| [Purpose] The active promotion of county medical service integration reform and construction is an important strategy and approach to solve the current shortage of medical and health resources,low quality,unreasonable structure and layout,and fragmented service system.This study takes Tianchang City of Anhui Province and Dangyang City of Hubei Province as examples.It takes the characteristics of the reform of medical service integration in the sample area as an entry point,analyzes the status quo of its development,and realizes the cooperation mechanism among related elements in the integration process.The effects and obstacles provide reference for the integration of county medical services.[Methods] Taking the county-level medical service integration construction practice as a starting point,a typical case study is conducted to investigate the integration of county-level medical service construction in the cities of Tianchang,Anhui Province and Dangyang,Hubei Province,as well as construction initiatives and integration services.At the same time,based on a synergistic perspective,using the analysis of system fundamentals in system dynamics,and analyzing the reform process of county-wide medical service integration,it is necessary to realize the key factors of integration and collaboration,and the synergy mechanism for achieving these synergies.This paper proposes a coordinated perspective to further promote and perfect the county medical service system integration reform,with a view to providing a reference for the balanced development of the county medical service system,the promotion of high-quality resource sinking,and the improvement of the hierarchical medical treatment system.[Results] 1.Integration and construction of county medical service in Tianchang City,Anhui Province.In Tianchang City,Anhui Province,county-level hospitals took the lead and formed county-level medical communities in the county.Through the integration,the rights of all types of administrative departments within the county area are reclaimed;the reform of the total amount of prepaid medical insurance funds for medical insurance funds is reformed;the responsibility and division of labor are clearly defined in the “Medical Community”;and the system of collaborative governance,the distribution of synergies,and the division of work of coordination and responsibilities are among others.A number of concurrent efforts were made to explore the county's integrated medical service system.After the development of the county medical community,the overall level of medical services within the county has improved and improved to a certain extent before the establishment of the “Medical Community”;the benefit coverage of the new rural cooperative residents in the county area has been expanded,and the benefit level of participating residents in the county has also increased year by year.The trend is that the medical institutions at various levels within the “Medical Community” will cooperate in an orderly manner in various forms.The level of medical services provided by grassroots medical institutions has not been significantly improved.Among them,the cumulative number of hospitalization compensations for township and township hospitals showed a downward trend.In 2016,cumulative compensation times decreased by 22.35% compared with the same period in 2014.Although 2017 increased by 23.92% compared to the same period of 2016,it was still slightly lower than the number of compensations for the same period in 2014.In the upward flow of care,the proportion of hospitalization outside the city did not change significantly before and after the establishment of the "Medicinum",but the proportion of hospitalized compensation for township health centers fell from 20.61% in 2014 to 15.2% after the establishment of the "Communist Community" and 15.98%.2.County health care service integration construction method and effectiveness in Dangyang City,Hubei Province.The city of Dangyang,Hubei Province has made full use of its region to vigorously develop the opportunities for the construction of information-based medical associations of “internet + grading diagnosis and treatment”,and in combination with the NCMS payment reform process within the county,the establishment of a multi-stakeholder centered on information service platform sharing in the county area.The medical service integration model in the county is based on mutual benefits and county-wide integration of medical resources.By means of informatization,Unicom's medical institutions at all levels in the County will implement unified management and uninterrupted medical services,so as to rationally allocate and use county-level medical resources,improve the county's medical service capacity in a balanced way,and improve county medical service quality and quality.After the integration of “Internet + grading diagnosis and treatment” was carried out,a total of 4,068 people were transferred to county-level medical institutions.Among them,96.85% were transferred from primary medical institutions;2905 were transferred out,of which 2.82% were down Patients who continue to be treated in basic medical institutions in the county.The number of referral applications involving the two county-level hospitals in Dangyang City was 9,396,and the total number of referral patients was 8,132,and the actual attendance rate was 88.09%.Reasons for the unsuccessful implementation of the application included the failure to pass the relevant information of the pre-advanced patients.The referral application of the rural cooperative medical examination and referral medical institution was rejected by the receiving institution,the referral application was successful but the referral patient did not actually go.3.Different forms of integration of medical service reform have different effects on the medical service-related activities of county-level medical service providers and medical service users.For health service providers,72.1% of the medical service providers in Tianchang City,Anhui Province,expressed their understanding of the form of integration of medical services in the region.50.4% of medical service providers in the city of Dangyang had heard of the integration of medical services.Not quite knowing,29.9% said they have not heard of it.In terms of acceptance of medical service integration within the county,among the medical service providers surveyed in the two regions,82.4% of Tianchang City agreed to carry out integration construction,and 13.1% said that it was unclear about its role and it was uncertain whether to build it;The city was 54.6% and 38.6%.Regarding the degree of acceptance of peer-level inspection results,169(79.7%)of the surveyed population in Tianchang City expressed approval,and 72(56.7%)in Danyang City expressed trust.For health service users,39.90% of health service users in Tianchang used county-level and primary-level medical services,42.86% used county-level medical services,17.24% used only primary-level medical services,and Dangyang City 41.76%,44.51% and 13.74%.The medical service users in the two cities have satisfied their satisfaction with the medical experience in this county and doctor-patient communication satisfaction(including very satisfied and satisfied),among which the number of people who choose “very satisfied” with the satisfaction of medical experience in Tianchang City is relatively low.The city of Dangyang was 10.32% higher,and the number of “very satisfied” doctor-patient communication satisfaction was 19.83% higher than that of Cangyang City.If county hospital experts visit a primary medical institution on a regular basis,whether health service users will be willing to visit the primary medical institution nearest to them,the two regions will have more opportunities to choose to visit the nearest clinic instead of choosing a township.Residents who received surgical treatment in the hospital accounted for 46.46% of Tianchang City and 48.35 of that in Dangyang City.4.Based on the basic model of the system,the analysis of the elements of county medical service integration synergy mechanism.The overall planning,governance system,medical insurance policy,responsibility and division of labor,and sharing of resource information for all types of medical institutions at all levels in the county area are the key elements for the operation of the county's medical service integration and coordination mechanism.The medical service users and medical service providers recognize it.Knowledge change and experience improvement are the focus of the synergistic effect of county medical service integration.[Conclusions] It is in line with the law of the development of medical and health services in the region and conforms to the social development trend that the reform of the medical service integration system carried out by the regions in various forms in the county area.However,currently,in the process of carrying out integration reforms in various regions,there are still problems with the unsmooth operation of the medical service integration coordination mechanism,unbalanced development of institutions at all levels,and the lack of awareness and attention of various stakeholders on integration.In order to give full play to the functions and advantages of county medical service integration,it is necessary to further clarify the key elements that need to be formed in the integration process,from the aspects of management collaboration,benefit coordination,and responsibility coordination,to establish an innovative and effective coordination mechanism to ensure overall The realization of the synergy effect.At the same time,to further improve the synergy mechanism and bring into play a synergistic effect depends on the joint efforts of various parties.It is recommended that efforts be made to increase the overall management of relevant government departments;the effective implementation of all levels of medical institutions and common development;the active participation of medical technicians within the county Residents in the county understand,understand and cooperate. |
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