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Objective To analyze the research hotspot and development trend of tiered health care system of type 2 diabetes in China. Methods The relevant research in the field of the tiered health care system of type 2 diabetes in China was sorted out and summarized by using CNKI, WangFang, VIP and Web of Science databases as search objects, and the relevant literature collected between January 1, 2009, and September 28, 2022, was searched. CiteSpace was used to describe the number of articles published, high-frequency keywords, emerging words, and trends. Results A total of 147 valid papers were included. The overall volume of related articles published showed an upward trend. After visual analysis, nine clusters were obtained, including family doctors, tiered health care system, health service system, and primary care. In the past two years, the research trends were mainly focused on primary care, general practitioners, specialist nurses, and quality of survival. Conclusion Research hotspots are focused on the areas of hierarchical diagnosis and treatment, primary care, family doctors, and community health services, with the words “medical association” and “specialist nurse” emerging in the past two years. In the future, research should be devoted to improving the tiered health care system of type 2 diabetes and opening up a multi-level cooperative research model, so as to effectively bring into play the advantages and effects of the tiered health care system.
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Recently , the country actively explores the pattern of an integrated healthcare which enables the as-sociation among hospitals of different levels , aimed to achieve maximum utilization of medical resources and lead a reasonable distribution of the patients .By reviewing the practices related to the integration of healthcare in Beijing , Shanghai , Zhenjiang and Wuhan city , this paper sums up in five typical mechanisms , i.e.organization and manage-ment mechanism , human resource management mechanism , interest distribution mechanism , service continuity and resources sharing mechanism .The effects of these practices were analyzed and the faced challenges were discussed . The following points were made clear during analysis and discussion:the sustainability of the collaboration mode and organization structure , human resource supports and incentive methods , health insurance guidance for hospitals and patients , two-way referral system and supporting measures , and building of information system .Then we put forward some suggestions , hoping to offer some references to the establishment of integrated healthcare in other regions .
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Objectives:To analyze the influencing factors and status of hospital seeking behavior among floating population by focusing on the function of health insurance , and provide evidence to comprehensively promote tiered health care system in China .Methods:Using data from 2014 National Floating Population Dynamic Monitoring Survey , multivariate logistic regressions were applied to analyze the influencing factors of hospital seeking behavior for inpatient care .Chi-square tests were used to analyze the different proportion of having basic medical insurance reimbursement and reasons for not having it for different hierarchical inpatient care , and T test were used to analyze the ratio of basic medical insurance reimbursement for hospital costs .Results:The proportion of hospitalization at the county level and below was 56.4%among floating population , the proportion of inflow patients being 51.5%and the rest of the hospital population being counted at a proportion of 37.9%, lower than the corresponding proportion of 72.6%among local res-idents derived from the Fifth National Health Services Survey , but this ratio was 78.9%among registered population . The multivariate logistic regression results indicated that demographic , socio-economic and flow characteristics , hospital location and reasons for hospitalization have significantly affected the migrant inpatients facilities , but health insurance did not significantly influence the hospital seeking behaviors among floating population .Conclusions:The proportion of hospitalization at the county level and below was low among migrants and this proportion presented great regional differ -ences;and medical insurance didn't play a guiding role in the diversion of the internal floating population .
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The definition and connotation of tiered health care system ( THCS ) is a fundamental field of re-search for the system and a logic orientation of institution establishment and smoothing as well. Through analyzing and distinguishing the related international and domestic THCS concepts and exploring its essence from the general prac-tice attributes perspective, we found several problems existing in the Chinese THCS. First of all, the three-tiered pa-tient transfer principle which, merely based on the disease, have seriously neglected patient’s health care system serv-ice requirements. Second, the specialty of the general practice lost the function of making a supplement of specialized disciplines. Third, it did not generate a straightforward boundary between the general practice and special care sys-tem. Forth, the organizational management was adopted to replace the professional one required by two specialties. Based on these findings, we gave a clear and smooth THCS definition and answered three fundamental TMSS ques-tions. Additionally, we proposed a concept for which TMSS management should be composed of micro-, medium-and macro-level institutions.
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We explore the difficulty of the possibility of the way to a “tiered health care system” in China. This means that high-end hospitals treat “serious” diseases and community ones and/or individual clinics focus on“non-serious” diseases. The exploration is done using a new theoretical framework in industrial economics, the plat-forms theory. The research achieved three main results which are as follows:Firstly, it shows that three main obsta-cles to build a“tiered health care system” comprise the employment relationship between doctors and hospitals, hier-archical hospital system, and positive hospital platform externalities, whose interaction enhance the high-end hospitals to be stronger and community ones to become weaker. Secondly, internet medical platforms will help doctors to leave the high-end public hospitals, build individual clinics, and thus achieve a“tiered health care system”. Finally, the“two-tier structure”, adopted by some internet medical platforms, is a possible way to build the “tiered health care system”, and means a large platform including many small professional platforms on one hand and patients on the other hand.
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Objectives:The objective of this study is to make suggestions for the internet medical development. Methods:Based on the field survey, this paper analyzes three kinds of internet medical mode in China, and sums up the pros and cons. Results:The internet medical has the ability of technically providing healthcare by internet, and meeting the patients’ essential health care requirements. The problems mainly include health insurance, regional dis-tribution, electronic prescription audit, electronic medical record and safekeeping the record files, operation supervi-sion etc. The corresponding countermeasures include elaborating laws, gradually completing the internet medical and health insurance cooperation, the government’s regional division handling, setting up a special supervision department in the hospitals etc. Conclusion:It is important to clear the internet medical related problems and develop a model which is suitable for healthcare institutions.