Study On Evaluation Of County Medical Community Reform In Zhejiang Province

ObjectiveIn October 2017,government carried out the policy about the reform of Countywide Medical Community(CMC)in 11 Zhejiang regions,which is aiming to build the service community,responsibility community,profit community and management community of county hospitals and community health service center.Based on the overall framework of "three unifications,three overall plans and three strengthening",this study used the three-dimensional evaluation model of structure-process-outcome to evaluate the CMCs‘ general implementation of the internal organizational structure,resource distribution structure,operational efficiency and so on.On the other hand,it also study the interaction of stakeholders such as the government,county-level hospitals,grass-roots hospitals and patients from the four dimensions of fairness,efficiency,quality and satisfaction during the operation of CMCs.Furthermore,this study expounds the results and achievements of the CMC reform,and finds out the problems and reasons in the implementation process of CMCs,and provides policy suggestions for further deepening reform.MethodsThis study uses the research method of "structure – process-result" to construct the evaluation framework and indicators from the perspectives of management department,doctors and patients through the expert consultation method,to understand CMCs well in Zhejiang Province.By statistical description,data envelopment analysis and regression score we can find out the problems of CMC and put forward policy suggestions for further deepening the reform of CMC in Zhejiang Province.Results11 pilot have set up 1-4 CMCs in different numbers,but each pilot has not completed the requirements of the construction of CMC,which CMC of Dongyang is relatively perfect.Since the implementation of CMCs for one year,countymide medical treatment rate have reached 90% in most pilots,while the primary medical treatment rate of all pilots has not reached 65%.In the process of CMC reform,11 pilots increased resource investment,improved the payment method of medical insurance,improved the utilization of health services,optimized the resource allocation structure at the county and township levels,increased the technical efficiency at the primary medical inistutions,implemented clinical pathways,controlled medical expenses,strengthened the publicity of the medical community,and increased the satisfaction of both doctors and patients.However,there are still inconsistencies in the division of power and responsibility within CMCs,the weak structure of the medical community,the lack of homogenized management of medical services,the sinking form is greater than the content,the overall efficiency of the medical community is low,the efficiency of county and township medical institutions are all problems,and the two-way referral mechanism still has problems,which need to be further improved.ConclusionAt the beginning of the pilot reform of CMC,good results have been achieved,but there are still some problems that need further improvement.One year after the implementation of CMCs,each pilot has not completed the construction of the medical community in accordance with the requirements of " three unification,three overall planning and three strengthening",and some pilots have "form is greater than content",and medical institutions at the county and township levels have not yet formed a close medical community.Experts have sunk under the suspicion of "administrative sinking",and the allocation structure of health resources is unreasonable,and some basic medical institutions need further construction.The scale of some CMCs is too large and the technical efficiency of county hospitals is too low,which leads to the inefficiency of the operation of CMC in a certain way.The quality gap between the county and township medical services is too large,the rate of grass-roots visits is low,and the phenomenon of patients following the experts still exists;the satisfaction of medical staff to the medical community is higher than that of patients,and the medical cost,hospitalization days and medical environment are still the main factors affecting the satisfaction of patients Prime.