Research On The Economic Operation Of Urban Public Hospitals In Shandong Province

BackgroundIn our country,hospital is the main body of medical service supply system,and its operation efficiency often determines the performance of medical service system supply system.In order to obtain good social and economic benefits and meet the maximum demand for medical care with the minimum health input,it is necessary to make a comprehensive analysis of the economic activities of the hospital,find out the problems in time and solve them.After the comprehensive reform of public hospitals,the compensation channels of urban public hospitals have changed from the three aspects of medicine,finance and medical service income to the two channels of finance and medical service compensation.However,in recent years,the government's subsidies to public hospitals are still generally low,and the state financial compensation for hospitals is difficult to make up for the losses caused by the operation of public hospitals.There is still a gap between the price of some medical services and their actual value.In this context,it is particularly important to improve the efficiency of economic operation and improve the mechanism of economic operation through the internal management of hospitals to make up for the deficiency of financial and medical service compensation.Combined with the relevant guiding opinions of the state council on modern hospital management,in June 2016,the Shandong provincial department of finance issued the implementation opinions on strengthening the financial and budgetary management of public hospitals to further standardize the budget management and financial revenue and expenditure operation of public hospitals.To solve the problems existing in the compensation and operation of public hospitals and improve their own economic operation ability is the key.Therefore,how to evaluate the economic operation of urban public hospitals?What are the problems existing in the operation of urban public hospitals?How to promote the healthy development of urban public hospitals?These are the concerns of health managers.Most of the existing studies focus on the income structure of hospitals,but little is involved in the economic operation.Most of the research objects are county-level public hospitals or specific hospitals,and most of the research methods are cross-sectional studies.Therefore,this study comprehensively analyzes the economic operation of urban public hospitals in Shandong province,and on this basis,it is of great practical and academic significance to use Dupont analysis method to discuss the financial status of hospitals.ObjectivesThis study comprehensively evaluated economic operation of the urban public hospitals in Shandong province,at the same time using Dupont analysis method focusing on hospital financial situation analysis,to explore the factors influencing hospital economic operation and enhance the capacity of hospital operation method.Methods1 Literature researchThis study selected CNKI,Wanfang,CBM and other Chinese databases.And searched PubMed,BMJ,MEDLINE,Web of Science and other English databases to search domestic and foreign research literature on hospital operation.The search terms are "public hospital","operating performance","financial analysis",and"economic operation".And according to the purpose of the study,the literatures are screened and summarized.2 Financial analysisIn order to comprehensively analyze the operation efficiency of urban public hospitals in Shandong province,this study starts from the aspects of asset operation capability,cost analysis,cost control,work efficiency and sustainable development capability,applies ratio analysis method and qualitative description to evaluate the economic operation status of hospitals from 2009 to 2017.Dupont analysis is applied to analyze the financial indexes of urban public hospitals before and after the comprehensive reform,and to explore the internal factors affecting the economic operation of hospitals.3 Key Informant InterviewWe conducted the interviews with four persons who are in charge of the financial departments of the Shandong Health Commission and the financial department of third-level first-class general hospital.The purpose was to analyze the existing problems based on the research results.Results1 Analysis of the reform of compensation mechanismThe asset operation level of urban public hospitals in Shandong province has been gradually improved.The turnover rate of dynamic assets,fixed assets and total assets has been increasing year by year,reaching 141.24%,122.06%and 65.47%respectively in 2017.The turnover rate of hospital assets has been increasing,but the turnover of medical receivables has been decreasing year by year.In terms of cost management,the growth of unreasonable expenses is well controlled.After 2015,the consumption of health materials in the medical income of 100 yuan of urban public hospitals in Shandong province decreased slowly to 28.82 yuan in 2017.In recent years,the ratio of administrative expenses and personnel expenses has been on the rise,especially the personnel expenses rate,which reached 34.08%in 2017.In terms of cost control,outpatient,emergency and inpatient person-times all show a significant decrease in the increase of medical expenses.The hospital has a significant effect on the control of medical expenses,and the social benefits are improved.In terms of work efficiency,the average outpatient and emergency visits per employee and the average hospital bed days per employee increased after 2016,and the work efficiency of hospital employees increased.After 2016,the utilization rate of hospital beds in urban public hospitals in Shandong province was on the decline,the number of hospital bed turnover was on the rise,and the efficiency of hospital bed use was improved.From the perspective of development capacity,after 2016,the growth rate of balance of payments decreased significantly and the growth rate slowed down.Net assets and total assets maintained a relatively stable growth trend,and the size of the hospital expanded.2 The effect of the reform of compensation mechanism on economic operation of the hospitalAfter the reform,the return on equity of urban public hospitals in Shandong province is 8.06%,which is higher than the one-year deposit rate of commercial Banks,proving its good profitability.Compared with before the reform,the return on equity after the reform has been improved.After the decomposition,it is found that the improvement of the overall profitability of the hospital is closely related to the business income and asset operation.Among them,the increase of business income and business expenditure are the main factors affecting the change of business profitability.At the same time,after the reform,the scale of the hospital and the efficiency of asset operation have both promoted the improvement of the profitability of the hospitalConclusions and SuggestionsAs an important part of the comprehensive reform of public hospitals in Shandong province,economic operation reform is a key link to meet people's medical and health care needs and save hospital operation costs.The achievements of urban public hospitals in Shandong province in economic operation are as follows:First,the overall situation of asset management is good:the turnover speed of hospital assets increases,the efficiency of asset utilization continues to improve,and the quality of hospital asset management also gradually improves.Second,to achieve cost management and reasonable cost control:the medical expenditure of medical income of 100 yuan and the consumption of medical materials of medical income of 100 yuan decrease year by year,and the hospital has better control over the unreasonable growth of expenses.Third,social benefits have been significantly improved,with the increase rate of average medical expenses per time and per capita medical expenses of inpatients both significantly reduced.Fourthly,the utilization efficiency of hospital resources and the working efficiency of staff should be improved.At the same time,there are still the following problems in the economic operation of hospitals:first,the current asset management still needs to be optimized:the asset operation capability is gradually improving,but there is still a gap with some regions,so it is necessary to reasonably arrange the asset structure inside the hospital,so that all assets of the hospital can be utilized to the maximum extent.At the same time,the turnover rate of medical receivables in hospitals decreased year by year,indicating that too much money remained in medical receivables,affecting the normal turnover of funds and solvency.Second,indirect cost control needs to be strengthened:the hospital management expense rate has increased,and the hospital managers lack efficient economic management methods.Third,financial risks need to be controlled:the hospital has a high asset-liability ratio,and the hospital is faced with high financial risks,so it needs to further adjust its debt situation.Based on the above conclusions,the research Suggestions are as follows:First,raise the level of asset management and strengthen current asset management.The management and use of assets will be included in performance appraisal,and the loss of bad debts will be reduced through multiple channels.Second,establish a dynamic cost control mechanism,focusing on strengthening hospital management cost control.Focus on items with large and controllable growth such as office expenses,travel expenses,repair expenses and business entertainment expenses.Classify these expenditures and adopt different cost control methods according to their nature.Thirdly,an effective financial risk assessment mechanism should be established to rationally utilize the leverage of liabilities and effectively prevent financial risks of hospitals.Fourth,the dynamic Dupont model is introduced to comprehensively evaluate the economic operation of hospitals.