Study Of The Model Construction Of Urban-Rural Health Association From The Perspective Of Stakeholder Theory Based On A Health Association In Guangzhou

BackgroundIn the "Thirteenth Five-Year Plan" in 2017,the reform of the medical and health system was deepened,and the hierarchical diagnosis and treatment system was listed as the first of five basic health systems.The construction of Health Associations as the carrier for implementing the hierarchical diagnosis and treatment system has also become a key task in deepening medical reform.Cities will have at least one typical health association and all the top level public hospitals must participate in and play a leading role in it.At present,the construction mainly focuses on four types of mature health association models.At the same time,due to lack of policy support or lack of endogenous power in the top level hospitals and limited capacity of primary medical institutions,health association development is limited.Therefore,it is necessary to proceed from the perspective of interest factors that determine the core factors of the linkage of the health associations,to clarify the relationships and interests of various stakeholders from the perspective of stakeholders,and to explore urban-rural health associations on the basis of existing common models.The establishment of the body will enrich the existing organizational model and effectively integrate urban and rural medical resources.ObjectiveFrom the perspective of stakeholders,this study carried out a case study on the four-level health association in Guangzhou.The purpose of this study is:1)To investigate the status of the urban-rural health association and analyze the existing problems;2)To understand the interests demand of all stakeholders in the construction of the health association,and clarify its action mechanism;3)To construct a model of urban-rural health association based on a multi-institutional collaboration model.ContentsFirst of all,through literature analysis,we summarize the current status and current model of the development of health associations,and sum up the theoretical research of stakeholders to form the analysis method and theoretical basis for this research,and review the implementation path and research methods of the construction of health association model.Research modeling provides the theoretical basis and implementation prerequisites.Secondly,through a questionnaire survey,we will understand the attitudes,advantages and disadvantages,and recommendations of the main body of the health association consortium,and analyze the current status and existing problems.In addition,semi-structured interviews were conducted to investigate the stakeholder s'knowledge,attitude,willingness,interests demand,existing problems,and suggestions for the construction,and provide strategic choices for constructing models.Finally,based on the results of stakeholder analysis and the multi-institutional collaboration model,the model of the urban-rural health association is proposed and demonstrated by expert through interview opinions and evaluations.The model is improved and corresponding strategies are proposed.Results1.Questionnaire survey resultsThis study investigated 588 effective samples from the staff of the southern hospital(311),the staff of Xintang hospital(257)and village doctors of health station(20).According to the survey results,the interest relevance degree of different construction subjects from the strong to the weak is Xintang Hospital,Nanfang Hospital and the village health station,their interests demand is slightly different;each subject has different perceptions and attitudes toward the health association;In addition,the degree of support for the establishment is also related to their perceptions and attitudes,and the needs of different subjects for supporting measures are basically the same.2.Results of interview with stakeholdersThrough collation and analysis of interview data,the local health administrative departments,tertiary hospitals and their staff are powerful impellers of the construction of health association;doctors of second class hospitals,village doctors,and local residents are lack of awareness and benefits which are the reason may be a hindrance factor in the construction of health associations,so it is necessary to focus on their interests and risks.3.Construction of urban-rural health associationIn combination with the multi-institutional collaboration model framework,the four-level health association model was constructed from five perspectives:t shared goals and vision,governance,formalization,internalization and common incentive.ConclusionThis study based on the perspective of stakeholder analysis and combined with the multi-institutional collaboration model,put forward that "Integration of Province,County,Township and Village" is the best choice for win-win cooperation in the construction of urban-rural health association.It is also the establishment of a variety of the supplement of the form of health associations.Based on expert interview opinions,we propose the following strategies and recommendations for the model:(1)Strengthen the government's leading role and improve related supporting policies and measures;(2)Establish a model of the close urban-rural health association model and formulate interest coordination mechanism;(3)Integrate multiple resources to maximize efficiency of urban-rural health association.