The Study On The Influence Of Essential Medicine System Implementation Based On The Principal Agent Theory

Objective Using quantitative and qualitative methods to analyse the impact of the essential medicine system from three angles of township hospitals,staff in town hospitals and residents.Then decomposing the impact of the essential medicine system from the perspective of expected,unexpected,positive and negative.To explain the impact of the essential medicine system by using the principal-agent theory integratedly,doing deep research focusing on the formation mechanism of unintended effects,and construct the principal-agent relationship model of essential medicine system in township hospitals.On the basis of the above study,designing the incentive-restricted mechanism for township hospital in integration perspective,in order to promote the interests of the two parties to share,to ensure the smooth enforcement of essential drugs system and the implementation of health equity of social public.Methods Multi-stage stratified random sampling method was used to determine the research objects,and the methods of literature and in-depth interview were used to designed questionnaires and determined the collection catalogue of qualitative data.Indicators such as mean,composition proportion were used to describing the differences and trends of township hospital,staff in town hospitals and residents after the implementation of essential drug system in township hospitals,used ?2 test and Z test to describe the differences of medication in the township hospital.Determined the decomposition quadrant of impact of the essential medicine system by the method of focus-group-discussion.Explained the expectations of the essential medicine system by using principle of participation constraint and administrative principal-agent relationship of the principal-agent theory.The principle such as multi-task principal-agent model and the principal-agent problem were used to studying unintended effects of essential medicine system.On the basis of comprehensive analysis,set up the principal-agent model of the implementation of the essential medicine system in township hospitals,based on the health objectives of the initial principal,the countermeasures and suggestions for optimizing the essential medicine system were put forward.Results Implementation of the essential medicine system had a significant impact for township hospital,staff in town hospitals and residents.In township hospitals,the number of outpatient emergency treatments had dropped,the change of medical service efficiency was not obviously after the implementation of the essential medicine system.In general,compensation ratio had increased from 0.96 in 2008 to 1.08 in 2011 shows that operating conditions had improved in township hospitals.The drug revenue reduced sharply,a significant increased in financial aid and clinical income,outpatient service revenue and drug revenue reduced,drug revenue proportion fell to 51.1% from 71.4%,total hospitalization revenue had increased,drug proportion fell to 41.53% from 52.54%.The number and expenses of single promotion declined,the rationality of drug use had enhanced.Doctors of township hospitals: the income has improved from1859 to 2200.47 per month,narrowing income gap and increasing workload had an affect on their work initiative.With doctor's enthusiasm of work decreased,the rationality of medication behaviors have improved,but number of intravenous has increased.Residents: Outpatient medical expenditure per patient,drug expenditure per patient and the proportion of drug expenses have decreased sharply;but inpatient medical expenditure per inpatient,average daily drug expenses,and the number of days of hospitalization have increased.The change of drug expenses is not significant,the average daily drug expenses decreased,medication compliance improved,and selection of treatment institution change not much.The impacts of the essential medicine system can be decomposed into expected positive influence,expected negative influence,unintended positive influence,and unintended negative influence.The causes of expected influence: In participation constraint condition,the benefit of township hospitals expected implementation is less than the retention effect after implementation of essential medicine system,but township hospitals are subjected to "local government administrative authority" which is characterized by restricting administrative agency relations,they are forced to accept the contract.based on this,the local government promote expected impact of township hospitals in the implementation of essential drug system through incentives and supervision.The causes of unintended influence: As inconsistency of target benefits,information asymmetry and the absence of supervision of the principals,township hospitals as a agent will pursue their own interests,take "disguised execution 'policy,and then that leads implementation of policy into deviation.Conclusion The implement of essential medicine system had a significant impact on township hospital,staffs in town hospitals and residents,including the expected positive impact,the expected negative impact,unintended positive impact,unintended negative impact.The expected impact basing on the agency theory formatted under the principles of participation and boundary,the agency relationship under administrative and the agency‘s encouraging and supervision mechanism;unintended effects which owing to inconsistent target asymmetric information between principal and agent,and the absence monitoring and other causes that let agents produce opportunism behaviors;by the balance remuneration principle,risk appetite,incentive methods and performance measurability constraints,the functions of township hospitals gradually transformed from the basic health care to basic public health services.Problems have been showed that agency relationship under essential medicine system lacking complete contract,reasonable regulatory indicators,adequate financing mechanisms and incentive compensation,and hospitals lack of integration issues under numbers of agency missions.On this basis,to achieve the initial principal health goals,this paper puts forward suggestions to promote the implementation of the essential medicine system from the aspects of perfecting the essential medicine system design,improving the financial compensation mechanism,and integrating the multiple principal agency tasks of township hospitals.