| From the 1990 s,the management mode of public hospitals began to change,from the unified management of planned economy to relaxing management for development.The behavior of pursuing profits in public hospitals is becoming increasingly obvious,and a series of problems,such as "benefit first"," encircles the ground in the horse race "," the difficulty and expense of medical service ",have become the common problems of public hospitals in China.In order to meet the people's medical needs,improve patient satisfaction and guarantee for the public welfare of public hospitals,a new round of medical and health system reform began in 2009.As the main body of China's medical and health service system,public hospitals assume the important responsibilities of reflecting the public welfare,solving the basic medical problems,and alleviating the difficulties of the people in seeing a doctor.Threelevel A-rate public hospital is the leader of the medical and health industry.The level of medical service and medical expenses of three-level A-rate public hospitals in a region directly determine the medical difficulty and economic burden of the local people.By studying the economic operation of these hospitals,we can directly judge the development of these hospitals in a period of time.In this study,31 three-level A-rate public hospitals(hereinafter referred to as sample hospitals)in Liaoning Province include 17 provincial hospitals and all municipal central hospitals,representing the highest service level and service capacity of public hospitals in the province.And the team's early research found that provincial hospitals and municipal central hospitals representing the highest level of local medical service are the main body of the growth of medical expenses in the region.Therefore,it is of great significance to grasp the overall situation of the economic operation of sample hospitals for a clear understanding of the current situation of the survival and development of public hospitals in the province.In addition,this study also discusses the economic operation of sample hospitals in groups,according to the reference variables of bed size,income,number of patients,and number of patients discharged from hospitals in 2018,in order to find out the characteristics of common problems.The results of the overall analysis show that since the implementation of the new medical and health care reform,the accumulation of assets and total liabilities of public hospitals have shown an increasing trend,in which the proportion of current assets increases,while the proportion of current liabilities is always stable at 86%.;the revenue and expenditure of public hospitals have continued to grow,but the growth rate has declined,however the growth rate has "picked up" in 2018,both of which are more than 10%;the absolute value of government financial input is increasing year by year,but the proportion is declining(down to 4.53% in 2018);the structure of medical revenue has been optimized,and the absolute value of all incomes except other incomes has shown a growth trend,but after the total cancellation of drug price addition in 2017,the proportion of drug income has begun to decline,the proportion of labor income is increasing year by year,from the perspective of business expenditure,the drug cost is decreasing year by yea(down to 32.43% in 2018),and the proportion of personnel expenditure increased year by year(up to 30.48% in 2018).From the perspective of operational performance,the asset liability ratio of public hospitals is at an excellent level(50%-60%),but the scale of liabilities continues to grow,the current ratio and quick ratio are far lower than the industry's excellent level,it shows that short-term solvency of public hospitals is poor,the turnover rate of medical receivables is worse(down to 9.49 times in 2018),but the asset turnover rate is better,the cost rate of business income and management expenses are decreasing year by year,the cost of health materials consumed by the 100 yuan medical income is much higher than the national requirement of more than 20 yuan,the profitability and development capacity of public hospitals are both high.Group research results show that,From the basic situation,the growth rate of each basic index of group A(composed of two hospitals representing the highest medical service ability in the province)and group B(composed of four hospitals with relatively weaker single service ability than group A)was higher than that of the other two groups.The growth rate of each basic index of group C(composed of seven hospitals with relatively weaker single service ability than group B)was the lowest,but the asset accumulation rate was the highest Fast,the debt growth rate is the highest(except that the non current debt of group a hospital has increased significantly in 2018).The growth rate of beds,employees,patients and inpatients of group D(from 18 hospitals with relatively weak service ability)hospitals is not the lowest,but the annual average growth rate of medical income is the lowest.The changes in asset structure and debt structure of the four groups of hospitals were consistent with the overall analysis results.From the perspective of income and expenditure,the revenue,medical income,expenditure,business expenditure and business balance of public hospitals of three-level A-rate public hospital in group A,increased the most.From the income structure changes,group A has a relatively high proportion of medical income,so it assumes a relatively high proportion of government financial project income and scientific and educational project income.Group D has the lowest proportion of medical income(90.79% in 2018),and its financial revenue accounted for the highest proportion(7.20% in 2018),the main source of hospital income in group B and group C is medical income(the proportion of them in 2018 is 94.45% and 95.80%).From the perspective of expenditure structure change,only the financial project expenditure of group C shows a downward trend,only scientific and educational project expenditure of group D shows a downward trend,and the proportion of hospital management expenses in four groups shows a downward trend;the change of medical income structure and business expenditure structure is similar to the overall analysis results.From the perspective of operational performance,group A and group B hospitals have better indicators of solvency,operational capacity and profitability.However,in the indicators of cost control capacity,group A hospitals have the lowest cost rate of business income(95.41% in 2018),but the highest rate of hospital management cost(12.72% in 2018),and group B hospitals have the lowest rate of management cost(6.70% in 2018),but 100 yuan of medical income(excluding drugs Income)consumption of health materials is the highest(38.84 yuan in 2018);In the development capacity index,except for group B hospital's net asset growth rate showing a slight upward trend,the growth rate of total assets,net asset growth rate and business income of other hospitals dropped to the lowest in 2017 except for special years,and "rebounded" in 2018.The results show that group D hospitals can seek development by increasing investment,while other groups need to be cautious.To sum up,this study summarizes the operation effect and main problems of Liaoning three-level A-rate public hospitals since the new medical and health reform,and analyzes the reasons respectively.On the one hand,its operation results are as follows: first,fee control in public hospitals has been effective in some ways;second,the medical income structure of public hospitals has been optimized,and the labor value of medical staff has been reflected;third,the economic operation of public hospitals is stable,and the public welfare of public hospitals has been guaranteed.Which reasons are as follows: The medical and health reform took the means of controlling the simple indicators firstly,then the more difficult ones,and pushed forward steadily.The new medical and health reform optimized the structure of medical income by controlling multiple indicators.The steady growth of income provides financial support for the stability of the economic operation of public hospitals.On the other hand,there also have many problems: firstly,the government's financial investment is insufficient,the financing structure of public hospitals is not reasonable,secondly,the phenomenon that the cost of public hospitals increases too fast has not been effectively controlled,thirdly,the debt scale of public hospitals continues to rise,and there are worries in the stability of economic operation,fourthly,there is a waste of resources in the cost control management of hospitals,and the internal management of hospitals needs to be strengthened,fifthly,The development of three-level A-rate public hospitals is not balanced and the transformation of development mode is relatively backward.The reasons are as follows: first,the government's sense of responsibility needs to be strengthened;second,the selection of cost control indicators is not reasonable;third,the relationship between the optimization of medical income structure and the control of public hospital expenses needs to be clarified;fourth,the receivables are difficult to recover;there is a gap in public hospital funds;fifth,the awareness of cost management is insufficient.Based on the empirical research and literature research,this study puts forward the following suggestions for the future development of three-level A-rate public hospitals in Liaoning Province during the "14th five year plan period " : First,implement government investment and strengthen the sense of responsibility of the government;second,control the rise of medical expenses and continuously optimize the structure of medical income;third,strengthen the cost control management system of public hospitals;fourth,build a scientific and reasonable performance evaluation and distribution system;fifth,accelerate the implementation of modern hospital management system;sixth,strengthen medical and health supervision;seventh,improve the informatization construction of public hospitals. |
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