ABSTRACT
Introduction: This study aimed to explore whether the establishment of county medical alliances can improve satisfaction with the vertical integration of healthcare systems among rural medical and healthcare service provider managers and service providers. Our study also sought to provide recommendations for the sustainable development of vertical integration in healthcare systems. Methods: A semi-structured interview with 30 healthcare service providers was employed in this research, and Nvivo software was utilized to analyze factors that influence vertical integration. From April to July 2021, a multi-stage random sampling method was used to select participants. The sample included two leading hospitals in medical consortia, 15 member units (healthcare service providers and medical staff), two county-level hospitals, and 15 township health centers/community healthcare service centers from non-medical consortia. Questionnaire surveys were conducted with these groups. Factor analysis was used to calculate satisfaction scores for healthcare service providers with the cross-institutional synergistic development of healthcare systems in both medical and non-medical consortia (denoted as M(IQR)). Propensity score matching was employed to reduce confounding factors between groups. The Mann-Whitney U test was used to compare satisfaction differences between groups. Results: The overall satisfaction scores for lead-county hospital managers, member institution managers, medical staff at the lead-county hospital, and medical staff at member institutions were 4.80 (1.00), 4.17 (1.17), 4.00 (1.38), and 4.00 (1.12), respectively. Lead-county hospital managers' satisfaction with cross-institutional collaboration, development capacity enhancement, and structure and resource integration in the Medical Alliance group showed higher satisfaction than the Non-Medical Alliance. Similarly, lead-county hospital medical staff in the Medical Alliance group reported greater satisfaction with collaboration efforts, supportive environment, and development capacity enhancement. Notably, while the Medical Alliance group's satisfaction scores were higher, the differences between the two groups were not statistically significant for lead-county hospital managers and medical staff. The Medical Alliance group did show statistically significant differences in member institution managers' satisfaction with collaboration, development capacity enhancement, and structure and resource integration. Additionally, medical staff of member institutions in the Medical Alliance group reported statistically significant higher satisfaction with collaboration, supportive environment, development capacity enhancement, healthcare service integration, and human resource development. Conclusion: To facilitate the establishment of county medical alliances, managers of leading county-level hospitals should adopt a healthcare system integration strategy. This strategy involves evolution from being a member of a single institution to a coordinator of cross-institutional vertical integration of medical and healthcare services. Additionally, revamping remuneration and appraisal systems for members of county medical alliances is necessary. This will encourage cooperation among healthcare institutions within the three-tiered system and their medical staff, ultimately facilitating the provision of integrated services.
ABSTRACT
Objective:To study the willingness of county-level hospital physicians within a county medical alliance(alliance)to participate in county-township human resource integration for medical institutions, for furthering the development of such integration.Methods:Based on a discrete selection experiment, a questionnaire was designed for the selection of the work attributes that affect the participation of county-level hospital physicians in such an integration. On-the-job physicians from four county-level hospitals in a prefecture level city were selected by multi-stage stratified random sampling method as the survey objects, and a field questionnaire survey was conducted from November to December 2021. The mixed logit model was used to analyze the preference of physicians in county-level hospitals for five types of work attributes(work unit, monthly income, seniority required for professional title promotion, training opportunities, serving as middle-level and above administrators), the relative importance of each work attribute, and marginal willingness to pay with regard to their participation in the integration.Results:A total of 172 valid questionnaires were collected. When county-level hospital physicians participate in county-township human resource integration for medical institutions, their statistically significant job attributes and level preferences included monthly income, working unit of county-level hospitals, 7 years for professional title promotion, and more training opportunities ( P<0.001). The relative importance of monthly income ranked the highest among the five categories of work attributes, up to 55.55%. Conclusions:When physicians in county-level hospitals participate in the integration of county-township human resources, the most important was their monthly income, and economic incentives could enhance their willingness to participate.
ABSTRACT
Objective:This study is conducted to analyze the impact of county medical alliance on patient flows under the NRCMS in Dingyuan county of Anhui province. Methods: data on patient-flow were collected through the NRCMS information platform and related policy documents for 2015-2016, and interviews were conducted to study the main reform practices in the county medical alliance. Results: The patient flow under the NRCMS varied in the way of 1) the total number of inpatients seeking treatment outside of the county decreased by 3.31%;2) the treat-ment volume of county-level hospitals and township health centers were increasing,and the latter one is growing faster than the former,meanwhile,the treatment volume of the village clinics declined,and 3) the hospitalization expenses per inpatient for patients who seek treatment outside the county are much higher than the expenses incurred within the county. Conclusions:the development of county-level medical alliance has influence on patients with common disea-ses who used to seek treatment by helping to reduce the number of inpatients outside the county and reduce the pres-sure of the new rural cooperative fund. However, significant problems still exist such as shortage of talented practi-tioners,and lagging development of information technology system.
ABSTRACT
This paper introduces the background, implication and construction of the county health services community (County medical alliance) model in Anhui Province under the background of new medical reform,and briefly introduces the relationship between medical insurance, enhancing the ability to upgrade and standardize services and medical treatment integration of the typical experience.It also analyses the challenges faced in the construction of medical syndicate, such as the mechanism of regional environmental restriction, compensation and assessment mechanisms which have not been established yet, and the sustainable development of information technology that has lagged behind, and put forward the policy suggestion to improve the construction of medical community, with a view to providing reference for the next work.
