Research On Special Public Hospital Operating Machism Reform

Public hospitals play a key role in the protection of basic process. As the externalsurvival and development environment of public hospitals changed significantly,accelerating the reform of public hospitals operating mechanism is not only related tothe sustainable development of public hospitals, but also related to the physical andmental health of masses. Besides, by doing so can deeply impact on China’s futuredevelopment and enhance the comprehensive national strength. Therefore, the12thFive-Year Plan emphasizes the key point of "actively and steadily promote the reformof public hospitals". Among the reform practices in recent years, although the reformof public hospitals has been made and even achieved some success, has not yetachieved a major breakthrough, and people’s demands for health services has not beensignificantly improved. We should consider the reform of public hospitals from thetop-level structure design height. We can not simply expect to solve all the problemsby increasing government investment, should take corresponding measures from bothinternal and external aspect, introduce the market competition mechanism to reallyencourage and contain the development of non-public medical institutions, and let thepublic hospitals play a leading role, rather than a main role to form the multi-modehybrid medical service supply mode.With respect to the general public hospitals, the practice of reform anddevelopment of some specialized public hospitals, especially those are closelyrelated to the mental health, is even more important. All is because as a psychiatrichospital, not only needs to deal with the health problems of general comprehensivepublic hospitals, but also needs to deal with specific environmental factors. If thegeneral health services in general hospitals can be defined as providing quasi-publicgoods or even personal items, health issues may affect the patient’s family and othersmall-scale problems, the crux of doctor-patient problems lies in the patient’s abilityto pay and if the diagnostic process is scientific and rational and so on, the the positive externalities of the treatment for psychiatric patients are more significant, andthe people with mental illness are mostly low-income groups, it is difficult to relysolely on their own strength to complete the medical procedure.From the situation of our province, the psychiatric hospitals present amulti-sectal medical pattern, but it has not been understood by the society, theproblems of low utilization efficiency of medical resources and friction problemsusually happen. The key issue of public hospital reform is to improve theperformance of public hospital services, including hospital management, evenspecific to all medical personnel, to implement an effective excitation mechanism fortheir performance, to restrict their behavior effectively, these are the practicalproblems that the hospital reform need to face under the new historical conditions.Organizations with different economic nature, could take different incentive andrestraint mechanisms, a scientific incentive system design is directly related to thehealthy development of the organization and the vital interests of all stakeholders. Itshould be said that, people pay more attention on the moral and other non-economicalincentive and restraint mechanisms about the hospital and medical staff, rarelytouched the design of performance and incentive system of public hospitalmanagement and medical staff. Since the non-scientific incentive and restraintmechanisms adopted, the strong dissatisfaction of all parties caused by domesticpublic hospitals reform, and the biggest flaw exists in the overall health care systemreform, has becoming the target of expensive medical cares and difficulties to get amedical treatment. Without the government investment and the involvement of thethird party billing agency, the hospital operating costs inevitably arise relying solelyon the diagnosis, treatment and drug sales.The domestic public hospitals in the past adopted an incentive and restraintmechanisms, which contained partial administration, despite the fact that they usedthe operation mode of entrust-agent with the separation of two rights, because of themanagement-conduct in one, defects of evaluation index exists for hospitals given bythe sanitation administrative department. With the establishment of separation of tworights of management-conduct and the independent legal system in public hospitals,the governance structure of public hospitals under the system of separation of two rights has a big similarity with the incentive mechanism of general businessorganizations without considering its profitability characteristics. China’s newmedical reform plan has also clearly stated the goal of public hospital reform is toestablish new hospitals with independent legal entity, the principal-agent problemappeared in public hospitals with the corresponding separation ofmanagement-conduct in public hospitals, and including other profit organizations,how to implement effectively an incentive and restraint mechanism for thesemanagers has become the important practical problem for public hospital reform.