| BackgroundCompensation mechanism reform is an important part of public hospital reform. It is closely related to various aspects of comprehensive reform of public hospital, which is a critical task and a key segment to improve medical and health system. Whether the compensation mechanism scientific or not is directly related to the implementation of the health care system, related to the normal operation of public hospitals, and will ultimately influence the long-term development of medical and health undertakings. For a long time, public hospital’s compensating channels mainly include three parts:financial assistance, medical service fees and the profiting from drugs. In recent years, the state financial inputs to health service remain low, and medical service fees is still below corresponding cost due to limited price policy. Under the background of canceling the drug addition, how to make up the loss and set up the scientific compensation mechanism by adjusting the price of medical service, increasing government assistance, designing payment methods, reducing hospital operating costs and other ways, is an important topic for the health economic research.In this study, first, we put forward the research idea and framework on the basis of sorting and summary for related literature at home and abroad about public hospital compensation. Based on the current situation of the compensation mechanism, the expected results of the reform, we point out the need to improve the support of government financial assistance in public hospital and the suggestion to adjust the medical service price by collecting and analyzing economic data of urban public hospitals in Guangdong province. What’s more, it gives support to the decision of the public hospital compensation mechanism reform in Guangdong province.Methods1. Literature ConsultationWe have done literature research in CNKI, WHIP Chinese, Wanfang database, EBSCO, Springer, PubMed, Google Scholar and other databases, and fully searched the public hospitals, financial compensation, zero slip, medical service prices, payment, social capital, Nonprofit hospital, compensation, Medical insurance and other key words. We summarized the present study from domestic and foreign related literature which provides a wealthy theoretical basis for our study.Through the analysis of the policy documents, we study the development of the compensation mechanism in Chinese hospital from the aspects of fiscal compensation, service fees compensation, drug bonus compensation. Then, we analysis the reason that leading to current situation, to provide decision basis for the establishing of scientific and reasonable compensation mechanism.2. Questionnaire SurveyWith the method of regionally stratified sampling, four categories of people in 30 public hospital from different areas in Guangdong province:the local administrative department of health, hospital managers, medical staff and patients participated in the survey in the form of post.3. Investigating MethodIn accordance with the financial data which extracted from government, we select 6 different representative hospitals in Guangzhou. Through the form of questionnaires and in-depth interviews with hospital management experts, we collected extensive opinions from interested parties, which would be good for the schemes of reform.4. Descriptive Statistics AnalysisWe used Excel to analysis health financial report data, used Epidata3.0 to input the questionnaire, and used SPSS20.0 to conduct descriptive statistics analysis, Chi-square test, etc.5. Data Envelopment AnalysisTaking the data in 2014 of urban public hospitals in Guangdong province as foundation database, we selected several input-output indexes, according to the classification of hospital, to conclude the relative efficiency value, the improving value of hospital by MaxDEA Basic 6.6 software.Conclusion1. The overall urban public hospital financial compensation is insufficient. The financial subsidies income accounts for 9.2% of total revenue in 2012-2014. To reflect the real compensation, we minus the maximum value of Shenzhen and minimum value of Maoming. The proportion then is adjusted to 7.91%. This data has too much difference between various regions, therefore, using the median to describe the central tendency would be more accurate. The calculated median of overall province is only 4.13%. What’s more, the data analysis also shows that, in 67%(14 cities) public hospitals in the province, hospital’s compensation levels are below 5%.In addition, compensation is not stable every year. The level of compensation, affected by the level of local economic development and policy factors, has great difference between cities. The financial compensation for hospitals in Pearl River Delta region is relatively more, especially in Shenzhen, Dongguan, etc. And different classification and types of hospitals have different compensation level.2. Part of the hospitals have inefficient output. Using Data Envelopment Analysis (DEA) with data in 2014, it concluded that the DEA efficient DMUs was only 27% in Guangdong public hospital of class Ⅱ and class Ⅲ. In the case of certain input, there’s different degrees of insufficient output in some hospitals. Technical efficiency values correspond to the overall efficiency of the hospital, which was influenced by the pure technical efficiency and scale efficiency. The pure technical efficiency of class Ⅱ hospitals was significantly lower than class Ⅲ hospitals (P <0.05), and they were both similar in scale efficiency. Therefore, the critical problem of class Ⅱ hospitals is that they should improve the level of technological and operational management.In this study, by means of DEA, we had attempted to set up a science compensation program at the same level hospital in an area, based on the relative efficiency values. You can see the detailed compensation scheme, especially for the part of policy-related losses, in the fifth chapter.3. The structure of hospital income is unreasonable. Medicine and health material have accounted for more than 50%, while treatment, surgical nursing and other services which reflected the value of skilled labor are low. The value of medical staff skills and knowledge has not been fully reflected in the medical price. At the same time, higher drug income is, the greater impact on the hospital operation in the context of canceling drug addition.4. Among the concerned parties, there are some differences opinions in three areas:financial compensation, service compensation, drug price addition. We should consider the recommendations from different stakeholder groups, and improve the existing compensation mechanism of the urban public hospitals.5. The overall design of the compensation system:According to the general principles that finance and medical health care insurance fund remain sustainable, the overall hospital income and expenses keep balanced, the burdens of patients can be reduced and the doctor’s salary will be increased and so on, we set up two reform schemes. Take Scheme One as an example:(1)The rated of drugs price addition will be totally eliminated by 2017; (2)Based on the current fees, examination fee should be reduced by 15%, laboratory test price reduced by 12%; (3)Based on the current fee, synchronous adjust the medical service fee:registered fee increased by 50%, diagnosis fee increased 50%, the treatment fee increased by 25%, the operation fee increased 33%, nursing fee increased by 80%; (4)Based on the current level, we suggest that the government should increase fiscal input, for example,the "basic allowance" increased by 17%; (5)"Personnel expenditure" of the medical cost increased by 6%, used for compensate reforming costs, improve the treatment of medical staff; (6)The hospital should compress non-business expenses, "other expenses" increased by 5%, the "other expenses" in the administrative expenses increased by 5%; (7)In actual reform, according to the hospital payments and local financial input, we should dynamic measure and adjust the input lines. Meanwhile, we should take into account the time effect of the reform measures, and timely adjust the input lines and the price level.Suggestion1. Improve the mode of the government financial investment:First, to strengthen the health programs. The government should clarify the "public" and "non-public", adjust the amount of stock and structure, optimize the layout of urban medical institutions, strictly control of incremental, establish the performance evaluation of regional health planning and accountability mechanisms. Second, clear the compensation object. The administrative departments for public health must further clarify the "urban public hospitals" list, comprehensive analysis of its resource allocation, service outputs, performance data, and adjust concrete reform policies. Third, the administrative departments should make the supply and demand balanced. As well as make efforts to increase financial investment in urban public hospitals, improve the mode of investment and enhance the medicare funding limits, reimbursement standards, perfect the Medicare payments ways to public hospitals. The fourth is to improve the information monitoring system construction. To establish a system of public hospital operating as investment decision auxiliary system. The system must be able to record the smallest unit of comprehensive information and update the data in time, so the information can generate relevant indicators, which will help managers make decisions. Fifth, to set standard for different input classification. Government finance is divided into seven categories. In view of the compensation object, motivation and purpose are different, so respectively we need to design the compensation standard, correlation index and engagement ways for disparity public hospital.2. More reasonable adjustment in medical service price:Accelerate the linkage reform of medical treatment, health care, medical. First, when establish the model of medical services pricing, we should strengthen the quantitative research of pricing factors, concluding the coefficient of hospital graded, the coefficient of risk degree of medical services, technology difficulty coefficient, the hospital scale, cost structure and other factors. Next, we should add the index of price changing, and establish the dynamic mechanism. Last, at the same, the government should give full functional to the Medical insurance Department who can regulate the medical service and quality health hospital security as a third party.3. Speed up the reform of medical insurance payment:First, we should promote the establishment of complex payment mode, such as pay per disease, pay per capitation, and pay per service unit, to gradually replace the mode of pay per project. Therefore, we should account the disease cost and DRGs statistical, formulate the index of monitor and improve the information-based ways. Second, we have to consummate the mechanism of control fee for medical insurance, and gradually explore the negotiated mechanism. We should set the equal negotiation mechanism and risk sharing mechanism between all kinds of medical insurance agencies and public hospital, and improve the awareness of quality and saving consciousness.4. Promote the reform of pharmaceutical and medical consumables in production and circulation field:one is the reform of the circulation patterns. First of all, when drugs and consumables from the production to circulation field, we should improve the system of centralized bid procurement, improve the double envelope system; Second, in the process of circulation, we should promote the concentration of circulation enterprise, reduce the intermediate links, to explore a new mode of circulation, which can be namely "pharmaceutical companies to hospitals, pharmacies and other terminals, last to customers directly", the decrease of the intermediate agents, dealers circulation; Finally, we should promote the terminals reform of the circulation, the implementation of "separation drug from medicine", and realize the right separate from the sale of prescription, encourage the chaining management for large drugstore. Second, we should play a significant role for medical insurance in medicines and consumable negotiating, especially for those medical insurance fund payment. We can set a standard for medical insurance payment, explore the reasonable price forming mechanism for medicine and materials. Third, other supporting measures. Sunlight procurement, we should introduce the social supervision mechanism; what’s more, with the aid of information technology, we should strengthen the dynamic monitoring for shortage drug.5. Build performance evaluation system for public hospital:In this paper, we mainly compared several performance evaluation methods for hospitals, including the balanced scorecard (BSC) and key performance indicators (KPI) and data envelopment analysis (DEA). This study uses DEA method to calculate the value of hospital relative efficiency. In addition, in terms of index selection, there is a big difference between different cities, classifications and types of hospitals in personnel quality and medical equipment configuration, so in the implementation of the performance evaluation, we should adjust the corresponding index and its weights according to different situations. |
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