Study On Coordination Mechanism Of Health Service Network Of Urban Communities

Social and economic progress has accelerated the development of medical technology and information and as well raised people's expectations for health services. The linear increasing tendency of per capita spending in total health expenditure in China indicates that health service is a financial burden for most citizens."Being too difficult and too expensive to see the doctor" is still an important issue of national concern. State "proposals on deepening the medical and health service system" of2009advocate to "perfect the new community-based urban health service system, to speed up the construction of community health service centers as the framework of urban community health service network, and to establish the coordination mechanisms between urban hospitals and community health service centers "。In recent years, network of community health service has gradually established in China but there are still some problems and difficulties. The allocation of medical resource has become the leading problem in the development of community health service problem in China. Therefore, the construction, development and improvement of community health service network, the effective allocation of medical care resources between regions and between lower and upper medical institutions, and the coordinated development of community health service centers and urban hospitals, all these are essential measures for optimizing the allocation of medical resources and improving the fairness and efficiency of health services. In the urban community health service network, the connection between medical institutions is achieved mainly through referral medical activities. The bi-directional referral between community health service centers and hospitals thus becomes the key issue to realize the graded health services. Therefore research on the coordination mechanism of urban community health service network has become an urgent topic based on the advanced experiences of developed countries, combining with the present conditions in China.It is a complicated systems engineering to establish the urban community health service network for its target is to realize the cooperation between community health service institutions and effective allocation of the limited medical resources of urban hospitals, so as to maximize the value of cooperation from the economic perspective and ultimately to guarantee people's health. But exact measures requires further research as to how such a target can be achieved with coordinated efforts.The construction and operation of urban community health service network involve many parties such as patients, community health service institutions, city hospitals, and medical insurance institutions and the local governments. Yet the behavioral relationship between community health service institutions and city hospitals, both as the suppliers of urban medical service market forms the most fundamental part of our analysis. From economic and managerial perspective, economic behavior is the essential form of behavior. But the literature reviews indicate that in recent years many studies mainly focused on referral activities within community health service centers and most researches are conducted under strategic analysis, qualitative analysis and comparison analysis. Fewer researches have conducted under mechanism analysis and empirical analysis on city community medical service supply chain network.Therefore, it is of theoretical significance and practical value to study the behavioral relationship between different forms of community health service from the perspective of economic agents, and thus from the perspective of economic organization research on urban community health service organization and operation law for better understanding of the medical service market and the urban community health service network.This research, from economic organization of perspective, focuses on urban community health service network, establishes the basic framework of analysis starting from the referral relationship between community health service institutions and city hospitals to construct urban community medical service supply chain network and realize the coordination within this network, proposes a managerial institution based on ability, and trust and information. This paper also conducts a systematic study on the coordination between urban community health service networks, establishes Hotelling Model and Salop Model to indicate the quality of medical service to analyze city residents'choices of medical services. As for the three coordinating patterns of interaction between city hospitals and community health service institutions in China, analysis is conducted from the perspective of relationship rent and concluded that vertical integration model is a Pareto Improvements, and establishing a long-term relationship-oriented relationship between compact mode better than vertical integration models; to medical service capability for coordinated elements, construction of urban community health service supply chain network of relational contract coordination model;In addition, this dissertation has studied the trust relationships between members of the community medical service supply chain network, proposed a framework and suggestions for the establishment of trust between members of the urban community health service supply chain network; Finally some strategic recommendations are offered based on this study for the development of community health service network in China.This dissertation applies health economics, theory of transaction cost theory, relational contract theory to form the basic framework for analysis of the coordination of urban medical service supply chain network, and conducts some studies from the micro level, the organization level and the system level on the coordination between urban community health service networks, with a view to providing certain theoretical support and practical basis for medical system reform in China.