Evaluation of the Effect of New Health Reform Policy of China Based on Prospect Theory

Background: New health reform policy of China has gone through more than ten years from 2009 to 2019, it has come a critical period. It is important to evaluate the effect of health system reform policy, but there are a few existing studies and the researchers have not considered the impact of psychological factors on person decision-making. This study using the prospect theory can overcome this defect. Let the evaluation of the effect of new medical reform policy of China more scientific and reasonable. Methods: Data on the effect of the new health reform from China Health Statistics Yearbook and National Bureau of Statistics of China were obtained. And the indicators were selected by Corrected Item Total Correlation and Cronbach’s α reliability coefficient. The selected indicator data were calculated by the prospect theory model. Meanwhile the gray relation analysis method is introduced to enlarge the difference between the advantages and disadvantages to making the comprehensive evaluation result more obvious. Results: The results of comprehensive evaluation of the effects of health reform policies in China fluctuated from 2000 to 2017. From 2000 to 2004, the fluctuation range of the comprehensive prospect value is large; from 2004 to 2009, the comprehensive prospect value shows a slow downward trend; from 2009 to 2012, the comprehensive prospect value has decreased slightly, and then it has rebounded substantially; from 2012 to 2014, the comprehensive prospect value is stable; and from 2014 to 2017, the comprehensive prospect value is declining. Conclusions: This study showed that the implementation of new health reform policy of China has a significant impact on China's medical and health system. The new health reform advanced hard in exploration. It is worth affirming that the overall goal and direction of the new health reform are correct, but the practice is unsatisfactory. The releasing and implementation of supporting policy have the important influence on the progress of the new health reform. And the effect of the policy will decrease with the increase of the total amount. Therefore, scientific and effective late management can ensure that the policy continues to play its role.


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of China has undergone a transformation from government-led to market-led mode before 2009[9,10]. Through the "marketization" to stimulate medical enterprises, which has led to the rapid development of the health system of China. However, the drawbacks of the market-oriented model have became increasingly prominent.The primary health institutions have been weak gradually [ 11 ], because of the government's investment in health was seriously inadequate and medical service institutions generally pursued economic interests ,and the public health system has been vulnerable [12]. "difficulty and high cost of getting medical service" has became a livelihood problem puzzled Chinese. In view of the various problems, the community began to doubt the "marketization" of the health system. Therefore, in order to break the original health system and build a new scientific health system, health reform must begin as soon as possible，which will solve the historical problem of "difficulty and high cost of getting medical service " thoroughly [13,14].
The problem of "getting medical service difficulty" is mainly caused by unreasonable allocation of medical resources. High quality medical resources are concentrated in the tertiary public hospitals of the city, and the shortage of primary medical resources has become a common phenomenon in China [15,16]. Therefore, how to make medical resources go to the primary health institutions, which has undoubtedly became a major challenge to the new health reform policy [17]. Based on this point, the reform of regional health system has been focusing on adjusting the allocation of medical resources, " Integrated Health System "is the major method to promote the rational allocation of regional medical resources and the implementation of the policy of hierarchical medical system [18]. At the same time, China has been attaching importance to training high-level general practitioners and let them go down to the grass-roots unit [19]. China hopes that these measures can divert patients, make the allocation of medical resources more reasonable, and then solve the problem of" getting medical service difficulty ".
The causes of the problem of " high cost of getting medical service" are complex, which mainly include: (1) unreasonable operation mechanism of medical institutions[20]; (2) unbalanced development of health services; (3) irregular order of medicine production and circulation. In view of the above problems, China government has been committing to letting medical institutions more public welfare, so as to make health services more equitable and accessible to public. In order to break down the phenomenon of "to increase the revenue of hospital by excessive sales of drugs", China has been implementing the policy of canceling medicine markups in public hospitals, reconstructing the scientific compensation mechanism, medical service price system and doctor's personnel salary system. Reforming the payment mode of medical insurance in order to avoid excessive medical treatment and increase medical insurance financial subsidies [21].And China government has implemented "Major Disease Protection Policy"to reduce the burden of medical treatment for patients, to prevent patients becoming or returning poverty due to illness. In the aspect of drug price reduction, China government has also introduced relevant supporting policies such as "Two Invoice System", "Centralized Procurement with Target Quantity " and "Price Negotiation" to support it [22].
Evaluating policies can analyze whether these are scientific and the implementation is effective, which is important for functioning smoothly [23,24]. In recent years, there are some researchers in various industries have conducted in-depth research on policy evaluation [25][26][27][28][29]. The main research methods are the use of theoretical tools and construction models. Hongsoo Kim and Boyoung Jeon established a policy evaluation framework based on the six-step method to evaluate the care system effect in Korean [30]. Pengfei G and Yingnan Z have put forward three key factors of the policy evaluation system, analyzed their relationship, and built an evaluation system accordingly, so as to evaluate the green transformation policy of the city [31].
Xiaoshan C et al. have used the Keynes DSGE model to assess euro monetary policy and pointed out effective ways to increase policy returns [32]. Haiqun M and Chang F have evaluated the information policy of China, introduced the S-CAD method to systematically test the policy documents, and excavated the problems in the process of policy formulation and implementation [33].
To sum up, there are various methods for policy evaluation, but few researchers evaluate the evaluation of the effect of health reform policy [34,35]. And the existing studies have evaluated the policy mainly by giving weights subjectively, the impact of psychological factors on person decision-making has not been fully considered.
However, the prospect theory can avoid this shortcoming. At the same time, the gray relation analysis method is introduced to enlarge the difference between the advantages and disadvantages, making the comprehensive evaluation result more obvious. Therefore, based on the prospect theory, this paper will take the effect evaluation of the new health reform policy as the research object, and establish a set of scientific and feasible indicators system of the effect of the new health reform policy, in order to provide reference for the implementation and improvement of the new health reform policy.

Theory brief
Prospect theory, also known as the expectation theory, is proposed by Nobel Laureate Kahneman and cognitive psychologist Amos Tversky [36]. It is used to predict the individual's decision-making in the face of risk, which is different from the traditional theory of expectancy [ 37 ]. Prospect theory divides the risk decision-making process into two stages: editing and evaluation. In the editing stage, decision makers collect and process information according to frame and reference point; in the evaluation stage, decision makers make decisions based on value function and weighting function [38,39]. Therefore, the prospect value function ( ) and the probability weight function ( )will influence the prospect value together, the prospect value can be expressed by the following formula： U = ∑ ( ) ( ).
Grey System Theory originated from the Control Theory, which was put forward by Julong D, a famous Chinese Control Scientist in 1981 [40]. Grey Relation Analysis 8 (GRA), as a multi-factor system analysis method, is based on the grey system theory.
The core of GRA is to explore the geometric correspondence among the factors by relying on the data series of each factor [41]. It is important to quantitatively determine the primary and secondary factors affecting dependent variables according to the size of grey relation coefficient. Compared with other analysis methods, the grey relational analysis method has a lower requirement on the sample size of each factor in the system, which can reduce the loss caused by information asymmetry to a large extent, and is suitable for solving the problem of determining the relation degree of less sample size [42].The grey relation analysis method can be expressed by the following formula:  (Table 1) [46,47]. In order to purify the indicators system, SPSS19.0 is used for data analysis, and the Corrected

Item-Total Correlation (CITC) is used as the standard of purifying indicators, and
Cronbach's alpha reliability coefficient is used to test the consistency of the Indicators system. The results showed that the CITC of "average hospitalization days", "natural growth rate of population", "number of health institutions" and "number of medical and health institutions" was less than 0.5, so it was excluded.
Generally, the internal consistency of the Indicators of α> 0.7 is good, and two Indicators-"the number of health personnel" and "the number of medical postgraduates", are excluded in turn. Finally, we get the evaluation Indicators system of the effect of the new health care reform policy after purification ( Table 2).

Use of indicators
Based on the prospect theory, this paper uses grey relational analysis method to enlarge the difference between the advantages and disadvantages of the indicators, and then calculates the weight of the indicators by using the entropy weight method.
The specific steps are given below.

Dimensionalization of indicatiors：
According (1) The decision matrix can be simplified as follow:

Calculate the comprehensive prospect value:
If the scheme i is inferior to the positive ideal solution, the scheme is loss-type; if the scheme i is better than the positive ideal solution, the scheme is a benefit-type.

Results
The results of comprehensive evaluation of the effects of health reform policies in  reform policy effect, which also exposed the loopholes of the public health emergency mechanism and the weakness of the prevention system of China [49].
From 2004 to 2009, due to the inherent drawbacks of the "marketization" mechanism, the phenomenon of chasing interest has spreaded in the health industry in China, and various problems began to appear, such as imbalance of medical resources allocation, rapid growth of drug fees, imperfect medical insurance system and chaotic circulation links [50]. In view of the above problems, the government has including "hierarchical medical system", "canceling medicine markups " and "Two Invoice System", has not yet fully played its effectiveness, and its development is very slow. For example, the system of "hierarchical medical system" was proposed in 2013, and related documents were issued in 2015 to establish its general program.
It was not until the end of 2018 that the trial of "hierarchical medical system" was launched [52]. Third, a reasonable incentive mechanism should be gradually established during the implementation process to ensure that the new health reform policy can continue to exert its effects and enable the citizens to obtain long-term benefits.
The new health reform has gone through more than 10 years under the situation of interest game and fierce confrontation among all parties. Although it is faced with numerous obstacles in this process, it has always been moving forward in the midst of contradictions. It can be predicted from the progress status that the new health reform policy is expected to look up successfully in the next few years. When health reform is only in progress, but not completed, China should make full use of its institution advantages, combine with innovative ideas, and explore a new health reform road which is scientific, beneficial and sustainable.