Out of the Public Hospital's Public Welfare Six Misconceptions (1)

Author: He Ziying Yu Jianxing as one of the five strategic tasks of the 2009 "New Medical Reform" program,public hospital severing the reform of public hospitals, and even called the "hardest bone" in medical reform, however, the progress and effectiveness of thereform ofpublic hospitals is directly related to the success of the "new medical reform"The reform of public hospitals includes not only the reform of internal operation mechanism, but also the reform and reorganization of various forms, especially through the combination of public hospital reform and encouraging social medical treatment, to reduce the proportion of public medical institutions, and to form a level playing field between public hospitals and private hospitals, which is not only conducive to solving the overall shortage of medical resources, but also to improve the operation performance of the whole medical service systemSince the "new medical reform", the central government in a series of relevant policy documents have emphasized the importance and support for social medical care and public hospital reform, but they are generally stagnant, difficult to implement, some places even appeared a huge buy-back of private hospitals, the return to "total publicization" tendencyAmong the many influencing factors, the so-called "mainstream of medical reform" ideas and ideas play a huge roleTherefore, in order to smoothly promote the reform and reform of social medical and public hospitals, we must sort out and analyze some ideas and understanding of prejudiceand and misunderstandingFor deepening reform, the power of ideas is the most powerful, and the innovation of ideas is more important.Myth 1: Public welfare can only be achieved through the public welfare of public hospitals to return to the medical and health service "public welfare", is the current new medical reform in China's basic principles and objectivesToday, "public welfare" has become a fashionable concept in the population when discussing health reform, but the exact meaning of it is mostly not very muchWhat is more, as a shield against the reform of public hospitals and the introduction of market competition mechanism, it is believed that the public welfare of medical and health undertakings can only be realized through public hospitals, and that neither private hospitals nor market mechanisms can guarantee public welfareTherefore, the correct interpretation of public welfare has become the first prerequisite.To understand the connotation of public welfare, we must first clarify its "superior principle"The fundamental goal of medical and health services lies not in public welfare, but in the "health promotion" of its upper goal Thus, public welfare can be broken down into natural public welfare and derived public welfare two aspects Natural public welfare refers to the promotion of health through the provision of health services In this regard, any form of ownership of medical institutions have public welfare, which also means that the public welfare of medical and health undertakings is not necessarily through public hospitals to reflect and protect Derivative public welfare points to the principle of cost-benefit based on input and output, that is, to maximize the performance and fair accessibility of medical services with limited input of medical service resources The core of public welfare is the derivative public welfare, if the government increases the financial investment in medical care without improving the performance of medical services, only solves the problem of "expensive to see a doctor" and does not solve the problem of "difficult to see a doctor", only reduces the proportion of patients' out-of-pocket expenses without controlling the excessive growth of total medical expenses, still can not be regarded as the realization or protection of public welfare.　　Therefore, to ensure public welfare not only to increase the government's financial investment in medical care, but also to improve the overall performance of the medical service delivery system As we all know, public hospitals, because of their public institutions and their close flesh-and-blood ties with the health administration, especially under the monopoly pattern of public hospitals, can not fundamentally overcome the lack of external competition and cost control awareness caused by inefficiency, waste of resources and other problems In order to protect the derivative public welfare, we must construct a fair competition system environment, form an orderly competition pattern between public hospitals, private hospitals, public hospitals and private hospitals, and improve the performance of the whole medical and health service delivery system through competition mechanism In general, both private hospitals and public hospitals have endogenous natural public welfare, and the realization of derivative public welfare depends on the fair competition between the two.　　Myth 2: Basic medical treatment to public hospitals, non-basic medical treatment to private hospitals and think that only through public hospitals can protect the public welfare of medical and health undertakings, a more popular view that the function of public hospitals should be positioned to ensure that everyone has basic medical services, non-basic medical services follow market principles and mainly provideby by private hospitals This view lacks both theoretical basis and the law of reality First, from the modern clinical medical path, there is no basic and non-basic difference between medical services Secondly, the so-called "public hospital insurance basic" is essentially to understand basic medical care as relatively low-cost medical services However, modern medical service is a combination of evidence-based medicine and individual ized medicine, even if the cost of the same disease has a greater uncertainty Third, basic medical care in our country can only be more from the perspective of government health insurance affordability to understand, including medical insurance is basic medical care This means that basic medical care is a dynamic adjustment concept, with the improvement of medical insurance affordability and financial input, the scope of basic medical care can be extended to the original non-basic medical services.　　Whether it is to protect public welfare through public hospitals or basic medical care to public hospitals, in fact, it contains the premise that basic medical services are a public product that the government must provide However, public goods must have non-competitive and non-exclusive, medical services obviously do not have the above two characteristics, so basic medical care is not pure public goods but quasi-public products, the acquisition of quasi-public product attributes mainly comes from moral pursuit and value judgment (i.e social benefits) and the risk of market failure Because of the serious asymmetry of information (service-side information monopoly) and (patient's) irrational consumption, the supply of medical services has obvious market failure characteristics Therefore, the medical field needs the government's active intervention to make up for the market failure, which includes strict industry supervision, especially to prevent inducing over-medical treatment, but also strengthens the public medical institutions and their service capabilities in the grass-roots areas that the market and the people are unwilling to enter, and also provides medical services directly in the all-round, multi-tiered establishment of the public hospital system.　　It is a traditional form of government intervention, but not the most effective way, to provide medical services directly by holding public hospitals In terms of global health-care trends, it is being replaced by a government buying model based on public health contracts that are significantly better performing In this model, the government as the buyer of public services and the role of the direct provider is separated The government uses the medical insurance fund to open the contract tender and negotiation to all forms of ownership, negotiates and decides on the specific contents of medical service package, service standard, service quality, budget allocation, payment mechanism and performance evaluation, and decides whether to maintain or terminate the contract relationship through the evaluation results of the contract performance evaluation Its success depends on three main points: first, the fair competition environment of hospitals in all forms of ownership, there is no monopoly or monopoly of some kind of ownership hospital; (Responsible Editor: Wang Jinbao) 3
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