Research On The Positive Incentive Mechanism Of One Public Hospital In Shang Hai

BackgroundMedical and health system is related to people’s physical health, medical and health system reform is closely related to people’s immediate interests. Since the new medical and health system reform in 2009, the government is trying to build the new public health service system, the medical service system, the medical security system and the drug supply security system which cover both urban and rural residents, aiming to establish the basic medical and health care system. In the reform, the reform of public hospitals is considered to be one of the most influencing areas and it is also the key factor that matters whether the new medical reform will succeed or not. In district-level public hospital reform, the government demand the hospital to establish a new operating mechanism providing public welfare, ensuring the positivity and persistence. On December 25,2012 Shanghai Municipal Peoples’ Government formulated and issued a document about public hospital reform three-year action plan. The policy document demands to build a new public hospital operating mechanism.ObjectivesIn this thesis, through the combination of theory research and case study, we identify the core factors of public hospital, and design district-level public hospital running mechanism model of positive incentive mechanism. Then we combine the reality of public hospital X in Jiading district, provide suggestions for X hospital, and also provide policy suggestions for district-level public hospital reform in Shanghai.MethodsIn the thesis, I use the literature analysis method, policy combing method, expert consultation method, group discussion method and, case study method, key person interview and survey method. Firstly, using literature analysis method, I write a review about the current situation of public hospital research, sort out the problems of public hospitals and make a review of the incentive theory. Secondly, through reading the policy of medical reform, I make it clear that what is the background of medical reform and the direction of shanghai medical reform. According to the problems and policy, combining with expert consultation and group discussion, we design a pattern of hospital operating positive incentive mechanism. At last we use the case study method, questionnaire investigation and key person interview method to investigate the current situation of X public hospital. And we can give some policy suggestions to the X public hospital compared to the designed pattern. Then we make some more suggestions to the Shanghai district-level public hospital operating positive incentive mechanism.Main results(1)There are lots of research about public hospital, but they are limited in some one aspect. Their suggestions can also solve some questions in hospital operating mechanism, but not consider the hospital as a whole. The study of public hospital incentive mechanism is absent in our country now.(2)The incentive mechanism is based on organization goal, through analyzing the needs and motivation of subordinates, on the basis of the organization and management of resources and combination of management mode, and form a series of policy, regulations, rules and work principles. In a word, there are 4 models of the incentive mechanism:content model, process model, behavior modification model and comprehensive model.(3)In the building of hospital operating incentive mechanism, the government should consider both public welfare and economical efficiency, find the balance between government management and market function. The mechanism should according to the government policy, comprehensive evaluation and performance appraisal system.(4)Jiading public hospital X has many problems in its running system, such as complete budget management system, comprehensive evaluation system and the performance appraisal system. But the hospital has also got some effectiveness during the reform.Discussions and Suggestions(1)The public hospital reform is a key point of medical and health system reform., it is also a key factor of pushing the reform into a deeper aspect.2015 is a closed off year of district-level public hospital reform in Shanghai. On the background, the research of public hospital operating incentive mechanism is necessary and significant.(2)Through the theory study to identify the problems existing in the operating mechanism of hospital and its core elements, combined with the incentive theory research and policy analysis, starting from the core elements, we change the government compensation mechanism and hospital salary mechanism to achieve the goal of returning it back to public welfare.(3)Public hospital X in Jiading district still remains in the primary stage of operating mechanism reform. It should continue put the pattern into practice according to our research.(4)The success of public hospital operating mechanism reform is not achieved overnight, it needs the comprehensive try of all of government, hospital management and medical workers. Particularly, we need to improve level of many aspects such as the cost accounting system, the comprehensive budget management system, the compensation system, the salary system, the cost control and quality management system.