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Based on the reality that the Health Management Alliance(HMA)has been initially established nationwide as an important component of the integrated health care service system,on the basis of summarizing the evolution process of transaction cost theory,discriminating the essential characteristics of HMA,deconstructing HMA transaction cost and putting forward a quantitative measurement model,the coping strategies of HMA transaction cost are summarized into three levels:"knowing","reducing"and"increasing".It aims to solve the high transaction cost effectively and explore the economic system supply path;correct the deviation of the field of vision which only focuses on the"output orientation"of HMA in the early stage,and arouse the attention and thinking of all parties on the transaction cost of HMA;provide a new position and a new idea for HMA policy research and reform practice in China.
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The access evaluation of new medical technology is an important part of the preclinical application of medical technology and plays a vital role in ensuring the quality and safety of medical services.However,in the con-crete practice of access evaluation,there are still some problems such as imperfect access theoretical framework,imperfect evaluation index system.With the strategic support of health policies,laws,and regulations,the theory and method of HB-HTA are used for reference,core elements such as assessment subject,assessment object,and assessment content are comprehensively considered,the index system is designed from the dimensions of tech-nical characteristics,safety,effectiveness,economy and applicability,and the access evaluation framework of im-ported medical new technologies is constructed.To offer a theoretical framework and evidence-based basis for medi-cal facility medical technology access management.
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Objective To construct a systematic evaluation model of the operation and management capacity of pub-lic hospitals,and to objectively and realistically assess the current status of the operation and management capacity of public hospitals.Methods The"input-process-output"framework was used to construct a systematic evaluation model for operation management capability.56 public hospitals at or above the secondary level were sampled to con-duct empirical research.Results The results showed that,operation management in current stage emphasized a"re-sult oriented"approach,with insufficient basic investment and unclear core activities.Increasing funding investment,strengthening hospital marketing,and improving output quality were the core tasks of operation management.The operation management were generally in the initial stage,and the overall ability was not strong.The ability advantages of tertiary hospitals were relatively prominent.Conclusion It recommended that public hospitals should focus on the five major elements of human resources,finance,information,systems and decision-making mechanisms to com-prehensively optimize operation management investment;precise core activities,and promote the modernization of the economic system by improving the efficiency of resource allocation;stimulate the potential of hospitals,medi-cal staff,and disciplines to improve the quality of comprehensive outputs.
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Objective:To analyze the satisfaction of referral patients for the medical services provided by the countywide medical community, for reference in further improving its quality and continuity of medical services.Methods:From April to July 2021, a systematic sampling method was adopted to selected the survey subjects from the outpatients from the leading hospitals and three affiliated units of two medical communities, as well as those from two county-level hospitals of non medical communities and five grass-roots medical and health institutions. A total of 660 patients were included in the questionnaire survey. The questionnaire covered key demographic information and 15 satisfaction questions under 4 dimensions. The propensity score matching method was used to reduce confounding factors, factor analysis was used to calculate the satisfaction of referral patients in the medical community group and the non-medical community group, and the systematic dynamics approach was used to analyze the effect of patient satisfaction on referral intention.Results:A total of 641 valid questionnaires were collected. Based on a 1∶2 propensity score matching, 591 patients were finally enrolled, consisting of 102 up-referral cases from the non-community group and 273 such cases from the community group, as well as 76 down-referral cases from the non-community group and 140 such cases from the community group. The overall satisfaction scores by both up and down referral patients were 4.26(1.01)and 4.29(1.14)respectively.The overall satisfaction, medical service satisfaction, technical service quality satisfaction and non-technical service quality satisfaction of up-referral patients, as well as the overall satisfaction, non-technical service quality satisfaction of down-referral patients of the community group were higher than those from the non-community group, with differences statistically significant( P<0.05). The higher satisfaction of patients with their referral in the community, the stronger their referral willingness. Conclusions:The overall satisfaction of refrerral patients in the medical community group is higher than that of the non medical community group. The construction of county medical community has promoted the improvement of satisfaction of referral patients. However, it is still imperative to encourage high-quality medical resources to support primary institutions, to enhance the service level of primary medical and health institutions, to implement differentiated medical insurance reimbursement policies, and to improve the continuity of medical services within the community.
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Carrying out the optimal location selection of medical equipment in the medical community plays an important role in scientifically allocating equipment resources and improving the service capacity of medical community. Aiming at minimizing the operating cost of the location selection and configuration of the portable color Doppler ultrasound instrument in the county medical community and the shortest time spent on medical visits for residents, the authors established the total value objective function of the medical community configuration according to the value engineering method; and considered the relevant constraints such as distance, time and personnel quality, the mathematical model of optimal planning for the selection and configuration of portable color Doppler ultrasound equipment in county medical community was constructed. The empirical research results showed that based on the established constraints, after 5 000 iterations, the model output 5 relatively optimized allocation points among the 9 allocation points, and when the allocation number of each allocation point was 1, the total allocation value in the medical community reached the maximum. This study could provide a new idea and feasible method for the allocation of equipment resources of county medical community in China.
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Objective:To survey the status general practice residency training and career choice of trainees in Henan Province.Methods:From December 2017 to February 2018, 332 trainees from the first general practice residency training program (2014-2017) were enrolled in the study. The self- administered questionnaire included the demographic information and the current career status. The logistic regression model was used to analyze the influencing factors of the career choice when their completed the training.Results:Of 332 participants, there were 167 participants designated by the institutions and the others were directly enrolled by the program. The designated participants were from the 56 medical institutions in Henan. The percentage of participants from the tertiary hospitals was 75.5% (126/167), which was much higher than that from the secondary hospitals (24.5%,41/167). There were 24 participants who did not have a work six months after graduation. Of the 308 employed participants, there were only 111 (36.0%, 111/308) working in the department of general practice, and 197 (64.0%, 197/308) working in other departments. The participants designated by the institutions and with the post-graduate degrees preferred to choose other specialties, instead of the general practice. The reasons were that there was no department of general practice in their institutions or the participants had been designated to the other departments (57.9%, 114/197).Conclusion:The survey suggests that the general practice residency training program should enroll trainees mainly from the medical graduates in order to improve the effectiveness of general practitioner residency training and the allocation of health resources in Henan Province.
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Objective To explore the effect of troponin Ⅰ (anti-cTnⅠ) autoantibodies on the quality of life and prognosis in patients with ischemic cardiomyopathy.Methods Patients hospitalized in Henan Provincial People's Hospital for ischemic cardiomyopathy from June 2016 to June 2017 were enrolled.At the same time,physical examiners were selected as the control group.Anti-cTnⅠ autoantibodies were detected in the serum from the patients and control group,which were expressed as the OD value.After six months,all patients were followed up,including death,times of readmission,instrument treatment (CRT-P or CRT-D) or heart transplantation,and quality of life questionnaire (SF-36).The effect of anti-cTnⅠ autoantibodies on the prognosis and quality of life were analyzed.Results In 127 patients with ischemic cardiomyopathy,the OD value of anti-cTnI autoantibodies were significantly higher than that in the control group[(0.55 ± 0.24) vs (0.46 ± 0.07),P＜0.05].With a positive standard of more than 0.67,26 patients with ischemic cardiomyopathy were tested positive for anti-cTnⅠ autoantibodies,with a positive rate of 20.5％.After 6 months of outpatient or telephone follow-up,9 patients were lost to follow-up,and 118 patients were followed up,including 24 patients with positive anti-cTnⅠ autoantibodies.Compared with patients with negative anti-cTnⅠ autoantibodies,the times of readmission in patients with positive anti-cTnⅠ autoantibodies increased significantly[(1.42 ± 0.79)vs (0.30 ± 0.55),P＜0.01] and the physiological function was decreased significantly[(56 ± 19.4) vs (67 ± 20.8),P=0.032].The physiological function,vitality and social function of patients with reduced ejection fraction in the anti-cTnⅠ autoantibodies positive group were significantly worse than those in the anti-cTnI autoantibodies negative group,but there was no significant difference in quality of life between the anti-cTnⅠ autoantibodies positive and negative groups in the patients with preserved and median ejection fraction.Conclusions Patients with ischemic cardiomyopathy of seropositivity for anti-cTnⅠ autoantibodies have worse prognosis and quality of life,especially in those with reduced ejection fraction.
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Objective To learn the cognitive appraisal of the necessary conditions for the medical services delivery synergy by doctors at county and township levels,and to provide evidence for the health policy in question.Methods One county-level public hospital and one township hospital were randomly sampled from five sampled counties of Yancheng city in Jiangsu province for a field survey.The questionnaire was designed to cover such dimensions as institutional,information,service,interpersonal and management,in an effort to learn the cognitive appraisal of such doctors on such aspects as the two-way referral between county-township medical institutions,medical information sharing,good personnel relationships of medical workers,service collaboration,and necessity of inter-agency physician teams. Results These doctors in general presented different appraisal for two-way referral between county-township medical institutions,medical information sharing,service collaboration,good inter-personnel relationships and necessity of inter-agency physician teams.Those of lower academic titles considered it necessary to set up inter-agency physician teams(χ2=6.723,P<0.05);while county public hospitals′physicians considered that two-way referral between county-township medical institutions and inter-county agency information sharing as necessary to achieve the synergy of medical services delivery (P<0.05);most township physicians considered that good personnel relationships and service collaboration as necessary to achieve the synergy (P<0.05 ).Conclusions The characteristics of county and township physicians′appraisal of the necessary conditions for synergy of medical services delivery deserve attention,for improvement of their appraisal of two-way referral and information sharing among institutions.
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During the process of China’s healthcare reform, the concept of “costly access to health care” has been discussed for quite a long time. However, big data indicates that a small number of patients (5%) account for disproportionate costs ( approximately 50%) . “Costly access to health care” may not be a ubiquitous perceived prob-lem for all residents. In this paper, the concept“high-need patient” will be introduced and the characteristics of the population will be analyzed. According to the healthcare reform experience from the international perspective, this paper proposed healthcare strategy for Chinese high-need patients and policy recommendations for China’s healthcare reform.
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Objective To establish an influencing factors system for the implementation effect of the vertical integration of services between the hospitals and community health service institutions.Methods Primary data related to influencing indicators were collected by literature review,questionnaire method and in-depth interview,and then the analytic hierarchy process (AHP) and Delphi method were used for the construction of final influencing factors indicator system.Results An influencing factors indicator system which coincides with the status of the vertical integration between hospitals and community health service institutions in Nanjing,Wuhan and Zhenjiang was established,including 4 firstlevel indicators,10 second-level indicators and 36 third-level indicators.Conclusion This study can provide a basis for hospitals and community health centers to improve the integration service system,and fill the gap of research on the influencing factors of the vertical integration of the domestic health care system,which are meaningful for the vertical integration of health care system in other districts and patterns.
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Primary care physicians' visit services for diabetes management are now widely delivered in China's rural public health care. Current studies mainly focus on supply but risk factors from patients' view have not been previously explored. This study aims to present the utilization of rural primary care physicians' visit services for diabetes management in the last 12 months in southwestern China, and to explore risk factors from patients' view. This cross sectional study selected six towns at random and all 385 diabetics managed by primary care physicians were potential participants. Basing on the inclusion and exclusion criteria, 374 diabetics were taken as valid subjects and their survey responses formed the data resource of analyses. Descriptive indicators, chi[2] contingency table analyses and Logistic regression were used. 54.8% respondents reported the utilization of visit services. According to the multivariate analysis, the positive factors mainly associated with utilization of visit services include disease duration [OR=1.654], use of diabetic drugs [OR=1.869], consulting diabetes care knowledge [OR=1.602], recognition of diabetic complications [OR=1.662], needs of visit services [OR=2.338]. The utilization of rural primary care physicians' visit services still remains unsatisfactory. Mass rural health policy awareness, support, and emphasis are in urgent need and possible risk factors including disease duration, use of diabetic drugs, consulting diabetes care knowledge, recognition of diabetic complications and needs of visit services should be taken into account when making rural health policy of visit services for diabetes management in China and many other low- and middle-income countries