| [Purpose]This study aims to define the concept and characteristics of vertical and compact medical consortium and clear the operation goals of it,then this study built the theoretical framework of performance formation mechanism and performance connotation on vertical and compact medical consortium through grounded theory analysis method.At the same time,this study built the performance index system and performance evaluation model of the vertical and compact medical consortium,based on the development situation of vertical and compact medical consortium in China.Then,the performance evaluation model was used to carry out comprehensive evaluation on sample medical consortia,and to explore the problems and internal and external environmental factors the sample medical consortia faced.Finally,this study proposed the performance improvement concept framework and performance improvement strategies suitable to the vertical and compact medical consortium in China,which will provide reference for the performance improvement and overall development of the medical consortia in China.[Methods]1.Field investigation methodOur study investigated 10 vertical and compact medical consortium coming from Zhijiang and Yicheng city in Hubie province,Tinjin municipality and Shenzhen city in Guangdong province.In the process of investigation,we collected the health statistical report forms,the home pages of the disease records and the medical consortium policies;the we conducted questionnaire survey on 539 core hospital staff and 311 rooted medical institutions and 345 outpatients and 278 inpatients.2.Qualitative research method(1)Literature analysis method: we used English database-Pubmed and Web of Science and Chinese database-CNKI and Wanfang to collect relative literature on medical consortium,to understand the study situation and development tendency of the international literature.(2)Depth interview method: we designed interview outline based on grounded theory,and then conducted interview work on 43 people from the health management institutions in the sampled areas,to know the performance situation of the sampled medical consortium.(3)Expert consultion method: through designing the expert consultion table,we invited 15 experts to screen the index system of the vertical and compact medical consortium.(4)Expert grading method: we selected 18 medical consortium experts to score for the operation aim system;and selected 7 experts to score for the performance index to test the content validity;and to select 13 experts to score for the index importance;(5)Grounded theory:we used the grounded theory and principle to analyze the 43 interview record to define the performance formation mechanism and performance connotation of the vertical and compact medical consortium;(6)Content analysis method:we used this method to analyze these 43 interview records to build the performance improvement questions collection of the vertical and compact medical consortium;(7)SWOT analysis method: we explore the environmental factors from sights of streanth,weakness,opportunities and treats;(8)Stakeholder analysis: it is used to understand the interest demands and games of the stakeholders of samples’ performance improvement.3.Quantitative analysis method(1)Comparative sample selection method: we obtained 10 empirical samples through typical sampling;We conducted in-depth interviews with 43 intimate lovers through theoretical,objective and snowball sampling.(2)Mathematical and statistical methods: we used descriptive statistical analysis to analyze the resource allocation and service provision status of 10 sample longitudinal compact medical consortium.We use entropy method to optimize the weight of performance evaluation index system of vertical compact medical consortium.The efficacy coefficient method was used to evaluate the performance of 5 counties and 5 urban vertical compact medical consortiums.[Results]1.Results on the definition of concept and characteristics of the vertical and compact medical consortiumThe concept of the vertical and compact medical consortium which was defined by this chapter was as follows: the vertical and compact medical consortium is the interest community and responsibility community consisting of the higher-level hospitals and primary health care institutions,which takes the ownership and property rights between the high-level hospitals and primary medical institutions as the link,uniformly managed and allocated the medical resources such as human resources,financial resources,material resources,information and technology between them,integrated through reorganization,direct management,custody or merger,and implemented corporate governance management system,aim at improving the allocation efficiency of medical resources.The vertical and compact medical consortiums are characterized by uniformity,group and system.2.Results on builtion of operation aim system of the vertical and compact medical consortiumThe operation target system of the vertical and compact medical consortium built in this chapter were the collection of the goal set of four aspects including the medical service providers,medical service administrators,health service demanders and the society;among them,the health service demanders were the main target dimension which the policy target system concentrates on(the average value of its importance and tightness to the policy target system was 4.71);improving the medical and health environment(4.88),optimizing the medical resource allocation and efficiency(4.79),and improving the health service experience(4.67)were the top three target items in the sub-target of the operation target system.3.Results of theoretical framework construction of performance formation mechanism of the vertical and compact medical consortiumBased on the principle and procedure of grounded theory analysis method,this chapter built the theoretical framework of the performance formation mechanism of the vertical and compact medical consortium through rigorous project design and three-level coding analysis after obtaining 43 interview records,among wihich 34 were used for therotical builtion and the other were used for saturation test.After three-level coding with Nvivo 10,the theoretical framework showed that the performance formation of the vertical and compact medical consortium consisted of prerequisite conditions(government administrative command,primary medical institutions demand,the ability and willingness to medical institutions integration of the high-level health institutions,residents demand,competition in the market)and action strategy(management system construction,resources sharing)and sustain conditions(reform of the medical insurance,and formulation and implementation of the government supporting policy).The theoretical framework of performance mechanism of vertical and compact medical consortium also included five theoretical assumptions,which expounded the formation of the vertical and compact medical consortium performance and the link and the interaction relations of various factors in the process of the performance formation.4.Results of performance connotation definition of the vertical and compact medical consortiumThe performance connotation theoretical framework of the vertical and compact medical consortium built by this section includes seven performance level(the health services accessibility,health services affordability,health service quantity,health service quality,health services efficiency,health services effect,and health service benefit),19 performance points(medical services amount and other services amount,material affordability,mental adorability,geographical accessibility,time accessibility,service accessibility,life expectancy,health literacy,health level and academic benefit,social benefit,economic benefit,the result quality,process quality,structure quality,work efficiency of medical staff and efficiency of resource utilization efficiency,other efficiency),a policy goal of theoretical framework,and six theoretical assumptions.On this basis,this study put forward the concept of "performance of the vertical and compact medical consortium" : the vertical and compact medical consortium performance is the comprehensive change and the change degree of the health services accessibility,health services affordability,health service quantity,health service quality,health services efficiency,health services effect,and health service benefit,under the action of some certain conditions,in order to realize the goals of improving the medical service quality and efficiency,improving the medical service utilization,optimizing the environment of health service,and improving the level of residents’ health experience,after a certain amount of time of that the vertical and compact medical consortium takes some certain measures such as improving internal and external management system construction and sharing the medical resource of medical staff,goods,content,information,technology and so on,combined with their own medical services provision and management behaviour.5.Results of performance evaluation model construction of the vertical and compact medical consortiumThe performance evaluation theory framework of the vertical and compact medical consortium includes 7 dimensions-the health services accessibility,health services affordability,health service quantity,health service quality,health services efficiency,health services effect,and health service benefit.The performance evaluation index system contains six primary indicators and 24 secondary indicators.The reliability of performance evaluation index system developed by this study was 0.758,and the item-level content validity of each indicator was all above 0.78;the content validity from the system level was 0.96,showing that the index system had good reliability and content validity.At the same time,this chapter also adjusted and optimized the performance evaluation index system weight based on the entropy method,and finally finished constructing the performance evaluation index system of the vertical and compact medical consortium.This study suggested that the government and its relevant departments should carry out the performance evaluation of the vertical and compact medical consortium.At the same time,the results of this study suggested that the index data can be obtained through health statistical reports,supplementary questionnaires,home page of medical records,and questionnaires,etc.This study indicated that performance evaluation should be carried out once a year,and the performance evaluation results should be used for feedback communication,goal promotion,tool improvement,and incentive mechanism construction,etc.In the end,this study constructed performance evaluation model of the vertical and compact medical consortium containing the operation target,evaluation object,evaluation subject,evaluation methods,evaluation index system/tools,evaluation implementation and evaluation results application possibility.6.Results of empirical study on performance evaluation of the vertical and compact medical consortiumIn this chapter,the efficacy coefficient method was used to evaluate the performance of five county and five city’s vertical and compact medical consortia.The empirical results showed that A1 vertical and compact medical consortium in the county had the best performance,and D2 vertical and compact medical consortium in the urban area ranked first in the performance evaluation.A1 and D2 had some common characteristics,that is,their high-level hospitals had the condition and ability to establish the vertical and compact medical consortium;the government did well in support the consortium construction;the construction of the regional informatization was relatively better;other special practices were better,such as the key crowd demonstration management of A1 vertical and compact medical consortium.This chapter found that among every link of the performance formation process including preconditions conditions,action strategies,maintaining conditions,the problems can emerge,which would block the performance improvement of the vertical and compact medical consortia.(1)The problems in the premise conditions included that the government didn’t support the consortium construciton,didn’t give up the right,and held old ideas.The high-level hospitals and primary health care institutions didn’t have the willingness and ability to carry out integration.The medical concept of residents was poor,unrecognized and distrustful.The market competition was unreasonable.The socioeconomy was in low level and the disease spectrum was complex;(2)the problems in the action strategies link included internal management system construction strategies,such as unreasonable consolidation pattern choice,not unified business management,bad internal rules and regulations,and a lack of function orientation,and a lack of performance assessment,etc.,and the potential problems of resource sharing strategy such as the lack of personnel system,the lack of personnel incentive mechanism,information lag,cultural conflict,and the lack of cooperation in the department.(3)The problems in maintain conditions included the lack of health insurance,the lack of supporting policies and health care preferential policies,the lack of modern hospital management system and other personnel,finance,medicine,as well as the imperfect supporting policies,such as price.7.Results of study on performance improvement strategies of the vertical and compact medical consortiumThe performance improvement strategy of the vertical and compact medical consortium indicated that the performance improvement needed the joint efforts of the stakeholders.In the performance improvement strategies,(1)the government should make the top-level design and strengthen the supervision and performance management of the vertical and compact medical consortium;formulate and perfect supporting policies and systems;reform the health care system;guide residents to seek suitable medical treatment.(2)the high-level hospitals should improve the internal management system and operation mechanism of the vertical and consortium medical consortium,improve the standard of graded diagnosis and treatment;and perfect the staff sharing incentive mechanism construction,etc.(3)the primary medical institutions need to focus on the development of key and specialty specialties,strengthen the cooperation with the various services of the superior hospitals,and implement the contract service system of family doctors.(4)the non-member medical institutions need to realize the common performance progress with the vertical and compact medical consortium through reasonable competition.(5)The residents need to change the concept of medical treatment,improve their health literacy,and scientifically express the medical service demand.[Conclusions]1.The vertical and compact medical consortium is a interest and responsibility community with characteristics of unity,group,synergy.Following the support increase to its construction from the country,it’s necessary to conduct performance evaluation,find the performance situation and prompt the performance improvement around its operation aim.2.The vertical and compact medical consortium performance evaluation model is a synthesisi including operational objectives,performance evaluation subjects,performance evaluation objects,performance evaluation tools and performance evaluation index systems,and performance evaluation implementation,the possibility of the application of performance evaluation results,and other aspects.The performance evaluation of the vertical and compact medical consortium in various places can refer to the contents of this performance evaluation model.3.The problems that the vertical and compact medical consortium performance improvements face can be summarized as the benefit gambling of government,the superior hospital,grassroots medical institutions,other non-members and residents.The vertical and compact medical consortium performance improvement strategies not only need the joint efforts,support and cooperation of many stakeholders,but also need the joint efforts,support of residents and patients from the countries and its different regions and departments.[Innovation and deficiency]1.InnovationThis study takes the vertical and compact medical consortium as the research object for the performance evaluation,pays more attention to exploring the performance connotation of the vertical and compact medical consortium,hence,this study has the innovation on research perspective and thinking.Combined the quantitative and qualitative analysis method together,this study not only built a scientific and applicable performance evaluation model,but also proposed the performance improvement strategies using this evaluation model,indicating the innovation of the results application.2.DeficiencyAt present,the real vertical and compact medical consortium is few in China,we only selected 10 samples of vertical and compact medical consortium for performance evaluation under the this condition.Due to the availability of data,this study did not consider some very valuable but difficult accessible indicators,such as first option rate at the grass-roots level.At the same time,because the data is difficult to obtain,and the performance evaluation model is result and product oriented,it is difficult to reflect the characteristics of structure and process of the vertical and compact medical consortium in model construction and indicator selection.Nevertheless,this study can still provide some reference for the performance management of vertical and compact medical consortium from the perspective,thinking and method utilization level. |
PDF Full Text Request