Study On The Influence Of The Linkage Mode Of Medical Union On The Development Of Primary Medical Institutions

Objective: To study the mode of cooperation between the core hospital and the grass-roots medical institution in the present two types of medical union pattern in Fujian,and to sum up the main methods in the background of promoting the construction of the union to improve the ability of the grass-roots health service.To evaluate the actual effect of the development of the grass-roots medical institutions in different medical union patterns,and to make corresponding suggestions for the existing problems and to provide reference for further promoting the further development of the medical union.Methods:The data of this study mainly came from the compilation of health and family planning statistics in Fujian Province,related yearbook data and questionnaire survey,etc.,combined with the methods of quantitative analysis and qualitative analysis.Using the method of literature research,this paper analyzes and summarizes the current policy environment of the development of medical union and primary medical institutions,the construction of two different modes of medical union in Fujian Province and the main practices,and so on.Descriptive statistical method was used to analyze the influence of different medical consortia models on the changes of health services in primary medical institutions.The data enveloping method was used to evaluate the relative efficiency and the change of efficiency before and after the reform of the primary medical institutions in the medical union,and the TOPSIS method was used to evaluate the comprehensive benefit of the primary medical institutions.On this basis,a questionnaire survey was carried out to understand residents' satisfaction with health services in primary medical institutions and the evaluation of health services provided by primary medical institutions after participating in the establishment of medical union.Through the interview method to understand the managers and medical staff to the construction of medical union views and problems.Results:(1)The current governments at all levels have provided a solid policy basis for the development of medical union.The existing medical union models can be divided into three categories: "contract type" loose medical union,the "transitional" semi-compact medical union and the tight medical union with property rights link are the main ones.(2)According to the influence of the cooperation mode between the core hospitals and the primary medical institutions in Fujian Province,it can be seen that the primary health services are affected by the cooperation between the core hospitals of the medical association and the primary medical institutions in Fujian Province.Under the loose and compact medical union model,the quantity of outpatient and emergency services in primary medical institutions increased,but the quantity of in-patient services decreased.(3)Data analysis shows that the comprehensive benefit evaluation results are as follows: the influence of loose medical association on the development of primary medical institutions is not significant,but the development trend of compact medical associations in primary medical institutions is getting better year by year.Efficiency evaluation results show that the overall efficiency of primary medical institutions in the two models is less than 1,and TFP shows a downward trend,and TFP of primary medical institutions is less than 1,and TFP is decreased.(4)According to the results of the questionnaire survey,it can be seen that in the aspect of residents' evaluation,the awareness rate of the residents of the medical association is not high(34.2%),and the participation of two-way referrals is low(9.7%).The proportion of residents' understanding of the association and its related policies,the satisfaction with the provision of services,the frequency of primary visits and referrals in the tight medical union were higher than those in the loose medical union(P<0.05).In terms of evaluation of medical personnel,more than half of the medical staff(51.5%)were not satisfied with the evaluation of the form of support and training in higher-level hospitals in the medical union.Among them,the loose type accounted for 56.5%,and the compact type accounted for 44.8%.The frequency distribution and difference were statistically significant(P<0.05).For two-way referrals,"no referral patients" is the most,it can be seen that the two-way referrals in the body of the medical association is not ideal.Conclusions:At present,the effect of different medical union construction on promoting the implementation of primary medical institutions needs to be further strengthened.On this basis,in order to further promote the development of medical institutions at the primary level,starting from the aspects of government support and policy protection,the form of assistance in the medical union,the residents,and so on,put forward the policy suggestions to promote the construction of primary medical institutions in Fujian Medical Union.Efforts should be made to promote the transition from loose medical union to tight medical union,and to improve the ability of primary health services to meet the needs of residents' health services.