The Analysis On The Influence Between The Global Per Capita Budget Based On Countywide Medical Service Community And Tiered Health Care System In Tianchang

Objective:Based on case study and network policy theory,this study explained the stakeholders' behavioral change as well as demonstrate the effect of tiered health care system in Tianchang county after the implementation of global per capita budget based on countywide medical service community.Consequently aiming to explain the effect mechanism of payment reform on tiered health care system with attempting to establish a causal connection between the two factors,and accordingly summarizing the reform's experiencesMethods:This study mainly adopts qualitative research method.Firstly,by literature review and expert consultation,the research hypothesis and framework are put forward.On the basis of the logic of case study,this study employs quantitative method to describe the effect of tiered health care after the implementation of the payment reform in Tianchang County.Then the framework of network policy is used to elaborate the behavioral changes and interaction between different stakeholders,so as to explain the influence mechanism of the payment reform.Results:1.The payment reform resulted from the requirement of national policy and Tianchang county's inner need including the inadequate capability of primary-level healthcare provision,disordered treatment and patient flow,and excessive pressure on new rural cooperative medical system(NCMS)2.The objective of the payment reform is appropriate,legitimate,and practical.The core measure of the policy that packages to pay to the two public medical service community in advance optimizes the profit distribution,and the surplus fund is allowed to distributed by the healthcare providers.The performance appraisal supervision and referral procedure,as a supporting system,are the guarantee of the payment reform.3.The payment reform causes the stakeholders' behavioral changes:(1)The health sector strengthens the management system and promotes the democratization of decision-making.And the management authority is transferred to the healthcare provider from the health insurance administration.(2)The county-level hospital increases the input intensity and improves the service capability to alleviate the burden of the reduction of the county-level service.The cooperation and coordination between the county-level hospital and primary-level health care institutions is enhanced,and the referral tends to be reasonable.(3)The resident gradually develops the reasonable referral habit.4.the data result shows that the trend of tiered health care emerged:in 2014-2017,the county consultation rate is on the rise,and the amount of service in county-level hospitals and primary-level institutions increased.In 2016-2017,the number of referrals of county-level hospital increased by 16.4%,the number of inpatient referrals from county-level hospitals increased by 1.05 percentage points,and the proportion of primary-level referral decreased by 2.27 percentage points.Furtheremore,the NCMS outpatient number surpassed that of county-level hospitals.As the proportion of primary-level service amount decreased and the primary-level health manpower is insufficient,it failed to full fill the goal of tiered health care.Conclusion:The global per capita budget based on countywide medical service community improved the stakeholders' behavioral changes by regulating the distribution of benefits to enhance balanced and effective interaction between the interests of all parties.In general,the capability of county and primary-level health care provision was promoted,and the referral system was optimized.However,there is shortage of primary healthcare workers,and the capability of primary-level healthcare provision is inadequate.Besides,most NCMS funds flowed to county level hospitals.Ultimately,the goal of the payment reform is fail to achieve.Recommendations:1.Improving the community-based medical capability and enhancing the enthusiasm of grassroots healthcare workers to provide better service.2.Enhance the awareness of health promotion of medical community and improve the health level of residents3.Strengthen the compactness of medical community and improve the synergy of county-level and primary-level health care development4.Make the function of the health care provider match with the grading of diagnosis and treatment,and improve the complementary development pattern of the county medical service community.