1, the current property rights system is not clear, the government management function is misplaced, the hospital lacks operational autonomy
The existing property rights system of public hospitals is formed under the planned economy of the structure of property rights, property rights were subordinate to the administrative department and the main enterprises and public institutions, hospitals do not have the property rights of the legal person in the reality of the formation of government property rights. reality the formation of government property rights. It is because of the existence of government property rights, in the planned economy, the health administration both runs and manages the hospitals, and the hospitals lack the autonomy and flexibility of operation and management. In the process of transformation to a socialist market economy, this phenomenon has still not undergone a fundamental transformation. The government intervenes directly in hospital management, with excessive discretion, misplaced and overstepped management regulation, and insufficient administration in accordance with the law, which, together with the limitations of administrative and economic capacity, makes it difficult to realize the efficient use of resources. The health administration still has a large monopoly on hospital affairs; the leadership team is all staffed by the higher organization department, which requires the director to be responsible for the work of the entire hospital, but the director does not have the right to choose his or her deputies. In addition, the government as the owner and manager of medical institutions has led to the government department's social management function and the operation of state-owned assets function is not separate, in the governance of medical services market failure in the government management function lack of strength, or even serious in place; at the same time, due to the government's lagging behind in health care control, but also caused by the inefficiency of the allocation of health resources, affecting the fairness and efficiency of health services.
2, a single financing channel, the hospital compensation mechanism is not sound, medical cost growth is too fast
China's public hospitals have been using the internal financing mechanism, its compensation channels include government financial subsidies, medical service charges and drug price difference income. Since the reform and opening up, in order to promote the development of the health sector, all levels of finance have been increasing their investment in the health sector under relatively difficult circumstances. However, health departments at all levels have generally reflected the relative inadequacy of government financial subsidies, and the proportion of government financing in total health costs has declined sharply; the efficiency of health resource utilization has also been low, with the medical resources generated by the country's massive investment being excessively concentrated in most public hospitals, either in the form of high-end equipment and infrastructure construction in some of the larger hospitals, or in the form of institutional wastage. In terms of medical service charges, China has implemented a supply-side financing policy that depresses service prices and a health compensation policy that "compensates doctors with medicines," with no income from labor in medical charges and a large number of technical labor services priced below cost for a long period of time, and basic medical service charges are strictly controlled by the government's pricing department, with no timely adjustments made to them in line with socio-economic development. The fees for basic medical services are strictly controlled by the government's price department, and are not adjusted in a timely manner in accordance with socio-economic development, but are set at cost only for the application of new instruments and equipment and for new medical treatment services.
3, entrusted - agency relationship exists under the administrative management is weak
China's current governance structure of public hospitals exists in a entrusted - agency relationship. The principal - agent relationship is a contractual relationship, under this contractual relationship, the principal authorizes the agent to engage in certain activities to achieve the interests of the principal, in order to prevent the agent from taking advantage of the principal's authorization to engage in activities detrimental to the interests of the principal, there is a need to devise a mechanism or contract to provide the agent with some kind of incentive to work hard in accordance with the objectives conducive to the principal. The principal-agent relationship is widespread in all organizations and all cooperative activities, and exists at every management level of the organization.
In our country, there is a principal-agent relationship between the state and public hospital managers. The principal, the state, as the funder, enjoys ultimate ownership of the assets of the public hospitals, and operates the public hospitals by appointing an agent, the hospital operator, and urges the agent to fulfill the mission entrusted to him by the state. As the principal, the health administration department does not have the ownership of the public hospital property, so it lacks the motivation to collect information in the face of information asymmetry with the hospital operator. And in the supervision of hospital operators, due to the difficulty of measuring business performance, the supervisor should be made to enjoy the residual claim right, otherwise the lack of supervision responsibility and efficiency.