Study On The Stakeholders And Evolutionary Game Theory Of Vertical Integrated Of Rural Health Services

The rural health service system is an important part of health and family planning system.Country hospitals as the leading units,township hospitals as the hard-core units,village clinics as the foundation units,shoulder the responsibility for the peasants in rural public health and third medical service network.With the change of national health policy as well as driven by economic interests,different medical institutions become relatively independent economic subjects,lack of coordination and cooperation with other organizations.It’s not practical to play synergies and overall advantages.Through vertical integration of rural health services and promote cooperation between different medical institutions,patients can get the continuous,convenient,high-quality medical services.ObjectiveThis study was conducted in the rural areas of vertical integration in Jiangsu province.To explore and analyze the role,position,authority,important degree,resources,interest demands and troubles.Through building an evolutionary game model to construct the game strategy analysis of participants in integration and seek the promotion mechanism for integration of strict implementation,aiming to mobilize the initiative and enthusiasm of the integration.The participants in the main influencing factors on rural medical service vertical integration,to promote the rural medical service vertical integration to provide a theoretical reference and basis for decision making.MethodsDefine the main stakeholders of the vertical integration of rural health services by literature analysis and group discussion.Based on stakeholders theory and evolutionary game theory,questionnaire and qualitative interview are used as empirical analysis.The self-designed questionnaire and interview outline are used for stakeholders analysis.A fundamental evolutionary game theory basis has been used in this study to deal with interests between different stakeholders.A study on the influencing factors is conducted to understand the determinants of the rural health service vertical integration.The survey completed a total of 330 questionnaires on the importance of integration factors,202 stakeholders questionnaires and 119 stakeholders interviews.Results1.The main stakeholders in the vertical integration of rural health services,namely:the health sector,department of medical insurance,country hospitals,township hospitals,village clinics and patients.The health sector,department of medical insurance and country hospitals play important roles in integration.In terms of position,the county hospitals remain neutral,the rest are supportive attitude.The health sector focus on the rational allocation of medical resources and the rise of health service ability;The department of medical insurance aims to balance the medical insurance payments and increase the efficiency of funds;Country hospitals in the integration look at hospital reputation and market share;Primary health care institutions are to enhance the ability of medical services and increase economic benefits;Rural patients pay more attention to the quality and economy of medical service.Four common factors were extracted,namely organizational management,incentive mechanism,policy and supporting measures,information sharing and further professional work communication.The comprehensive scores given by the health sector,medical insurance department,country hospitals,township hospitals,village clinics and patients.were 0.025,0.030,0.032,0.015,-0.013 and-0.037.2.The preconditions of forming a cooperative game system,there were:（1）The benefits of cooperation exceeded the unilateral speculative benefits（w₁-v₁-d₁>0&w₂-v₂-d₂>0）;（2）The stakeholders depended on different indicators of systematic evolution in the process of evolutionary game.The reducing of cooperation cost and rising of the income would make the evolutionary game converge to point（1,1）.SuggestionsThe government improves the supporting policies and measures of the vertical integration of rural health services.Country hospitals need to strengthen cooperation with rural primary health institutions to enhance the medical service capacity.Strengthen the integration of country medical resources and speed up the reform of medical insurance payments.Increase health finance investment,perfect the allocation of medical resources,create conditions for collaboration and reduce the operation space of the system.Meanwhile,we should build an incentive and restraint mechanism,aiming to increase the enthusiasm of medical institutions and medical staff.Finally,improve the publicity and education for the patients about the vertical integration to enhance the patients’ trust in primary hospitals,and gradually form good medical order.