| In recent years, governments at all levels of our country strengthen theconstruction of urban grass-roots health service system continuously.Their goal was torealize the comprehensive cover of community health service of city in threeyears .The community health service system will play more and more important roleon the aspect of the health protection for the urban residents .To display the functionof the community health services institutions, it will become the major obstacles toenhance the capacity of the community health services institutions rapidly.In order toenhance the capacity of the community health services institutions, ministry of Healthpromulgate the Document of The Proposal for Regarding Public Hospitals Supportthe Community Health Services Work,it demands Local Government to explore theCollaborative relationship between the community health services institutions andhospital and effective information communication channel for two-way referral. TheCPC central committee and state council promulgated the Document of The advice fordeepen the reform on the medical and health ,it also pointed out that the mechanismof division and cooperation for the community health services institutions and urbanhospital should be established.However, what about the present situation of thedivision and cooperation between the community health services institutions and hospital?Which links are the key factors to impact the two-way referral?How toestablish the operations mechanism of two-way referral?What is the improvementstrategy for the different model of two-way Referral? Etc.The problems above arebecome the most important ones on the mangagement of two-way referral operationswhich are demand to research and solve.This research apply stakeholder theory and the theory of demand for medicalservices to analysis the operations and management of two-way referral. Based on thestakeholder theory ,it pointed out that it should be established the related health policy,the medical security system and the corresponding management strategy for differentstakeholder in the process of two-way referral. Based on the theory of demand formedical services, it pointed out that to explore the relevance between the demographiccharacteristics and the medical behavior of the community residents. Based onreviewing the literature and analyzing the second-hand information,we investigatedthe present situation of the different two-way referral model in representative cities;compared the advantages and problems of various models; discussed the variousinfluencing factors in the management of two-way referral and found out the essentialones,and at the same time establish the related policy, management strategy and theincentive and restraint mechanisms,in order to construct the management model oftwo-way referral operation which fits the condition of our country. To realize thepatients' reasonable Fan Lau and promote the two-way referral to carry out effective,and offer the basis for decision making to the related departments.Data Source and Research MethodsData SourceCollecting the information in and abroad about the effect factors, the governmentdocuments of different regions and related second-hand information,to analysis thepresent situation and the pros and cons.The research methods inelude qualitative andquantitative study, making research in the hospital and community health service institutions in Beijing, Tianjin, Shanghai, Nanjing, Wuhan, Shenzhen, ect, abouttwo-way referral; invite the health management scholars, the experts of communityheath, the health officials of the executive branch, community health service staff andclinical professional experts to discuss on the pros and cons of various models oftwo-way referral.At the same time,we have a site investigation for different models'medicare payment, the wishes for medical treatment, the number of referred fromcommunity health service institutions to hospital and the number of referred fromhospital to community health service institutions.Research Methods1,Review the literature and analyze the informationReading widely the famous works, the learning discourse, the major magazineand the index literature information on the Internet in and abroad the country.Collecting the information in and abroad about the effect factors, the system and therunning system of the dual referral. Concluding the main points of them. They are allthe basis of the research. Meanwhile collecting the information of the denizen medicaltreatment and willings, which provides the basis to the denizen medical treatment andlead patients to have a treatment.2,In-depth iterviewInterviewing 26 pepole including the health administrators, community healthservice staff and clinical professional experts, Analysis of the the quo status and prosand cons of the two-way referral between community health services and hospitals invarious areas. In order to provide reference for determining two-way referralmanagement models between community health service institutions and hospitals thatsuitable for the reality of our country.3,Questionnaire survey methodMaking research in citis run two-way referral better , including Nanjing,Beijing, Tianjin, Shenzhen, Wuhan, ect.Acorrding to manegement model and Two-way referral mechanism.Choosing 3 hospital and 9 to 12 Community healthservices to survey, surveying 288 patients treatment in different models communityhealth random.4,Focus group discussionsThrough focus group discussions relating to the relevant personnel of healthadministrative departments, hospital personnel and community health services staff ,to find the influencing factors of Two-way referral between community healthservice institutions and hospitals. Definituding the problem of the two-way referral ,exploring effective solutions.5,Typical case analysisAnalyze typical case and he advantages and disadvantages of two-way referralbetween community health services and hospital of different models, combined withthe literature summarized and in-depth interviews with individuals.6,Data analysis approach6.1 Statistical analysis method: using descriptive statistical analysis of the number oftwo-way referral , referral constitutes of disease between community health servicesand hospital in areas . Application of chi-square test analysis of the differences inbehavior and the will by comparing demographic characteristics in different treatmentgroup, application of logistic regression to analysis of influencing factors in differentpopulation groups6.2 Analysis of stakeholders: take the analysis on the related benefit group by definingthe government, residents,hospitals, community health service institutions and healthinsurance institutions into different stakeholders. Study the dynamic and resistance ofthe dual referral by the way of summarized interpretation to explore the interaction ofthe behavior character.The results and analysis1,Theoretical research on two-way referral between community health service institutions and hospitalStakeholders in two-way referral process including: hospitals, community healthservices, patients, health insurance institutions. Theory based on the needs ofstakeholders need to establish the two-way referral coordination mechanisms ofconflict of benefit between China's hospitals and community health services, on thebasis of protecting the fundamental benefit of patients, At the same time taking intoaccount the benefit of community health institutions and health insurance agency,Giving full consideration to all aspects of community affordability. Research healthpolicy, medical security system and the corresponding management strategy tocoordination of different stakeholders.Behavior based on the theory of demand for health care study found that thewaiting time for patients to seek medical treatment, distance from the patient's age,educational level, gender, medical treatment costs, the severity of disease lead verysignificant impact on personal medical need in specific areas,and important for thepatients will of two-way referral.The supply behavior analysis theory of medical services showed that the demandfor medical services and supply was infected by the medical price mechanism,medical services can be achieved only when marginal income was equal to themarginal cost. Motivation theory analysis showed that we should give fullconsideration to the needs of managed objects in order to take effective incentiveswhen two-way referral management of the establishment of incentive and restraintmechanisms was established.2,Analyzing status of the domestic two-way referral models, as well as the pros andcons of different modelsAbroad: Australia hospitals and community health institutions to establish a morecomprehensive two-way referral system, the United Kingdom to implement thesystem of general practitioner services, the Singapore government has formulated strict level of the patient transfer system, the United States to rely largely on the healthinsurance system in the role of norms.Domestic: There are four type two-way referral models between communityhealth service institutions and hospitals in China, including the model of cooperationagreement , On behalf of the City is Nanjing, Beijing, Tianjin. And model ofoperation and management by hospitals, on behalf of the City is Shenzhen,Daqing.The model of delegated administration, on behalf of the city is Wuhan, Tangshan. Themodel of Oriented to the interests.Different co-operation models consist of advantages anddisadvantages .Agreement co-operation model , model of operation andmanagement by hospitals and trust model are suitable for different regions toexplore ,however, Loose model oriented -interest does not deserve recommendationdue to short of Long-term goals and awareness.3,The key influential factors related to two-way transfer treatment systemThe key influential factors of two-way referral include: Laws andRegulations ,hospitals ,CHS, medical insurance , the crowd sentiment.4,Establishment of two-way transfer treatment system among CHS and hospitalsAfter research & analysis ,we find that many cities have explored kinds oftwo-way transfer treatment systems on the basis of local conditions which compriseadvantages and disadvantages .On the condition that analyzed different models andkey influential factors ,we established the strategies to promote the operation oftwo-way transfer treatment systems.the strategies involve basic principles ,cooperating agency , functional responsibility ,indicators,agreement,process,mechanism of information communication,equipment sharing and performanceevaluation of two-way transfer treatment system.5,Supporting policy analysis of the operation of two-way transfer treatment systemsConstruct sustainable development model : After research & analysis ,we find that many cities have explored kinds of two-way transfer treatment systems on thebasis of local conditions which comprise advantages and disadvantages . Aftercomparative analysis of different models ,we summaried relative policies to push thedevelopment of two-way transfer treatment systems and outlined the strategies : todefine responsibilities ,to strengthen co-operation ,to improve the medical surancepolicies,financial compensation policies,personnel training policies , to developlaws and regulations , to strengthen the supervision by the governments orindependent party to promote the implement of the resposibilities and policies toobtain the good perfermance of two-way transfer treatment systems.Discussion and suggestionsAccording to the current situation and the key factors and policies analysis,different models of two-way transfer treatment systems will co-exist for a long time inour country.At present , agreement co-operation model is a main model betweenhospitals and CHS . At the same time , the model of hospital operation andadministration and the model of hospital trust have practical significance ,however,loose model oriented -interest which attaches more importance to short-term interestsis not conducive to the long-term development of two-way transfer treatment system.According to the actual conditions ,we raise special suggestions about the first threemodels.1,Agreement co-operation modelThe full realization of government functions is the key of the successfuldevelopment of two-way transfer treatment system which need effective supervisionand guidance of governments ,public interest of CHS.at the same time ,the standardsof two-way transfer treatment system should be designed and mechanism of thedistribution of benefits should be established.2,The model of hospital operation and administrationEstablish management center of CHS. The center is responsible for supervision of relative work,especially, pay great attention to supervision andassessment .Establish the mechanism of selection and removement CHS becominginsurance institutions.Design incentive and constraint policies .Change concepts ofhospital manangers to increase the number of patients being transferred to CHS fromhospitals.3,The trusting model between hospitals and CHSAdjust the interest relationship between hospitals and CHS, changing fromcompetitive relationship to co-operative relationship, the managers of CHS shouldchange concepts and take participate in two-way transfer treatment system.
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