Research On Influencing Factors Of Regional Medical Service Quality From The Perspective Of Organizational System

The health of the people is an important symbol of the prosperity of the nation and the country.It is an important social goal of the governments of all countries to give strategic priority to the protection of the people’s health and improve the policies to promote the people’s health.Medical service is a major livelihood undertaking to safeguard people’s health.It provides basic medical services for the majority of citizens,which is the concrete embodiment of government functions.Since the "Healthy China" strategy was put forward at the 19th CPC National Congress,people’s health has been elevated to a higher level.The report of the 19th CPC National Congress pointed out that we should establish a basic medical and health security system with Chinese characteristics and a high-quality and efficient medical and health service system to provide all-round and full-cycle health services for the people.The outline of the "Healthy China 2030" plan clearly states that we will "improve the level and quality of medical services and provide high-quality and efficient medical services for the people",which marks the elevation of people’s health to a national strategic level.The report of the 20th National Congress of the Communist Party of China proposed to continue to promote the building of a healthy China,promote the expansion of high-quality medical resources and the balanced distribution of medical resources in different regions,improve people’s wellbeing and improve people’s quality of life.After 70 years of construction and development,China has explored and developed a medical and health system in line with China’s national conditions,established a large-scale and high-quality medical and health service system in line with the level of economic and social development,experienced a shift from "treating diseases as the center" to giving priority to people’s health,and played a fundamental and key role in safeguarding people’s health.However,a phenomenon contradicting the rapid development of medical industry and the obvious improvement of the overall medical level is that the improvement of medical service technology has not brought about the improvement of patients’ collective satisfaction and sense of trust.Meanwhile,the imbalance of medical service resource allocation and the difference of medical service level between regions have not been completely solved.So,what are the factors that affect the development of regional medical services?How to improve the quality of regional medical services?Centering on the above problems,after reviewing relevant domestic and foreign research literature,it is found that the existing researches mainly reveal the influencing factors of the development of medical service from financial aspects and technical factors,and seldom consider the discussion of medical service in the organizational system.This field has not been deeply explored by domestic and foreign scholars.Since the medical and health system of any country is determined by its political and economic system,the study of factors influencing regional medical service quality based on the perspective of organizational system,on the one hand,is helpful to enrich the dimension study of factors influencing the quality of medical service,and expand the theoretical perspective of the study of medical service quality.On the other hand,it expands the evaluation methods and tools for the formulation and implementation of the new medical reform policy to a certain extent,which is helpful for the government to formulate medical service development policies according to local conditions,so as to achieve sustainable development of medical services.As the development of medical service is embedded in the environment of political,economic and social development,the development of medical service is not only affected by technical requirements and resource dependence,but also influenced by broader institutional environment factors,that is,affected by specific ideology and macro system,and always subordinate to and serve the needs of economic and social development at that time.Starting from the perspective of organization system,based on China’s national conditions and centering on the research theme of influencing factors of regional medical service quality,this paper adopts a mixed research method combining qualitative and quantitative research to clarify the evaluation dimension of influencing factors of regional medical service quality from the perspective of organization system.A statistical model was established to analyze the influence of various factors on regional medical service quality.The main research content is divided into the following four parts:Firstly,it analyzes the influencing factors of regional medical service quality from the theoretical perspective,which forms the theoretical basis and research starting point of this paper.Based on the theory of organization system,this paper constructs a theoretical analysis frame and compels the theoretical foundation of the study.The second is the government and market,decentralization and centralization,and the historical evolution of medical service reform,to sort out the impact of different institutional environments on medical service,as well as the development and change of medical service in different historical stages in the 70 years since the founding of the People’s Republic of China.Medical service is related to people’s health,and it is a social public service with both public and private property.Whether it is provided by the government or the market,the single medical service has produced many disadvantages in the past and now.The practice in the field of medical service has proved that in order to achieve the goal of medical service,it is necessary to combine the two mechanisms of government and market,establish an effective connection and coordination mechanism between the imperfect government and the imperfect market,so as to maximize the total utility of the two.The relationship between the Chinese government and the market is particularly unique.Along with the reform and opening up,the central government has carried out a series of political and economic system reforms around the economic growth.As the external institutional environment of local governments,these reforms affect the objectives,strategies and behaviors of local governments.As embedded in the context of political,economic and social development,health services are also influenced by a broad institutional context.China’s medical service has gone through the process of gradually developing from government unified provision to market provision,and the return of government in the field of medical service,and has explored and developed a medical service system in line with China’s national conditions.Third,based on the theoretical basis and theoretical analysis framework summarized in Chapter 2,and based on the research ideas and methods of the grounded theory in qualitative research,a model of influencing factors of regional medical service quality is constructed.Through field interviews with relevant officials,doctors and other staff in the field of medical services,data collection and coding analysis of the interview data are used to explore and study the specific dimensions of influencing factors of regional medical service quality,further refining the theoretical analysis framework constructed in Chapter 2,and putting forward the influencing factor model of regional medical service quality.Through coding analysis,it is found that the influencing factors of regional medical service quality are composed of four dimensions,namely market competition,integrated medical service governance,local government competition and local official heterogeneity.Among them,the integrated governance of medical services includes system integration,organization integration and service provision,while local officials include promotion incentive,official mobility and official professionalism.On this basis,a model of influencing factors of regional medical service quality is put forward,and the theoretical analysis framework proposed in Chapter 2 is perfected and concretized.Fourthly,the statistical model is used to quantitatively analyze the effects of market competition,integrated medical service governance,local government competition and local officials’ heterogeneity on the quality of regional medical service.The statistical results show that market competition and integrated management of medical service have significant positive influence on the quality of regional medical service,which is conducive to the improvement of regional medical service quality.However,local government competition has a significant negative impact on regional medical service,which is not conducive to the improvement of regional medical service quality.For the heterogeneity of local officials,promotion incentive has not volatilized in the improvement of regional medical service quality,and it has nothing to do with the development of regional medical service quality.There is a positive U-shaped nonlinear relationship between the tenure of officials and the quality of regional medical services.And the older the officials,the more beneficial to the improvement of regional medical service quality.As for the flow of officials,whether the lateral flow comes from the party secretaries of other cities,or from the party secretaries of higher departments from the top down,or the party secretaries hold concurrent posts in the province or the central government,all have a significant negative impact on the quality of regional medical services,which is not conducive to the improvement of the quality of regional medical services.As for the professionalism of officials,municipal Party secretaries with management and medical professional backgrounds did not promote the improvement of regional medical service quality.Compared with professional background,the working experience of municipal Party secretary,especially the working experience in health system,can promote the improvement of regional medical service quality,which is conducive to the improvement of regional medical service quality.The collocation of party and government leaders with the same professional background is not conducive to the improvement of regional medical service quality,while the collocation of party and government leaders with the same working experience is conducive to the improvement of regional medical service quality.Based on theoretical discussion and empirical analysis,this paper puts forward countermeasures and suggestions from three aspects.First of all,the government should strengthen its responsibility and promote the high-quality development of medical services.Including a focus on health and the leading role of government;Optimize the system environment and promote the play of market competition mechanism;We will improve the fiscal restraint mechanism and adopt reasonable and effective forms of regional competition.Secondly,we should strengthen integrated governance to build a high-quality and efficient integrated medical service system.Including strengthening government guidance,improving the operation mechanism of medical consortium,and ensuring "high-quality development";Change the value orientation and promote the modernization of medical insurance management;To transform blood transfusion into hematopoietic blood transfusion and strengthen the construction of community-level medical and health service system;In-depth use of information technology to break through the bottleneck of medical integration.Finally,we should pay attention to people’s livelihood and improve the governance mechanism of local officials.We will improve the evaluation mechanism for officials and improve people’s livelihood.Strengthen the construction of official mobility system,promote the advantage of cadre mobility;Attach importance to the professional background and working experience of cadres,and innovate the matching mode of Party and government leading cadres.