| Objective:This study aims to make a comprehensive analysis of the implementation of graded diagnosis and treatment in Jiangsu Province and seek for the difficulties and pain points in the construction of graded diagnosis and treatment system in Jiangsu Province after understanding the graded diagnosis and treatment policy,two-way referral,fairness and efficiency of resource allocation.Based on the analysis of medical service system in developed and developing countries,this research combines the experience of foreign countries with the actual situation of Jiangsu Province to put forward practical suggestions for improving the graded diagnosis and treatment system in Jiangsu Province.Hoping the effective suggestions can also provide reference for further deepening the reform of medical system and promoting the hierarchical diagnosis and treatment system in China.Research methods:Roberts model was used to analyze the current situation of medical service system in various countries from control project,intermediate performance measures and performance implementation objectives.Gini coefficient,Lodz curve and density index(HRDI)were used to study the fairness of resources allocation in Jiangsu Province,including the human resources,material resources and financial resources.Data envelopment analysis and Malmquist were used to analyze the resource allocation efficiency and productivity of Jiangsu Province.Results:1.This paper systematically reviews the historical evolution and current situation of medical and health service systems in the United States,the United Kingdom,Japan,Cuba and Thailand,and draws the following enlightenment:the necessity of hierarchical diagnosis and treatment system;the positioning of government and market in the medical service system;attention to the cultivation of general practitioners;the implementation of family doctor system and limit the choice of patients;pay attention to the quality of medical service and make information public.2.Allocation of medical and health resources in Jiangsu Province:(1)Resource allocation status:The total amount of resources in Jiangsu Province showed an upward trend,among which the number of beds increased by 99229,with a growth rate of 25.3%,the number of medical institutions increased by 1233,with a growth rate of 3.85%,the number of health workers increased by 149696,with a growth rate of 25.4%.The revenue from government financial subsidies increased by 17.1 billion,with a growth rate of 83.5%.The total expenditure of medical institutions with an increase of 107.4 billion,the growth rate reached 56.2%.The proportion of medical care in 2018 is 1:1.114.The proportion of primary medical institutions in the total number of medical institutions is more than 90%.Both the number and growth rate of beds owned by hospitals are far higher than that of primary medical institutions.The number of diagnosis and treatment of hospitals and primary medical institutions are increasing,but the number of diagnosis and treatment of hospitals is increasing while the number of diagnosis and treatment of primary medical institutions is decreasing.The two-way referral rates of hospitals and basic medical institutions are lower than 1.5%.(2)Allocation fairness:The allocation of basic medical resources in Jiangsu Province is generally fair.The fairness allocated by Region is institutions>beds>health workers and the fairness allocated by population beds is beds>health workers>institutions.The fairness allocated by population is higher than that allocated by region.The degree of fairness is the middle of Jiangsu>the south of Jiangsu>the north of Jiangsu.The density index of basic medical resources in southern,central and northern Jiangsu all showed an upward trend,among which the density index of medical institutions in northern Jiangsu was the highest,the number of beds and the density index of health workers in southern Jiangsu were the highest.The fairness of health financial resources allocation is not high,relatively unfair according to regional distribution,relatively fair according to population allocation.The fairness of financial subsidy income in northern Jiangsu is the worst,and the fairness of total expenditure in southern Jiangsu is the worst.The HRDI and growth rate of Nanjing are far higher than the average level of the province and other cities,and the HRDI value of the cities in Northern Jiangsu is the lowest.(3)Allocation efficiency:the allocation efficiency of medical and health resources in Jiangsu Province is high.In 2018,the comprehensive efficiency reached 0.947.There are nine cities with effective DEA,namely Nanjing,Changzhou,Suzhou,Nantong,Taizhou,Xuzhou,Huai'an,Yancheng and Suqian.The cities with weak and effective DEA results are Zhenjiang and Yangzhou.The cities with ineffective DEA results are Wuxi and Lianyungang.From 2014 to 2018,the tfpch of Jiangsu Province was less than 1,and the changes in technology and pure technology efficiency were decreasing.Except for Nanjing and Yangzhou,the total factor productivity of the other 11 cities was declining,and the overall total factor productivity was declining.Conclusion:1.The current situation of medical and health service system in Jiangsu Province:(1)Policies and measures have been steadily promoted,and the hierarchical medical service system has not yet formed.(2)The total amount of health resources increased steadily,but the structure was not reasonable.(3)The overall allocation of health resources is fair,and there are great differences among regions.(4)The overall efficiency of health resources is high,and some cities need to adjust.(5)Total factor productivity declines,technical efficiency needs to be improved.2.Combined with foreign experience,the following suggestions are put forward:(1)Improve the top-level design and strengthen the combination of government and market.(2)Defining the function orientation of medical institutions and constructing three-level medical service system.(3)Improve the training and incentive mechanism of general practitioners to improve the service ability of primary medical institutions.(4)Promote the reform of medical insurance payment mode and play the leverage role of medical insurance policy.(5)Establish residents' health information database and promote "Internet+medical treatment".(6)Optimize the allocation of medical resources and consolidate the foundation of hierarchical diagnosis and treatment.(7)Improve the service system of traditional Chinese medicine and enhance the service ability of traditional Chinese Medicine. |
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