthresources in Guangzhou from2008to2010, the annual growth rate of the number ofhealth workers was7.52%, the average annual growth of the number of hospital bedswas11.34%, the annual growth rate of fixed assets was13.76%, in terms of resourceequity, between2008and2010, Guangzhou, the average annual health resources’ Ginicoefficients of the number of county public hospitals, health personnel, number ofbeds, fixed assets were0.803,0.792,0793,0.787, respectively, in Guangzhou.（2）Human resource management of public hospitals in Guangzhou: from2008to2010, the average number of health workers in public hospitals in Guangzhou was761, composed of55.3%permanent staff,5.4%dispatch staff,39.2%contract staff. The ratio of doctor and nurse was1:1.21in2010, including tertiary hospitals’ ratiowas1:1.42, secondary hospitals’ ratio was1:1.05. In2010, only the17doctors from4(5.40%) hospitals were allowed to work in more than one place in Guangzhou.（3）The situation of public hospitals’health service in Guangzhou: in2010, theaverage hospital outpatient and emergency clinic visits, the number of hospitalizationin public hospitals in Guangzhou were78million and16,400, respectively. From2008to2010, the average annual growth rates of outpatient and emergency clinicvisits, the number of hospitalizations in first class hospitals were6.97%and12.80%,respectively, while those of secondary hospitals were10.96%and9.22%, respectively.In2010, there were only40(54%) hospitals to implement appointment in clinic, andthe hospital appointment was90,700. the service workload of social responsibilitywas increasing.（4）Management of public hospitals’ financial assets in Guangzhou: in2010,78.37%hospitals reached the total balance with a slight surplus, but71.62%hospitals’business balance is negative, with in financial loss. Various medical arrears increasedyear by year, of which the largest increase is medical malpractice arrears. If thededuction of interest from drugs was canceled, tertiary hospitals and the secondhospitals required compensation for each outpatient visit with15.3yuan and6.9yuan,respectively, compensation for each bed every day with45.8yuan and20.7yuan,respectively.（5）The DEAevaluation of management of public hospitals in Guangzhou: only26hospital had completely positive effective, accounting for35.14%, while48(64.86%) hospitals had no-completed positive effective, in hospitals those withoutDEA positive effective, if they take measures to adjust to achieve valid DEA, thentertiary hospitals can save3721health personnel,6415beds,3453.47million yuan infixed assets,1,557,490,000yuan business expenses, secondary hospitals can save2234health personnel,3824beds,771.61million yuan in fixed assets investment,442,600,000yuan business expenses. （6）The focus group of Guangzhou public hospital dean interview results: first,basic hospitals lacked managerial and technical personnel,which need policies andfinancial support;second, the characteristic of dean’s position was not clear, whichrequires more detialed guideline of the responsiblity of dean; third, to establish a newmode of doctor can work at more than one hospital requires various supportingmanagement; four, it is necessary to clear the essential of abrogate ofdrug-profit,concerns about the difficulty of public hospital compensation.4.Conclusion（1）The number of public hospitals, health personnel, number of beds, fixedassets, resources are unevenly distributed in Guangzhou. Health resources in differentregions were disparities, which could be classified to the unfair level.（2）Although the reform of hospital personnel system was deepening and theratio of permanent staff decreased, the staff’s title system bounded talent development,the doctor-to-nurse ratio was not reasonable, the situation of doctors can work morethan one hospital was unpopular. Most hospitals implementeed presidentresponsibility system, but they lacked effective personnel management.（3）The outpatient and emergency visits was growing faster than tertiaryhospitals in Guangzhou, two-way referral mechanisms still need to improve. The needof health services increases year by year, especially the increase of demand forhospital services was greater than the increase of the number of health workers, sothat medical staff workload increased. The coverage of optimize service processes isnot wide.（4）Hospital financial troubles, most hospitals business income were in loss,mainly caused by the loss of medical payments which related to low standard medicalfees policy. Most assets were at risk.（5）The overall operation of Guangzhou public hospitals was less efficient,hospitals without DEA efficient need to be treated differently, after the adjustment, itcan save a lot of health resources.