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Objective:To provide reference for the sustainable development of county medical communities through analyzing key issues in the construction of such communities in China.Methods:Such Database websites as CNKI, Wanfang Data and VIP Information were selected to retrieve journal papers and dissertations with the keywords of " county medical community" " county medical alliance" " county medical and health community" and " medical alliance" . The time period ranged from the establishment of the database to December 2021. Content analysis and social network analysis were used to classify and sort key issues of county medical community construction in the included literature, and the descriptive analysis was used for all the data.Results:274 literatures were obtained in this study, 82 high-frequency issues were extracted for the construction process of county medical communities. It was divided into 3 dimensions of service system, operation mechanism and fund guarantee, including 14 items of integration of resources, integrated management, resource intensification, information construction, medical services, medical quality, family doctors, public health, management system, personnel system, salary system, supervision mechanism, medical insurance fund and financial input. The results of social network analysis showed that the top three high-frequency issues of point centrality and intermediary centrality were lack of highly unified information exchange platform (107.00, 514.48), insufficient service capacity of primary medical institutions (61.00, 238.48) and lack of sustainable benefit distribution mechanism (45.00, 192.38).Conclusions:The construction of county medical community covered three aspects: medical service system, operation mechanism and fund guarantee.The shortage of primary medical service capacity, the lack of coordination of an information platform, the general shortage of essential drugs, the imperfect internal assessment and incentive system, the imperfect supervision system and the imperfect medical insurance supporting policy becomed the main roadblocks in building county medical communities in China. In order to promote the sustainable development of county medical community, the authors recommend to further upgrade the county integrated medical service system, perfect the operation mechanism, and strengthen the input into county health care.
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Objective:To evaluate the impact of the reform of the county medical community on the expenditure of medical insurance funds, and to provide references for maintaining the stability of the medical insurance fund and deepening the reform of the medical community.Methods:Medical insurance data of urban and rural residents in M County, Yunnan province from 2016 to 2019 were collected, and a discontinuous time series model was used to analyze the impact of county medical community reform on medical insurance fund expenditures.Results:Since the reform, the number of patients discharged from county-level hospitals has shown a downward trend, averaging a decrease of 25.996 people per month; yet increases have emerged with the average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure, averaging a monthly increase of 90.931 yuan, 50.014 yuan and 1.528 yuan respectively. The average hospitalization expenditure, the average hospitalization overall fund expenditure, and the average outpatient overall fund expenditure of the township hospitals all showed an upward trend, averaging a monthly increase of 31.191 yuan, 38.678 yuan and 0.085 yuan respectively. The flow of external medical insurance funds of the medical community has shown a continuous upward trend, averaging a monthly increase of hospitalization fund expenditures of 33.005 yuan, and a monthly increase of outpatient overall fund expenditures of 4.896 yuan overall.Conclusions:The M County medical community should further strengthen the top-level design, explore the reform of medical insurance payment methods, improve the regional information platform, standardize the referral system, and strengthen supervision to deepen the construction of the medical community to ensure the sustainable operation of medical insurance funds.
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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 construct the public health performance evaluation index system for the county medical community, so as to provide reference for the assessment of the public health work in the county medical community.@*Methods@#According to the 2019 Public Health Tasks of Zhejiang Province and the current status of the county medical community's public health work, a framework was developed. Twenty experts from universities, CDCs, and county medical community were invited to construct the index system after two rounds of Delphi expert consultation, and the index weight was determined by the analytic hierarchy process. @*Results @#The experts aged ( 46.10±6.41 ) years and worked for ( 23.85±7.37 ) years, all of whom had a bachelor degree or above, and 18 had associate senior titles or above. The response rates of two rounds of consultation was both 100.00%; the authority coefficient was 0.811; the values of Kendall's W all had statistical significance ( P<0.05 ) , which in the second round were higher than those in the first round. The public health performance evaluation index system for county medical community finally included 10 first-level indexes, among which priority diseases surveillance and management weighed most ( 0.165 7 ) ; 32 second-level indexes, among which food-borne diseases surveillance, infectious diseases/public health emergencies reporting and infectious diseases/public health emergencies response weighed the top three ( 0.071 5, 0.064 7, 0.063 8 ); 120 third-level indexes, among which the timely reporting rate of food safety incidents, the reporting rate of infectious diseases and the information response rate of infectious diseases/public health emergencies weighed the top three ( 0.039 4, 0.022 1, 0.021 7 ). @*Conclusion @#The public health performance evaluation index system of the county medical community has been established, which can provide reference for the health administrative departments.