Effect Evaluation And Influencing Factors Of Grading Diagnosis And Treatment In Regional Medical Association Model

Objectives:Since the new medical reform,China has made breakthroughs in key areas.However,the current distribution of medical and health resources in China is unreasonable,leading to the disorderly medical treatment and difficult medical treatment.In order to solve these problems,relevant departments have vigorously promoted the grading diagnosis and treatment and the construction of medical associations,aiming at guiding patients to seek medical treatment reasonably and orderly,and to achieve effective sharing of medical resources.Based on the combination of theoretical analysis and empirical analysis,this paper constructs a scientific,practical and reasonable regional medical complex model to evaluate the implementation effect of graded diagnosis and treatment,and find out the key influencing factors of the effect of graded diagnosis and treatment.In order to promote the sustainable development of the medical association,improve the graded diagnosis and treatment system to provide countermeasures and suggestions.Methods:Firstly,based on stakeholder theory,game theory and principal-agent theory,we analyze the interests of the various stakeholders and their relationship,and provide a theoretical basis for improving the implementation of the graded diagnosis and treatment in the regional medical association mode.Secondly,Based on the literature analysis method and the opinions of experts,the effect index system of the graded diagnosis and treatment implementation under the medical complex model was preliminarily constructed,and the experts in the fields of college teachers,health administrators and medical institutions were invited to add or delete the preliminary indicators through the Delphi method.And further improve the indicator system;Thirdly,select four cities in Jiangsu Province for empirical research,and analyze the implementation effect of grading diagnosis and treatment under the four-city regional medical complex model through expert consultation method and multi-level fuzzy comprehensive evaluation method to understand the status quo of the implementation of the city’s grading diagnosis and treatment and the problems in the promotion;Fourth,through the literature research method and the established evaluation index system of the grading diagnosis and treatment implementation effect of the regional medical complex model,combined with the opinions of relevant experts,determine the factors affecting the implementation effect of the grading diagnosis and treatment in the regional medical complex model,and use the DEMATEL method to influence the factors.Factor analysis of causality and order of importance to identify key influencing factors.Finally,based on the theoretical and empirical analysis results,put forward the countermeasures to promote the sustainable development of the medical association and improve the graded diagnosis and treatment system.Results:(1)The evaluation index system of the implementation effect of graded diagnosis and treatment under the model of regional medical association is constructed from five dimensions:basic level medical service,core hospital medical service,two-way referral,regional medical association member unit cooperation and patients’ medical treatment.(2)Through comprehensive evaluation of A,B,C and D cities in Jiangsu Province,it is found that the implementation effect of A city is better than that of B,C and D city,the implementation effect of B city is slightly weaker than that of C and D city.There are mainly two-way referral progress,the construction of regional medical association information platform,and the efficiency of standardized management of chronic diseases needs to be improved.(3)Using the DEMATEL method to find out the factors,outcome factors and key influencing factors affecting the implementation of graded diagnosis and treatment;from the perspective of the demand side,the causes include the occupation of the patient and the income level of the patient.The outcome factors include medical concept and medical habits,and medical treatment,the distance from medical institutions,chronic diseases,knowledge of the graded diagnosis and treatment,and the type of insurance.The key influencing factors include the patient’s medical concept and medical habits,the patient’s occupation,the knowledge of the graded diagnosis and treatment system,and the income level of the patient are the key influencing factors.From the supplier’s perspective,the causes include the facilities of primary medical institutions,equipment conditions,the construction of information platforms for primary medical institutions,the construction of hospital information platforms,the basic drug system,and the proportion of medical insurance reimbursement.The outcome factors include the technical level of medical personnel and medical staff.The salary level,the incentive and restraint mechanism of medical staff,the medical environment of primary medical institutions,the expansion of hospital scale,the siphon phenomenon of hospitals and doctors,the internal evaluation of hospitals,the supporting compensation mechanism and the reward and punishment system,the key influencing factors include the supporting compensation mechanism.And the reward and punishment system,the salary level of medical staff,the siphon phenomenon of hospitals and patients,the expansion of hospital scale,the internal evaluation of hospitals,the facilities of primary medical institutions,the equipment conditions,the construction of information platforms for primary medical institutions,the construction of hospital information platforms,Medical insurance reimbursement ratioSuggestions:The first aspect is to improve the relevant supporting policies and increase financial compensation,including improving the proportion of medical insurance reimbursement,promoting the reform of medical insurance payment system;improving the relevant performance appraisal mechanism,implementing the doctor’s multi-point practice policy;increasing financial compensation to improve the level of grass-roots medical services.The second aspect is to unblocked the two-way referral channels and strengthen the sharing of medical resources,mainly including defining the two-way referral standards,openning referral channels,strengthening the construction of information platform for members of the medical community units,and realizing the mutual sharing of medical resources.The third aspect is to improve the relevant incentive and restraint mechanism,strengthen the internal division of labor and cooperation within the medical association,including the establishment and improvement of incentive and restraint mechanism,promote the development of grass-roots medical institutions;formulate a reasonable doctor’s salary system,improve the internal evaluation mechanism of medical institutions.The fourth aspect is to improve the concept of patients seeking medical treatment and guide patients to seek medical treatment in an orderly manner.It mainly includes increasing publicity,improving patient awareness and cognitive ability,improving patients’ health management level and enhancing self-management consciousness.