Establishing Appropriate Agency Relationships for Providers in China

Liu, Yu; Saltman, Richard B.

At the meso level, a physician governance body, either independent physician group companies or the physician governance body within a health care facility, should design, To be a role model for young physicians • • Role modeling is a crucial area for physician professionalism development and mutually beneficial for both educator and learner 59 monitor and evaluate physicians' professional behavior as part of the physicians' key performance review. 53 Health care facilities should seek to create a clear culture to support physician professionalism and to align their internal culture with an overall physician professionalism framework. 54 Physician leaders' roles in nurturing this new environment and to be a liaison between physicians and health care facilities are also important. 55 At the micro level, physician professionalism is a lifelearning experience, 60 and needs to be reinforced during already challenging daily practice. 61 The establishment of physician personal professionalism requires a combination of medical school and graduate medical education, 56,57 self and peer assessment, 58 role model of attending physicians, 59 and specific values and behaviors to interact with patients, health care team, and health care facilities. 55 A combination approach. We recognize that every reimbursement structure has its caveats, either in efficiency, quality, or cost control. 62 However, in any reimbursement structure, a strong financial relationship between physicians and health care facilities can always enable health care facilities to design mechanisms to benefit their own financial goals. 63 The current most important barrier for the Chinese public hospital reform is the lack of competition caused by the existing financial relations between public hospitals and senior physicians. The Chinese government has tried to leverage private hospital investment, use policy to promote physicians' mobility, and change reimbursement policy, to overcome these barriers. However, the financial relations between large public hospitals and senior physicians still allow public hospitals to design mechanisms to maintain their dominating positions. A RBRVS system reimbursing senior physicians directly will be able to eliminate such financial ties. Separating senior physicians from public hospitals as "free-agents" will promote the current provider-side reform, even though this strategy may also create other issues, such as the need to more closely monitor and supervise physician behavior. Therefore, a well-designed comprehensive physician professionalism system can serve as the foundation for a long-term solution that can promote provider-related reform activities.