The Policy Network Analysis On The Nrcms’ Tiered Health Care System In Pingliang,Gansu Province

Objective:Based on the policy network analysis,we regard the NRCMS’ Tiered Health Care System in Pingliang city as a complete policy network.We aim to understand the running environment,institutional measures of this policy network,and to analyze the network actors,network structure and interaction relations between them.Then we try to explore the operational mechanisms of the policy network.According to the effects and problems and reasons behind,we put forward some references for the further improvement of the tiered health care system in Pingliang City.Contents:1.Concepts,connotations and relevant theories of the tiered health care system are reviewed.And an analysis framework of the tiered health care system in Pingliang City is built.2.Based on the analysis framework,the environment,institutional measures,network actors,network structure and interaction relations are described and key operational mechanisms of the tiered health care system are explored.3.According to the effects and problems,some references are provided for improvement of the tiered health care system in Pingliang City.Methods:1.Literature reviewBy searching the databases,such as CNKI,Chinese VIP,Wan Fang database and Pubmed,Springer,the domestic and foreign related literatures on the tiered health care system are combed.2.Policy network analysisThe policy network analysis method is adopted to analyze the basic elements of policy network,such as network actors,network structure and interactive behavior.Then key operational mechanisms of the tiered health care system are summed up,so are effects and the existing problems.3.Expert adviceBy consulting experts in the field of health policy and health service management,the rigor and reliability of the research design,analysis process and conclusions are demonstrated.Results:1.The network actors of the tiered health care system in Pingliang City are divided into five parts:Policy community,Intergovernmental network,Producer network,Professional network and Issue network.The Health and Family Planning Commission,the NCMS Office,the Bureau of Finance and the NDRC of Pingliang City belong to Policy community.The Health and Family Planning Commission,the NCMS Office,the Bureau of Finance,the NDRC of the County or District belong to Intergovernmental network.Managers and health workers from the primary health care institutions and hospitals,pharmaceutical company belong to producer network.Experts and scholars belong to professional network.Patients and the media belong to the issue network.2.The network of the tiered health care system in Pingliang City is more loosely organized.The NDRC of Pingliang City,the Bureau of Finance and the NDRC of County or District and the pharmaceutical company are marginal actors,and the others are key actors.3.The interaction relations of policy network of the tiered health care system in Pingliang City are between policy community and intergovernmental network,intergovernmental network and producer network,producer network and issue network.It relies on three sub-mechanisms:the mechanism of governing regulation,the mechanism of interest coordination and the mechanism of division and cooperation.In terms of the governance regulatory mechanism,the planning plays a leading role in building the tiered health care system.The supervision and assessment play a normative and binding role on the supplier’s actions.The publicity mobilization plays a role in facilitating the participation of relevant parties.In terms of interest coordination mechanism,the level and means of financial compensation act as a guarantee for the operation of primary health care institutions.The method of payment of health insurance and differential expense account for the action of the two parties.The pay level,structure and way of promotion motivate the attitude and behavior of doctors.In terms of division and cooperation mechanism,a clear division of labor between different medical institutions is a prerequisite for collaboration.Improving the service ability level of primary health care institutions is the basis for conducting collaboration.Information sharing between different medical and health institutions is a tool for unimpeded referral.Conclusion:Among the network actors of the tiered health care system in Pingliang City,the policy community and intergovernmental network are the main drivers of this network.The producer network is the key performer,but the interests of some actors are not fully guaranteed and the execution will not be strong.The issue network and professional network are important participants,but the discourse consciousness is low and effective interaction way is lack.The network of the tiered health care system in Pingliang City is more loosely organized.Through the interaction between different actors,three core mechanisms of governance regulation,interest coordination and division and cooperation are produced.It has achieved a good result.But there are still some problems,such as:inefficient in enforcing the regulations of the administrative department,insufficient of interest guarantee of part of the primary health care staff,lack of supporting conditions for the division and cooperation.Recommendations:1.The awareness and participation of the issue network and professional network should be strengthened,and effective interactive should be established.2.Benefits of primary healthcare workforce should be improved gradually to strengthen the weakness of producer network.3.A long-term governance mechanism should be established to make full use of the intergovernmental network.4.An incentive division and cooperation mechanism should be explored to facilitate the integration of producer network.