ระบบบริหารงานโรงพยาบาลรัฐกับโรงพยาบาลเอกชน : การบริหารจัดการทางการเงินและธุรกิจสำหรับโรงพยาบาลรัฐที่จะบริหารอย่างอิสระ

Abstract

Management of public and private hospitals : financial and business apportunities for the autonomous hospitalsThe aim of this research was to compare the managerial systems between the sampled public and private hospitals to illustrate similarities and differences between the two sectors in relation to these following categories : management for important services, personnel management, consumer and community relationship, accounting and financial management, and information system. Particular features relevant to the context of management were made as suggestion for developing the public hospital into the autonomous hospital in Thailand.Types of hospital ownership were determined to classify groups of hospitals in both sectors. Public hospitals were classified into hospitals under the MOPH, under the Universities, and under various Ministries. 12 public hospitals were purposively selected not proportionally to existing numbers. For the private hospitals, 8 hospitals were also purposively chosen not proportionally to its present numbers. The determined categories of private hospitals were not-for-profit hospitals, for-profit hospitals and private hospitals under the public limited company. This study was basically qualitative and quantitative in order to maximise understandings of the sampled hospitals’ management. The questionnaires were developed to ask the sampled hospitals about features of general and financial management. Group discussions among the directors and finance managers in addition to visits to some of the hospitals were made as complementary to data collection. The response rate to the mailed questionnaire was 70%(14 of 20 hospitals). 18 hospitals had their representatives to participate in focus group discussions and five hospitals were visited by the research team. Five main features of management of the public and private hospitals were compared which were service policy, human resource management, financial management, cost-accounting management, and information system management. The public hospitals provided more wide ranges of services than did the public hospital concerning comprehensive care including curative, promotive, preventive and rehabilitative care. The private hospitals emphasised curative care; however, they were likely to include promotive and preventive care from which they were able to make profits. In regard to main structure of hospital management, the private hospital had hospital boards while the public one did not exceptionally for Ban Paew Hospital which had the community leaders on the board committee. The private hospital board was mainly responsible for making decisions at the policy level and liable to debts incurred if the hospital went bankrupt whereas the director acted as a key agent transferring the policy. In private hospital management style, interaction between the leader of each functional unit and the staff was crucial as the leader had greater authority to monitor and evaluate his or her own staff than did those in the public hospital. The public hospital policy was more either centrally or provincially oriented. Payment system in the private hospitals was related to staff’s work productivity in terms of quantity and quality while the public system was basically a salary system in which promotion was likely to link with work years. However, training and development for public hospital staff was more formalised than the private hospital’s. Both public and private hospitals considered information system as a key element to enhance evidence-based decision making but both had yet fully utilised the IT system as expected. Nevertheless, the private hospitals demonstrated greater utilsation of the IT on account of management efficiency for example through the system linked with inventory and financial system.More number of qualified employees with specialty of financing and accounting were employed in the private hospitals. Their roles were relevant for providing inputs to make decisions while the public hospitals did have limited qualified staff leading to limited inputs-based decisions. However, cost-accounting techniques were increasingly considered and put into practice among the public hospitals. Auditing system was performed in the private hospitals as obliged to the law of Ministry of Commerce while the public hospitals simply did the financial report illustrating amount of cash received and cash spent primarily for monitoring budget expenditures. As an autonomous hospital was increasingly considered as an alternative to improve efficient use of health resources in public hospitals, some recommendations of general management for transforming the public hospital into the autonomous hospital were made as follows: comprehensive care should be provided, three levels of management composed of the hospital board, the hospital management team and functional units should be established, Internal and external auditing system should be carried out to improve management transparency, Payment system should be designed to encourage workers to work more productively, Qualified people whose backgrounds are accounting and financing should be more recruited, As a fundamental structure of the hospital management, the information system should be developed to produce beneficial inputs for decision making, The accounting system should be based on the accrual system, used for auditing and estimating care costs to facilitate more equity of resource allocation.