Study On Incentive And Restraint Mechanism Of Dual Referral Between Urban Hospital And Community Health Service Institutions

ObjectiveThe study is based on the research of the literature, and the demonstration research of the dual referral between urban hospitals and community health service institutions. It analyses the effect factors and the incentive and restrain measures of the dual referral, and set up the incentive and restraint mechanism of urban dual referral and the manage system which is suitable for our country, that will deliver the patients properly. It will advance the hospital and community health service institutions, and will offer the basis for decision making to the dual referral system.Methods1. Review the literature and analyze the information: Reading widely the famous works, the learning discourse, the major magazine and the index literature information on the Internet in and abroad the country. Collecting the information in and abroad about the effect factors, the system and the running system of the dual referral. Concluding the main points of them. They are all the basis of the research. Meanwhile collecting the information of the denizen medical treatment and willings, which provides the basis to the denizen medical treatment and lead patients to have a treatment.2. Local research: Making research in the hospital and community health service institutions in Wuhan, Shenzhen, Nanjing, Hangzhou, Wuxi, Suzhou, ect, about dual referral; Having interviews with the managers in the health management and the medical insurance institution.3. The special group discussion: invite the health management scholars, the experts of community heath, the health officials of the executive branch, community health service staff and clinical professional experts to discuss on the dual referral of the factors and the corresponding countermeasures.4. Residents survey: According to the statu of dual referral in our country, in some hospital and community health service institution in Wuhan, we select optionally 2-3 hospital as the research and make a research among 440 patients in the system.5. Conjoint analysis: analysis of patient's preference of medical agencies by conjiont analysis, combine the literature and interviews, and analyze the denizen treatments and willings.6. Analysis of stakeholders: take the analysis on the related benefit group by defining the government, hospitals, community health service institutions and patients (residents) into different stakeholders. Study the dynamic and resistance of the dual referral by the way of summarized interpretation to explore the interaction of the behavior character.7. Analysis of PEST: Analyze dual referral with politics, economic, society, technique. And explore the complex structure relationship between the deep-seated causes of the influence and the internal factors among community health service institutions, hospitals and residents.Results(1) Status of dual referralIn the survey show that 28 cities, to the city district as a unit, only 36.13 percent of the establishment and implementation of hospitals and community health services dual referral system, in 2006 the average community health service centres referred 212 patients to hospital. And the number of patients return from higher-level hospital to the community health service center is only 56, most of the city area has not yet been established dual referral system. The incentive and restrictive measures of the hospitals and community health services dual referral are: the economic means to attract patients to community treatment; relief to the referral of patients with some medical costs; choice of the disease in dual referral pilot ; Develop dual referral indications; government departments to increase dual referral of the intensity of supervision and examination.(2) Problems and causes of dual referralFrom the government, hospitals, community health service institutions, residents of dual referral to discuss the issue: the definition of the bodies of unknown function, the absence of dual referral of the relevant laws and regulations, dual referral is still unable to follow the stage, but also led to the dual referral lack of basis of supervision and examination. Dual referral was lack of support by medical insurance. And for the backward methods of payment, it was not advance to incentive and restraint the dual referral behavior of hospitals and community health service institutions.Dual referral hospital due to worries caused by reduced income patients do not want to be back to the community health service agencies.Community health service institutions its own technical strength is limited, staff level is not high enough, residents of low confidence.Residents for medical treatment at major hospitals have a choice of preference and to seek medical treatment concept of unreasonable, out-patients, 4.8 percent of patients in attendance before the self-serious condition, 23.1 percent of the former self-treatment in patients with more serious condition, because of asymmetric information, Medical treatment in the course of irrational factors.(3) Factors affecting of dual referralThrough the combination of literature survey and expert advice, the impact on hospitals and community health service agencies of the dual referral can be attributed to three factors. First, the government of supporting policies, including the development of dual referral on to the next turn and standards. And promoting the construction of medical information, the development of community health services, and other measures, the medical insurance policy, the three wishes of the residents for medical treatment and behavior.(4) Dual referral incentive and restraint mechanisms constructionAccording to existing problems and the main factors affecting of dual referral, the construction of the corresponding incentive and restrictive mechanism was provided. The basis of dual referral incentive and restrictive mechanism: promote the ratings medical treatment system to encourage hospitals and community health service institutions to strengthen collaboration; establishment of the medical referral process of quality assurance system: create the referral indications standards, based on the clinical pathway; establish an information sharing platform and communication system.Government incentives and regulatory mechanism: the better two-way referral to the hospitals and community health service agencies must give economic incentives; introduced dual referral laws and regulations to ensure that dual referral law, the establishment of dual referral assessment indicators And standards to strengthen dual referral of the assessment; strengthen capacity-building of community health services, enhance its attractiveness to the residents.Strengthening health insurance for hospital and community health service organizations in support of two-way referral, the establishment of the medical insurance system based on the incentive and restrictive mechanism: the reform of medical insurance payments, based on the clinical path, according to the disease were measured at different stages of the acute phase of hospital fees and Rehabilitation of health services in the community to continue treatment of the cost of health insurance agencies were paid to the hospital with acute phase of hospital fees and to pay for community health service organizations in the rehabilitation stage of community health service agencies to continue treatment costs; health insurance costs Cover and dual referral hospitals and communities linked to the examination results.For residents of the incentive and restrictive mechanism: changes in community health service agencies deliver services, improve service quality and enhance the residents a sense of trust and attract patients to the first community consultation; intensify the promotion of community health services, and changes in residents for medical treatment concepts, to guide residents Reason for medical treatment.Conclusions and recommendations(1) Dual referral of hospitals and community health service institutions was at the initial stage of exploration, in part through a series of measures, and achieved certain results. However, there were some problems of dual referral, including the number of referred from hospital to community health service institutions being too less, lack of the standard of dual referral, lack of incentive and restraint mechanisms.(2) Hospitals and community health service organizations involved in a wide range of dual referral, is a systems engineering project, a single incentive and restraint mechanism limited effect, respectively, should be established for hospitals, community health service institutions, with the incentive and restraint mechanisms from government and medical insurance.(3) The dual referral should be patients-oriental; the government should play a leading role in promoting dual referral process.