| Objective: This study starts from the perspective of the integration and utilization mechanism of medical resources in Anhui Province and takes the model of the medical community in the county as an example to study the four main measures of the county medical community: two-way referral,county inspection and inspection center,family doctor signing,The status quo of doctors' multi-practice operating mechanisms,discovering major influencing factors,and establishing or improving operational mechanisms to provide reference for government departments to adjust institutional mechanisms and formulate relevant policies,and to explore different regions for the reform of medical service supply side.Different levels of joint health planning,overall planning for health services and other aspects laid the theoretical foundation.Subjects and Methods:Three counties in Anhui Province that have carried out trials in the county medical community were selected as survey samples.Medical personnel from different departments and outpatients and inpatients were selected as the survey subjects in the tertiary medical institutions in the sample counties.Medical staff questionnaires mainly include: basic conditions,the impact of medical community after the implementation of the doctor,the degree of policy awareness,recommendations and so on.The patient questionnaire mainly includes basic information,understanding of the medical community related policies,and so on.Use EXCEL for data entry and SPSS for data analysis.Several face-to-face special interviews were conducted with relevant leaders of the selected sample counties,medical institution leaders,and outpatients and inpatients.The heads of personnel, finance,and medical departments at various levels of medical institutions in the sample counties were organized,and several clinical team physicians conducted small-scale seminars.Results:(1)The main situation of the two-way referral: In 2016,the number of transferees in the three counties increased,especially in C County,which increased by5,704.There was no significant increase in the number of transfers,and there was even a decrease in county B;91% of the medical staff said that they were very familiar with the referral process;86% of the medical staff clearly indicated the referral;and 32% of the medical staff proposed to block the current transfer.The main reason is the lack of effective incentive and supervision mechanisms,and another32% believe that there is a lack of effective communication between medical institutions.The degree of government support for two-way referral is relatively high,and a series of policies have been introduced;there are relatively complete referral standards and procedures,and the corresponding assessment mechanism is relatively sound;however,the incentive mechanism for referral is not yet complete,and the motivation for doctors is insufficient.The support mechanism is not sustainable and there is no independent referral information platform.(2)County inspection and inspection center The main situation: currently relying on leading hospitals to establish inspection and inspection center,the specific project is mainly hospital disinfection supply center,the development of medical imaging and pathological examination center has been stagnant;main influencing factors are: the timeliness of certain specimens,The transportation is inconvenient and the interest space is small.The enthusiasm of the hospital is not high.The state has already put forward some norms and standards for the construction of such centers.However,due to the late start,third-party inspections and inspections are still in the exploratory stage,and supporting mechanisms need to be further improved.(3)Signature of family doctors Main situation: 25% of medical staff believe that the main problem of family doctors signing contracts is the shortage of general practitioners,and 20% of medical staff said that the popularity of residents has become a more serious problem.Some village doctors work for a number of jobs.Most village doctors are over the age of 50.They are unfamiliar with the use of computers and work inefficiently.The workload has increased,the salary level has not increased,and the village doctors have been underpowered.The current assessment indicators of the medical management department are more focused on the number of signed contracts,and there is no detailed assessment index on the quality of contracted residents' health management.The evaluation index system is still not perfect.(4)Physicians practice more in the main situation: 68% of the medical staff generally understand the multi-point practice policy,19% of the medical staff completely do not understand;83% of the medical staff said that they are willing to conduct more practice,8% wait-and-see attitude.Due to the current pressure on doctors and the unclear attitude of hospitals,there are very few people who actually conduct more practice.The pressure of doctors' work shows that the distribution of medical resources in China is unreasonable,leading to unbalanced flow of patients.High-quality physicians are not allowed to practice freely.On the other hand,due to the imperfect related legal system,physicians are more at risk of practicing.Discussion and Recommendations:The two-way referral rewards and penalties mechanism is an important way to achieve efficient operation of the two-way referral.It can reward doctors who follow the referral system,especially for the doctors who transfer patients,and establish a punishment mechanism that restricts doctors' behavior.Institutions need mutual assistance to build sustainable support mechanisms;establish flexible referral mechanisms for practical difficulties in two-way referral;promote referral informationization;suggest cooperation with third-party software companies to build a two-way referral network system.The establishment of a county inspection and inspection center needs to coordinate the interests of various parties and improve the relevant protection system.It is recommended to formulate some preferential policies to obtain the support of medical institutions.As the core competitiveness of the inspection and inspection center,the quality of service should be strictly restricted to the mechanism and quality management mechanism as well as the logistics network protection mechanism to improve the personnel training mechanism;in order to allow inspection and inspection results to be shared,It is necessary to unify the information systems of various medical institutions and unify the project names.The perfect focus of the family doctor's contracting operation mechanism is on the number and quality of family doctors.It is necessary to strengthen the training mechanism for general practitioners;in order to ensure the signing power of village doctors,there should be a good interest distribution mechanism,in particular increasing government investment and improving village doctors.Treatment,in addition to the establishment of a systematic evaluation system.In addition to vigorously publicizing the doctor ' s multi-practice policy,it is more important to change the existing institutional mechanisms and liberate people's thinking.It is suggested that a reasonable interest distribution mechanism be established and that the medical responsibility-taking mechanism be improved.In order to ensure the quality of service,relevant policies can be established to govern the doctor's practice time,use physician associations to supervise physicians' practice behaviors,and supplement regional physician information platforms to keep abreast of physician practicing information. |
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