Effectiveness Evalution On The Vertical Collaboration Between Hospital And Community Health Service Centers In Zhenjiang

Objectives:Medical resource integration is one of the main goals of the the new health care reform. This paper takes Zhenjiang for example, which is one of the firstling pilot counties in Jiangsu province. Through evaluating the effect of the vertical collaboration of hospital and community health service centers (CHSCs) and comparing the differences of the structure, process and result among different cooperation models, the paper provides theoretical support and policy suggestion to promote the development of the urban healthcare system reform.Methods:A questionnaire survey was conducted on the medical staffs and patients in sample CHSCs and hospitals. The related policy documents and the forms about the structures of the sample CHSCs and hospitals were collected. To do qualitative survey, persons of sample medical institutions, local sanitary bureau, local finance bureau and institutes of health, who have participated in the collaboration, were collected to attend individual interview. This paper used Donabedian Framework of quality assessment based on measurement of structures, processes and outcomes as comprehensive analytical framework. The quantitative data was analyzing by using Chi-squared test, ridit analysis and logistic regression. The qualitive data was analyzing by content analysis, induction and deduction.Results:Based on the results of the study, conclusions were drawn as follows. Positive results:Special support activities have achieved initial success, there were64.1%medical staffs thinking the training works well, the quality of the service of CHSCs has been improved; the degree of device sharing among CHSCs and hospitals has deepened, in the two center hospitals, the number of patients who went to hospitals to do check-ups with the application forms from CHSCs has been growing year by year, the amplification are66.7%and33.3%respectively; the service volume of CHSCs has rised, the numbers of clinical visits of all sample CHSCs have rised. Problems:piece advantage of CHSCs is not obvious, the cost burden of patients has not been reduced; dual referral was floating in the form, the quantity of referrals has increased, but prescribed collaborative service often did not happen; the actual number of beds in CHSCs is very little, the numbers of beds of all sample CHSCs did not meet the requirement, thus the CHSCs could not provide enough rehabilitation service; the awareness rate of patients on collaborative services was low, there were only12.7%patients knowing this medical service collaboration. The degree of information communication among CHSCs and hospitals was low, there were only8.1%medical staffs getting infotmation of patients through communicating with staffs from other medical institutions.Policy suggestions:Propagandize of the medical service collaboration should be strengthened. The medical insurance policy should be reformed. The exchange information between CHSCs and hospitals should be standard. The communication and the consistency of drug application among CHSCs and hospitals should be strengthened. The government should provide more support to the medical service collaboration among CHSCs and hospitals.