Research On Collaboration Mechanism Of Different Grade Hospitals In Shanghai

Many documents of the medical reform proposed to explore the cooperation mechanism of different levels of hospitals,but none of them mentioned the specific operation path for the establishment of the cooperation mechanism.At the same time,medical alliance is an important mode for different levels of hospitals to carry out cooperation.Since 2011,Shanghai has been carrying out the pilot reform of medical alliance,and each district has explored the construction of regional medical alliance according to medical resources and medical needs of residents.However,in the specific process of implementation,a series of deep-seated problems such as the definition of rights,responsibilities and interests,the distribution of interests,the assessment and incentive,the medical insurance policy and so on gradually become prominent.Therefore,such key core issues as the reasons for different levels of hospitals to carry out the cooperation mechanism,the main contents involved in the cooperation mechanism,the motive source of different levels of hospitals to carry out the cooperation,and the action mechanism of various stakeholders are worthy of further research in the academic circle.This study comprehensively uses literature research,in-depth interview,level analysis and other methods to analyze the motivation and resistance of different levels of hospitals to promote cooperation from the perspective of internal game.Specifically,for the third level hospitals and community primary medical institutions,their overall willingness to promote is relatively strong,but there may be concerns that the third level hospitals bear more responsibility than power,and the community primary medical institutions are the main ones We need to worry about the loss of autonomy,the formation of new pressure on chronic disease management,and the lack of attention to public health work.However,the second level hospitals believe that cooperation can help to obtain technical support,and some disciplines can be strengthened,but they also worry about the loss of autonomy,the loss of part of the source of disease,and the lack of guarantee of interests,so their promotion attitude is relatively opposed.Patients’ willingness to cooperate with different levels of hospitals is relatively weak on the whole.They are mainly worried about the loss of the right to free medical treatment,the delay of referral,and the service quality of basic medical institutions.At the same time,through external benchmarking,we can draw the following enlightenment: first,the level of its own medical supply system is clear,the division of labor of the whole specialty is clear,to help realize the up and down flow.Secondly,the functional orientation and career planning of general practitioners and specialists are clear.Third,the government led the formulation of scientific and reasonable health development plan,and effectively allocated various medical and health resources within the region.Fourth,give full play to the guiding role of medical insurance,promote the strengthening of cooperation among medical institutions at all levels,and guide patients to diagnose and treat at different levels.In addition,based on the in-depth interview and analytic hierarchy process,this paper finds out the main problems faced by Shanghai to promote the cooperation of different levels of hospitals: the relationship between the main bodies has not been straightened out,the discourse power of large hospitals is too large,and there are obstacles in the downward flow of patients,etc.,and analyzes the causes,mainly because the basic medical service institutions are relatively weak,the internal management system and operation mechanism need to be improved The leverage of medical insurance policy has not been fully exerted and there are four obstacles in the operation of two-way referral.Based on the above analysis,the countermeasures and suggestions are put forward as follows: first,to improve the service ability of the grass-roots level,including increasing the training of general practitioners,promoting the internal flexible flow of medical staff and enriching the layout of community elderly care and rehabilitation resources;second,to improve the internal management mechanism,including promoting the internal resource sharing,building the information sharing platform and strengthening the assessment and incentive mechanism;third,to increase the medical service capacity The reform of insurance payment includes the reform of payment method,the establishment of medical quality assessment system and supporting policies for medical insurance;the fourth is to optimize the two-way referral process,including the reasonable adjustment of economic interests of different levels of hospitals,the establishment of a highly operational system and action guide,and efforts to build a family doctor system.