Analysis On The Management Mode Of Regional Medical Alliance In Beijing And The Effect Of Hierarchical Medical System

Objective 1.To understand the construction of Medical Alliance in Beijing and sum up the management models 2.To classify the management models and illustrate the current achievements in the construction of Medical Alliance combined with the situation of medical institutions and the attitude of patients and doctors in order to analyse the developmental issues of Medical Alliance and provide policy recommendations.MethodsThrough literature and policy research methods,we should study and arrange the relevant policies and requirements of medical conjoined and graded clinics.The second step is expert interview,face-to-face interviews were conducted among the heads of medical associations in each district of Beijing,questionnaire survey was conducted to investigate the cognition,degree of satisfaction and the degree of use of the doctors and patients in the conjoined medical union.Finally,combined with the data analysis method,the outpatient departments of medical institutions were analyzed year by year.ResultsBeijing has constructed 53 Medial Alliances until December of 2016 and has basically formed a hierarchical medical system with Medial Alliance as the main body.The author selected three aspects of ‘implementation of government-directed tasks',‘outpatient service of medial institutions' and ‘internal operation of Medial Alliance' to describe the effect of setting up a hierarchical medical system.After the establishment of Medical Alliance,that is,comparing the data collected from 2015 to 2016 and from 2013 to 2014,in 23 selected Medical Alliance,the amount of outpatient at grassroots clinics increased more higher than the amount of outpatient at grassroots clinics in Beijing while the amount of outpatient clinics in core hospital decreased more lower than Beijing.Patients orderly flowed to the grassroots.The Medial Alliance selected have carried out convenience measures such as dual referral system,the experts of core hospital going to the grassroots,mutual recognition of telemedicine and test results.However,there are still problems of failing to cure patients at grassroots clinics.The selected Medial Alliances were classified into two management models of compact and loose with the standard of whether the core hospital in the Medial Alliance participated in the management of cooperative hospitals.The results of questionnaire reflected that patients and doctors of compact management model in core hospital were more familiar with the Medial Alliance compared with loose pattern.The number of patients transferred to the primary hospital and visits to the rounds were also more than loose type.The compact type of Medial Alliances displayed more favourable pattern of transfer and better effect of visits to the rounds.Doctors in the cooperative hospitals under the compact management made better improvements of their own professional ability due to Medial Alliance than loose pattern.Patients approved Medial Alliance in the transfer of quality medical resources to the grassroots,improvements of the order of medical treatment and mutual recognition of the results.Increasing government financial investment was the main suggestion of doctors in the core and cooperative hospitals about Medial Alliance.The results showed that the decrease of outpatient clinics in the core hospital of compact model was more obvious than that of the loose model after the establishment of Medial Alliance.The increase of outpatient clinics in the grassroots was also more obvious than that of the loose model.The decrease of the ratio of drugs in the medical expenses under the compact management was lower than that of the loose model not only in the core hospitals but also at grassroots clinics.ConclusionThe construction of regional Medical Alliance is an important mechanism to promote hierarchical medical system in Beijing.The effective management mode in Medical Alliance is a significant part of setting up a hierarchical medical system.Medical Alliance should have the autonomy of management,autonomy of staff matters and rights of income distribution,deploy human,financial and material uniformly in hospitals in order to realize the integration of economic interests,which contributes to close integration of equipment,technology,personnel and management of different hospitals and leads to a more effective role of Medical Alliance in promoting hierarchical medical system.