RESUMEN
In order to further promote hierarchical medical system and enhance the capacity of primary healthcare services, China began to build compact county medical community. At present, the development of China′s compact county community still exists such problems as the construction of service system, the basic institutional mechanism, the quality of supply capacity and the core guarantee mechanism. In order to solve the existing problems, the authors took Shaxian District of Sanming City, Fujian Province, Dancheng County of Zhoukou City, Henan Province, and Yangqu County, Taiyuan City, Shanxi Province as examples to summarize the experience of the advanced pilot areas of the policy. In the future, the construction of compact county community in China should be based on the construction of " single-core multi-layer" system, starting from the five levels of collaborative management, practical operation, system construction, basic guarantee and multi-party supervision, to comprehensively enhance the healthcare services, and finally achieve the goal of the strategy of hierarchical medical and Healthy China.
RESUMEN
Guangdong province is experimenting with a model composed of various types of medical alliances, having achieved initial success with some of them and preliminarily has formed a holistic governance pattern. Experiences behind such initial success lied in a coordinated top-level design, reasonable and classified guidance, leader role of key governance subjects, and the construction of a telemedical system. However, as analyzed from the angle of collaborative governance, existing medical alliances have not yet formed a community of services, that of responsibility, that of interests, and that of services. In this consideration, the authors recommended to strengthen the collaborative governance of such alliances by respective governance subjects based on the theories of integrated medical service system and collaborative governance, eventually forming an integrated medical and health service system.
RESUMEN
The reform of medical insurance payment system could promote the transformation of medical services from price medical care to value medical care, which is very important to promote the construction of medical alliance. The authors discussed the reform of medical insurance payment system to promote the construction of medical alliance, and the order of medical alliance covering medical services and seeking medical treatment.For medical service providers, the reform of medical insurance payment system helped to promote the construction of closer medical alliance, guided the sinking of high-quality resources, helped to form a smooth referral mechanism, and strengthened the supervision and assessment of medical behavior. For the demanders of medical services, the differentiated medical insurance reimbursement proportion policy within the medical alliancewas more conducive to attracting the first consultation at the grass-roots level. At the same time, patients had a wider choice of medical treatment and more freedom of choice. In view of the problems existing in practice, the authors suggested that a variety of medical insurance payment and performance systems with value-based medical care as the core should be implemented to deepen the development of medical alliance, the medical insurance system and municipal subsidies should jointly undertake the salary subsidies for sinking medical personnel, and integrate the grass-roots fragmented health care business with the help of medical insurance payment tools, and promote the coverage expansion of the medical insurance reform of the medical alliance based on policy guidance.
RESUMEN
Objective:To explore an effective mode of medical preventive integration, so as to further the construction of county scale health-centered medical alliances.Methods:This study took five medical alliances from a county in Hangzhou as an example, and carried out the semi-structured interview method and typical case analysis to summarize the medical preventive integration operation mode in January 2020; the self-developed questionnaire was used to understand the operation effectiveness evaluation on county medical alliances by medical staffs and residents from fowr aspects: medical preventive team, medical preventive resources, medical preventive services and medical preventive information fusion.Results:Each county scale medical alliance promoted the integration of medical preventive by innovating the organizational structure, strengthening organizational guarantees, and integrating teams, resources, services, and information on medical preventive. The questionnaire survey showed that medical staff had highest satisfaction with the medical preventive service integration (3.75 points), and lowest satisfaction with the medical preventive information integration (3.69 points); residents had highest satisfaction with health information functions in medical preventive information fusion (4.20 points), and lowest satisfaction with preventive health care services in medical preventive services fusion (4.15 points).Conclusions:The evaluation measures related to medical preventive integration services need to be improved, and the quality of services needs to be promoted, all the information systems need to be interconnected, and big data on the information platform needs to be mined and utilized.
RESUMEN
Objetivos Los objetivos de este artículo son presentar: a. Las aplicaciones del Análisis de Redes Sociales (ARS) en el estudio de coaliciones comunitarias y redes inter-organizativas; b. Los indicadores estructurales de la red completa relacionados con su funcionamiento, y; c. Los métodos para identificar subgrupos dentro de las redes. Método Para ilustrar los procedimientos utilizaremos la visualización de grafos y datos de una investigación propia. Resultados Proponemos orientaciones metodológicas para evaluar y fortalecer coaliciones comunitarias a través de ARS. Conclusiones El análisis estructural es una potente herramienta para evaluar y optimizar el funcionamiento de coaliciones que prestan servicios socio-sanitarios, al mismo tiempo es necesario conocer el contexto específico y emplear herramientas de investigación cualitativas para contrastar la información obtenida mediante ARS.(AU)
Objectives The aim of this paper is to report: a. The main applications of Social Network Analysis (SNA) in the study of community coalitions and inter-organizational networks; b. The structural indicators of the whole network related to coalition functions, and; c. The methods to identify subgroups within networks. Method We will use graph visualization and data from our own research to illustrate the procedures under study. Results A set of methodological guidelines to evaluate and improve community coalitions through SNA are proposed. Conclusions Structural analysis is a powerful instrument to evaluate and optimize the functioning of coalitions that provides social and health services, and at the same time, it is necessary to understand the specific context of interaction and use qualitative tools to contrast the results obtained through SNA.(AU)