"Down-referral Being Difficult" Phenomenon In The Two-way Referral On The Stakeholder Theory

Objective: The allocation of health resources,to provide medical services and community residents on medical service social demand does not match,the implementation of two-way referral system is also "turn to come back to the embarrassing situation,the basic medical service for community residents is difficult to guarantee.This research is based on stakeholder theory,and takes the two-way referral of Guangzhou as the research point,and systematically combs and analyzes the existing problems.Based on the investigation of the cognition and interest demands of the stakeholders in the bilateral referral,the author tries to clarify the power and resistance of the implementation of the "downward movement",and puts forward the strategy of coordination of interests and relevant policy recommendations,so as to effectively promote the implementation of the "downward movement".Methods: Through literature analysis,the related research of two-way referral at home and abroad was collected and summarized,and the stakeholders of two-way referral were determined according to the results of literature analysis and induction.Based on the identified stakeholders and the research foundation,a two-way referral stakeholder questionnaire was designed to investigate.The questionnaire adopts cluster random sampling method,and the sample is mainly based on the level,including the Guangzhou municipal health administration departments,medical insurance departments,medical institutions,community health service institutions and community residents.The questionnaire content mainly includes: the degree of stakeholders under system of understanding;whether the stakeholders have been referral experience;stakeholders to turn the degree of support;key stakeholders to turn difficult views;stakeholder views on the implementation of the main pressure to the interests;the demands of stakeholders of the two-way referral back to the.According to the purpose of the study,we use the SPSS17.0 statistical software to do the nonparametric test analysis and chi square test for the relevant data.Results: A total of 374 two-way referral stakeholders were surveyed.For two-way referral stakeholders,the level of understanding varies across the two-way referral system,and the understanding of public hospitals and community residents needs to be further strengthened.In the referral experience,the number of upper rotation cases is higher than that of the lower rotation.In support of the implementation of the downward shift,the health administration departments and community health service institutions are more supportive,while public hospitals,community residents and medical insurance institutions are less supportive.The key factors in turn to stakeholders,most think the process and to guide the specification did not specify the level of medical technology,the lack of community health services and primary health professionals and community residents under the concept of transfer is not strong is the key.In the main pressure of the transfer,stakeholders believe that the lack of hardware and software of community health service institutions is the main pressure to implement the transfer.According to the survey results,the main interests of the administrative departments for public health under the difficulty is mainly through the functions of positioning clear at all levels of medical institutions,strengthen the close cooperation relationship,reduce the conflicts of the interests of all levels of medical.The main interests of the public hospitals in transferring to the lower levels are that they should clearly divide the legal responsibilities and implement them under the premise of not affecting the survival and development of the hospitals,so as to implement the transfer with the minimum input costs.The main interests of the community health service institutions to turn difficult is to strengthen the investment in hardware and software,introduce more talents,improve the level of medical technology,hope to expand the range of available drugs and health care policy,thus to smooth increase revenue,improve economic benefits.The main interest demands of the community residents for the next turn difficult is to lower the medical costs,facilitate medical treatment and ensure the level of diagnosis and treatment.The main interest of the medical insurance institutions is to make rational use of medical insurance policies,and ensure the reasonable input of medical insurance funds and enhance the stability of medical insurance funds under the effective implementation of the transfer policy.Conclusion and suggestion: The implementation of bilateral referral is closely related to all stakeholders.To a certain extent,only by meeting the interests of stakeholders,can the transfer be unblocked.Therefore,it is necessary to put forward the strategy of coordination of interests,mainly for the interests of all stakeholders to coordinate and balance issues.In addition,not in the coordination process,concrete analysis must be to equate "stakeholders specific issues,for the coordination of interests.Suggestions include: establish the interest coordination mechanism,medical institutions to solve the conflict of interest;to effectively adjust the compensation mechanism;optimizing the referral link,regulate the transfer standards;strengthen community investment,establish a long-term mechanism to attract talent;improve the medical insurance payment,the incentive and constraint mechanism to build the construction of medical insurance;two-way referral the information sharing platform,guarantee the continuity of the construction;medical rehabilitation service system,realize multi referral;vigorously the establishment of close medical consortium,to build a real community of interests.