essay代写_高分社会学代写范文

发布时间：2021-01-20 热度：

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Case 1

In order to solve the problem of inefficient operations, a reform of public hospitals  had been arisen all over the world. China had also participated in the trend of public health institution reform. With the reform, performance-related-pay system was widespread implemented.
This case aims at observing the changes of revenue, cost recovery, productivity which were resulted by the PRP system and whether the "bonus" system was the cause of unnecessary treatments and drugs. The case analyzes the data collecting from six hospitals and 2303 patients from 1978 to 1997.
The first hypothesis in the case is that the effect of the bonus system on hospital revenue, cost recovery, and the productivity is dependent on the different economic stimulus intensity of different systems and the reflection of the individual doctor. The case also presumes that doctors who take the necessary care will gain income as the form of the utility harvest. At the same time, they have to pay more efforts as the form of the loss. However, unnecessary care will undertake moral risk besides gain income and pay more efforts. Leisure desire and morals may limit the unnecessary care behavior of doctors.
There were three different PRP systems, be termed flat bonus, quantity-related bonus and revenue-related bonus, had been adopted.  The case assumes that flat bonus will encourage doctors to provide the necessary care, but are unlikely to stimulate the doctor provides unnecessary care.If there is sufficient demand, the necessary care provided by doctors is beneficial to the patient, the hospital and the doctor. Accordingly, the income, cost recovery, productivity of the public hospital will be improved. But the doctor will not take action when the demand is insufficient with flat bonus. The quantity-related bonus will also encourage doctors to provide the necessary care, and will also encourage doctors provide more care when demand is not sufficient. Finally, the revenue-related bonus strongly stimulates doctors to provide unnecessary services and drugs in order to increase their income.
In order to verify the assumption, the case collected abundant data to observe what kinds of bonus systems had been adopted by the hospitals, what kinds of changes happened in average activity levels and productivity in the panel hospitals, and what kinds of changes happened in revenue, cost recovery, productivity and unnecessary care with changes in bonus system.
All the panel hospitals had shifted their compensation system with no bonus to flat bonus to revenue-related bonus. With the change of system, revenue rose obviously, and cost recovery increased as well. Although the productivity remained downward because of the vast input relative to lesser output, the productivity dropped more slowly than before. But the average expense of the patient increased markedly, and much of this was unnecessary.
In general, to the hospital, PRP systems, called revenue-related bonus, have a positive impact on the revenue, cost recovery, and productivity. Meanwhile, to the patients, unnecessary care and expensive drugs became a burden.