Study On The Dynamic Mechanism Of Division And Cooperation Between Medical Facilities In China

[Purpose]Constructing the division and cooperation mechanism between medical facilities is mentioned many times in policy document. However, due to the lack of specific policy proposals and systematic research supports, there still are many difficulties and problems in those practices, and most areas don’t even carry out related pilot. Therefore, we need clarify the meaning of division and cooperation between medical institutions, explore its dynamic source and mechanism, then construct the theoretic model on dynamic mechanism. On this basis, we could put forward specific policy measures to provide reference on carrying out division and cooperation between medical institutions.[Methods]The literature study and comparative analysis method are used systematically to study the division and cooperation mechanism, which was discussion on the domestic and foreign relevant document. The thematic framework analysis and NVivo10software are used to index and analyze the content of interviews. Using system dynamics analysis to study the causal relationship between system internal and external environment and various factors. And based on the feedback loop analysis, combined stakeholder analysis and elimination method to construct theoretic model of division and cooperation dynamic mechanism. In addition, applying SPSS21.0software and using Pearson correlation analysis and the rank correlation analysis method to study on the relationship between the bed scale of public hospitals and their business capacity. Besides the case study, the t-test method and Chi-squared test are used to compare the indicators, such as outpatient amount, discharge amount, average length of stay and averaged hospital costs, the patients proportion of new rural cooperative medical system.[Results]1. According to the division theory and collaboration theory, the division and cooperation between medical services is necessary. It is the internal law of medicine that providing available, equitable and successional medical service to all people. Because the medical institutions are the carrier of medical services, so, the institutions must imply the division and cooperation.2. The meaning of division and cooperation between medical institutions is as follows: with the government guide and other factors, the medical institutions carry out labor division on primary health care and specialized medical services within limits. Primary health care is provided by Grass-roots health care institutions, and specialized medical services are provided by all levels of hospitals. Oversize hospitals mainly undertake diagnosis and treatment of rare and complicated diseases, scientific researches, teaching and training. Large and medium-sized hospitals mainly to diagnose and cure the common disease. Meanwhile, different medical institutions develop cooperation on disease prevention, health education, personnel training, scientific research and medical technology, and provide successional service for patients. Medical institutions play their different functions to provide people with different levels of service, and form the hierarchical diagnosis and treatment system to further protect people’s health.3. In Britain, Germany, Singapore and USA, their medical facilities can carry out division and cooperation, which advantages include excellent General Practices, planning health resources allocation, and effective first treatment in community health facilities and two-way referral diagnosis. However, the division and cooperation can not resolve the all issues in the medical care supply system, so, these countries often reform their policy such as hospital trust, managed care and the General Practices’service contract.4. According to the behavior patterns analysis of medical institutions, large hospitals unilaterally pursue the economic benefits with constantly expanding scale to obtain more patients and earnings, which results in the unfair competition with Grass-roots health care institutions. Moreover, it causes the siphonage effect and radiation effect, and squeeze the development of primary health care facilities. The development of the two sort medical institutions appears the Matthew phenomenon.5. Our dynamic mechanism theoretical model shows that the government is the pushing power of medical institutions’ labor division. By changing the large hospitals behavior model and improving technical level of primary health care institutions, in addition, strengthen propaganda and guidance to patients, and eliminate the resistance factors from the production and circulation departments of drugs and equipment. Medical insurance is the tensile force, using leverage to guide the rational flow of patients and take into account the interests of all medical institutions.6. The WuHan fifth hospital has erected medical joint community adopting personnel support, and the Huangpi district of Wuhan city based on the formation of medical conjoined, and reformed the new rural cooperative insurance payment. They both improve the technical level of primary health care institutions, promote the rational flow of patients and is benefit to the division of labor between medical institutions.7. On the government level, the first task is to stop unreasonable expansion of the large hospitals, and orient reasonably medical institutions function. At the same time, the government should constantly improve the technological of Grass-roots health care institutions and change their name, strengthen the health informatization, large the price difference of medical services, and eliminate resistance factors of drugs/equipments. At the medical insurance level, we should improve the collaboration between medical insurance and health administration sectors, promote the transform of medical institutions’behavior pattern, pilot the Grass-roots health care institutions to manage the fund of medical insurance. In order to do better this division and cooperation, we need to pay attention to the following aspects. The comprehensive reform must be conducted on the healthcare, medical insurance and medicine. Good things come in small packages. Obtain the support of medical staff, do not damage the legitimate interests of the patients, and do not reject the private medical facilities to take part in the division and cooperation mechanism.[Conclusions]1. It is the essential law of medicine that medical institutions should do the division and cooperation. However, in China, the current exploration exists many difficulties, resulting in most medical institutions don’t carry out the pilot. The key reason is that the siphon and radiation effects brought by large-scale hospitals’unreasonable expansion, which hinder the primary health care institutions, and health care delivery system presents a single-stage development trend.2. In the current situation of China’s health and medicine system, market mechanism can not facilitate the division and cooperation between medical institutions. After we erected the division and cooperation mechanism, we could use market mechanism to improve the micro efficiency of health system.3. The dynamic mechanism of division and cooperation is as follow. The main driving force comes from the government and medical insurance. The first task is to stop unreasonable expansion of the large hospitals, and orient medical institutions function. On this basis, they constantly improve the technological level of Grass-roots health care institutions and eliminate resistance factors of drugs/equipments, moreover, guide the patients. Secondly, the medical insurance promotes the behavior change of medical facilities by its leverage role, and promotes the rational flow of patients.4. Under the government guidance and regulation of medical insurance, the Healthcare Union which is organized by large hospitals and primary care medical institutions, can promote the division and cooperation between medical institutions. This model should be recommend. However, the hospital trust constructed by big hospitals and big hospitals is not reasonable model.5. The policy pathway of division and cooperation includes three stage, and we are still in the primary stage. On the base of government guidance, regulation of medical insurance, and comprehensive reform on healthcare, medical insurance and medicine, difference areas should pilot the division and cooperation between medical institutions according to their reality.[Innovation and Deficiency]1. Using system dynamics principle, this study deeply analyze the behavior patterns of medical institutions and prove large hospitals exist siphon phenomenon. We first find that the health care delivery system presents a single-stage development trend. Therefore, to facilitate medical institutions’division of labor, the first condition is to stop the expansion of large hospitals. Coupled with government guidance, health insurance’s regulation as well as conduction and coupling of patients, this study establishes the dynamic mechanism theoretical model of division and cooperation. This has reference value for guiding practices.2. This research studied the effect of Wuhan fifth hospital’s healthcare union and Huangpi district’s payment reform, using statistical methods to prove that with government guidance and the leverage of health insurance, it benefits medical institutions develop labor division and cooperation. Systemic case study has practical significance to promote the division and cooperation between medical institutions.However, there are some deficiencies in this research. It lack studies of health resources allocation, so whether the high-quality health care resources are adequate is unclear. In addition, the comprehensive statistical analysis is inadequate on the medical quality indicators in Huangpi district, which leads to it is unclear if launching the payment reform on the new rural cooperative medical system affects the quality of care. Finally, this study don’t measure the medical institutions’costs and benefits of both human resource and material produced by carrying out medical joint community.