| Objectives:The aim of the study is to create a model of management and establish the coordinated policy framework which promote continuously improvement of the coordination of the Chinese regional medical service network through systemic analysis of the network and its cooperation function, evaluation to the present situation of cooperation of medical service regional network, exploration of the influence factors in network and the synergies deficiency causes.Methods:This study uses the methods of standard research, qualitative research, documentary research and normative analysis, supported by empirical research and quantitative analysis. On the comprehensive study of coordination functions essentials, study applies the important comprehensive analysis paradigm of system:system-structure-function, to explore the establishment of a comprehensive and coordinated management of the model, from division of work, integration and coordination of medical delivery system, centre on the policy problem.There are three main sources of data:A's from the survey in WuHan and WuHan XieHe Hospital Group; B's from the health almanac of China and WuHan; C's from the second analysis of the investigation reports collected.Results:(1)Medical service regional network synergies function can be divided into the elements of integrated services, management integration and health information. The collaborative function of network is affected by systematization degree, management system and health care financing system, compensation and the paid way, which also deeply influence the differentiation, the division of labor and integration of the network. (2)The organizational model and the col laborative function of network interact and affect each other, which format the relationship of the construction and the function of network; (3)The organizational model of collaboration are those:trusteeship,merger and acquisition,invest and run,one-to-one assistance,contract, and so on.Conclusions:Although there are urgent needs to improve the health care service, enhance service efficiency and effectiveness as well, compared with the OECD and so on other high income countries and regions, our regional medical services system obviously lack of regionalization and organization, which is the new round of medical and health system reform must confront and overcome.The deficiency of co-ordination function of our medical service regional network are primarily the fol lowing:①Our medical services are provided mainly in a single, collaborative lack, there is a continuity obstacles;②The gaps of technological and management etc. among the medical services institutions make the organizations are difficult to create an effective synergies management;③The development of our health information is less, which provides coordination and management of operations vigorous support.The reasons why the coordination function is poor smooth are those:①Our current health management system restricts the exploration of the medical institutions in the area of organization, division and integration:high concentration of public finance power make the local governments are usually deficit financing public health work, Highly decentralized functional authority is hard to conduct effective management and catch the resultant. So there is lack of motivation to improve our health care;②Our primary health care financing emphasizes so much on individual responsibility that the level of medical insurance funds is too low to ensure more health services covering the mass of people. And the management of founds is highly decentralized, which could not cover the most of medical expenses, the reduce-expenses mechanism as a third party is hard to operate, so it can't prompt the medical institutions effective division of labor and integration, and no strict confine of community-first visit to guide the reasonable consumption of medical services;③The present cross-subsidizing and pay-for-fee system provide an incentive mechanism for medical institutions striving to a scale model, which using equipment and high technology to provide services and suppressing the inter-agency cooperation.Suggestions:The long-term goals of our regional medical service network are these:①Promote the services provided by a single agency changing to by medical institutions network;②The operate model of the medical institutions changes from competition as rival to co-operational service the whole domain;③Promote the transition of the inefficient resources to the configuration and efficient use. The chieve of these goals depends on the reform of the management system and operational mechanisms are successful. And the medical insurance system are needed to change the way of compensation to provide incentives to promote the division of labor effective, and differentiation and integration. However, in short term, there are still in the following ways to enhance the co-operation of our regional medical service network:①Through conglomeracy of the grass-roots and special hospitals to continuity medical services as a whole before public health services with a group of lines, and then step by step cluster lines into scope of the domain. Through integration and governance of hospital groups to promote management autonomy. Making the adjustment of hospital function and development of grass-roots institutions working in parallel;②By means of hosting, training to strengthen hospital supporting to grass-roots, promoting hospital and grass-roots management integration, enhancing the services capacity of primary health care sector, Increasing the trust and recognition of the residents on the grass-roots;③Promote medical services of intermediate differentiation, such as terminal hospitals, rehabilitation hospitals, long-term care centre etc.;④Through the Organization of the series professional institutes specialist and training to promote the standardization of diagnosis, treatment technologies and services processes;⑤By focusing on major diseases strategy and special population (such as the long-term care services for the old, the charity hospital for the poor, etc.)policy, key project policy (such as basic skills training, the construction of regional Collaborative medical information network, etc.) to increase the coordination ability of health areas such as project plans, investment, performance appraisal, etc.;⑥Accelerate the pace of medical institutions reform and Transition of Government function, implement the right management to medical institutions, promote the rational allocation of external regulation and internal control functions, strengthen integration of health services management interoperability.Innovations:(1)Theoretical innovationThe formal study of medical services co-ordination was limited primarily to the single-function research, such as continuity of services, the collaborative of informat ion and management, or confined to single institution or single level of network. This research studys the regional coordination function of the service network and macroscopic and microcosmic influencing factors, started from the collaborative network organization and co-ordination functions increased the research of systematic and comprehensive, and presents our corresponding coordination function management model of medical services regional network, which have the theory guide meaning of practice.(2)Innovation of methodsThis study starts from the collaborative network organization and co-ordination functions, recruits from the cluster and medical services network research results, which help to clarify the medical service network synergies and mutual influence, also be conducive to the establishment of management model.
|
PDF Full Text Request