| BackgroundGovernment compensation and regulatory mechanism reform of public medical institutions is aim to break "medicine to cure" mechanism, perfect the public hospital performance, enhance the efficiency of medical service quality, and improve the fairness and public welfare of health care.The new public administration theory actively advocates representative, reactivity, participation and social fairness, social responsibility as the core values, which is exactly the administrative philosophy of China attempts to build a high reactivity, respected, responsible government in recent years, our country health care system reform and compensation and regulatory mechanism reform should also be able to practice the theory. The new public administration theory provides the beneficial reference of evaluating the effect of the government health compensation and regulatory mechanism reform.Minhang district government health care compensation mechanism based on the performance of public welfare, supported by regional health information platform, government implement the regulation about medical services, public health, drug use, medical costs, operation, economic income and expenditure of public medical institutions.ObjectivesTo systematic assessment about scientificity and the achievement of Minhang district government health compensation and regulatory mechanism reform, according to the New Public Administration Theory as a guide, this study analyzes the performance-based government compensation mechanism and the regional-health-information-platform-supported regulatory mechanism, summarizes the characteristics of the compensation and regulatory mechanism, evaluate the effect of the reform, and study the influence of running performance for medical and health institutions, provides decision-making basis and reference for deepening government compensation and regulatory mechanism reform of public medical institutions reform for Minhang district and other areas.Contents and methods:The specific study contents include: ① To summarize the elements and characteristics of Minhang district government in health care compensation and regulatory mechanism reform;②To analyze the influence of public medical institution performance before and after Minhang district government health compensation and regulatory mechanism reform; ③ To evaluate the effect of Minhang district government in health care compensation and regulatory mechanism guided by the core idea of The New Public Administration, from promoting social fairness, improving the reactivity of medical institutions, representing the public interest, participation, reflecting the social responsibility.The Research methods include: ① Combing the health care compensation and supervision mechanism reform relevant policy documents of country、Shanghai and Minhang district government, using policy factor analysis method to summarizes the characteristics of Minhang district government compensation and regulatory mechanism reform for public medical institutions; ②Using on-site inspection, to descript minhang district health supervision regulation center, regional health information platform construction and their role in the regulatory system of the function; ③Using key person interviews and questionnaire survey, to analyze the relevant policy makers and practitioners about their reform attitude and evaluation; ④Through second-hand and institutional survey data, using descriptive statistical analysis and difference in difference method, comparatively analyze Minhang district and Shanghai with similar medical institutions on their performance and institutional development.ResultsThe main results are as follows:1. Characteristics of Minhang district government health care compensation mechanism——based on performanceThe design and implementation of Minhang district public medical institution government compensation mechanism is to "realize the public welfare of public medical institutions", government’s quota of compensation for medical institutions to a large extent depends on the organization performance appraisal result,In addition, Minhang district government health compensation considers the differences between general hospital and community health service centres, which makes the compensation mechanism more scientific and reasonable; Regional health information system ensure the amount of compensation by the government of each public medical institution accounting data are unified, objective and accurate.2. Characteristics of minhang district government regulatory mechanism—ased on the regional health information platformThe realization of the Minhang district government regulatory activities, to a great extent, depend on the regional health information system. Minhang district government sets up health supervision center and relies on the health information system to collect the indicators, which realizes information real-time collection of quantitative data, makes sure that the data can be obtained, measurable and operable. Information of medical institutions about efficiency, medical quality, medical expenses for the rational use of drugs, the public health service information and clinical inspection check critical value and implants using, make the government’s regulation of public medical institutions more efficient and effective.3. The influence of government compensation and regulatory mechanism reform on public medical institution running performance(1) Improve health service abilityCompared with 2008, comprehensive hospitals and community health service center of outpatient number increased by 5.92% and 5.92%, respectively, the comprehensive hospital inpatient surgery and income people also increased by 20.90% and 230.14%. Minhang district general hospital and community health service center of outpatient emergency care and hospital surgery services in terms of the number have better performance.(2) Continuing to deepen the development of public health serviceTo improve the level of public health services, Minhang district public health spending per capita increased from 40 yuan in 2008 to 55 yuan in 2012. The performance-based compensation mechanism reform has improved and promoted the public health service provision. Community health service center provides significantly increased the number of public health services, public health service quality is improved, compared to the average level, Minhang district community health service centers of quantity and quality are significantly higher than public health services of Shanghai.(3) Medical costs is under controlMinhang district general hospital outpatient emergency care are the average fee and time expended are 173.09 yuan and 173.09 yuan, increased by 14.40% and 12.99% compared to 2008; Community health service centers, on average, fee for all this time and time expended are 97.97 yuan and 97.97 yuan, with 2008 little change respectively; In addition, the public medical institutions of this all time and expended fee are maintain low and almost no growth.(4) Antimicrobial use is normative guaranteedSince 2008, the antibacterial agents use of medical institutions keeps within limits correspondingly, control effect of antibacterial drug cost is obvious, antibacterial drug expenses of general hospital maintains at a low level, cost of antimicrobial drug for outpatient emergency in hospital and community health service centers only 14.79 yuan and 199.1 yuan respectively.(5) Research and discipline development ability is still weakHowever, there are still problems that medical teaching ability is still weak, especially community health service center; scientific research ability and scientific research level is still slightly weak, Papers are mainly domestic journals; In addition, lack of a high level of municipal key disciplines.(6) The Human resources and equipment configuration improvement is not obviousCompared to the average level of health resources is relatively scarce. Since 2008, Minhang district general hospital clinicians number increased by 13.50%, but the community health service centers has dropped by 1.23%. Look from the title structure, the clinician number of senior and intermediate title of community health service centers than in 2008 dropped by 45.65% and 45.65% respectively. Minhang district number per million population of large medical equipment configuration was lower than average in Shanghai, the general hospitals of ten thousand yuan equipment is only 17.82%, the proportion of the government investment and ratio showed a trend of decrease year by year; Community health service center of the figure is 67.12%.(7) Payment form is continuously optimizedGeneral hospitals of medical income ratio increased, at the same time the drug income percentage decreases, which shows the Minhang district public medical institutions income structure has improved, the drug income ratio of 39.92%, compared with 2008. The percentage of antibacterial drug income has fallen more than 15%.4. Effect valuation on Minhang district government medical and health care compensation and regulatory mechanism reformMinhang district government compensation and regulation for public health institution embodies the main ideas of the new public administration theory. Research shows that, "strengthen the public health service compensation", "implementation of medical service cost reduction system", "adjust the public health service project", "control of public medical and health institutions, special medical services" reflect that the government role of promoting medical and health services and social fairness.In "improving medical service quality", "improvement of medical conditions" and "convenient for residents", "adjust medical service content", "control the cost of health care reform measures", meet the public voice of public on health service quality, safety, and cost controlling.To formulate and implement the "drug centralized bid procurement system",、 "medical complaint evaluation system"、"medical dispute system"、"poor practice behavior score system" and "record and report system" reflect the government represents the public interests of regulating the practice behavior of public medical institutions.In addition, the process of the design and implementation, government actively hears from managers, workers’ representatives of medical institutions and community residents about their opinions and suggestions, which makes the government policy has reflected higher institutions and the public participation, operable and represent the public demand.Finally, Minhang district government compensation and regulatory mechanism reform policy, and the implementation of performance appraisal system have reflect the social responsibility of the public medical institutions, also reflects the social responsibility of government in promoting the steady development of public medical institutions.Policy suggestions1. Suggestions about the government compensation mechanism reformMinhang district government shall guarantee the reasonable full specified amount of government financial input:first, continue to increase the intensity of compensation, compensation to improve revenue accounted for the proportion of total revenue continuously;Second, attaches great importance to the large public comprehensive hospitals in the subject status of the medical and health service system and its key role in the performance of the public welfare function, the guarantee of public medical institutions of large equipment investment, optimize the allocation of health resources;After the third drug addition, lifted compensation must be in place.Further clarify government on science and education and the discipline construction and pro bono compensation standard and method;Science and accounting the cost of public medical institutions to carry out the scientific research work, and as the calculation basis, factor price guarantee resources investment, incentive attaches great importance to the medical science and education and construction of key disciplines of medical institutions;In addition, clear the public medical institutions, undertake the task of government mandatory special compensation amount and accounting standard, scientific accounting project price, strengthen the public hospitals in the area of public welfare services provide funds investment.2. Suggestions about government regulatory mechanism reformPerfect minhang district for the medical and health institutions supervision system construction and execution, standardize supervision, establish public health regulators and other department communication cooperation mechanism;Strengthen professional technical regulation ability, with the change of the function of medical institutions continue to adjust, optimize and improve the public medical institutions supervision appraisal index system.Focus on implementation of the basic drug system and control the special service to acceptance; The government must guarantee to perform drug after zero rate reduce income to compensate in order to maintain the normal operation of the medical institutions, improve the enthusiasm of medical institutions;Balance the special medical services and basic medical service resource allocation, in improving the public medical institutions reactive and maintaining social justice.3. Suggestions to improve the performance of medical institutionsMinhang district government should strengthen the hospital for the concept of cost management and control, guide the hospital take the initiative to reduce cost and save money, in order to reduce the government financial burden and establish the long-term, scientific and sustainable government compensation mechanism.Minhang district government, medical institutions should consider area under the condition of constant increase and expansion of services, reasonable increase staff spending in the proportion of the total, actively adjust the human resource management policy, perfect compensation mechanism to reflect labor value, improve the enthusiasm of the medical staff.Minhang district government should attach importance to clinical practice teaching work, arrange special funds in the government compensation system to ensure resources, improve the ability of science and education work and medical education.Through increased investment in research and policy support, encourage and promote hospital scientific research level of ascension.To promote the hospital policy measures to enhance the level of scientific research.Minhang district government should attach importance to and take positive measures to improve the community health service center of human resources configuration; Through policy guidance to encourage and strengthen the training, and improve the education of clinicians and title level, promote the improvement of the overall business community health service center. |
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