Research On The Action Logic Of Different Participants And Its Adaptation Strategies In The Urban Medical-care Integration

In this thesis,we use the rapid transformation of our society and population aging accelerated development as a background,take the development process of urban medical care and integration as a context,and focus on the action logic of different participants participating in medical care and integration.The specific operating model of urban medical care integration agencies is examined from the perspective of neo-institutional theory and structural functionalism.Firstly,we built a preliminary analysis framework,according to the action logic of different participants,and then we introduced a current formation process of the two typical operation modes of medical care integration and compare the different characteristics of them.This clarifies the reasons for the transformation of the specific operation mode of medical care and maintenance from the extended mode to the collaborative mode.Furthermore,we discussed the relationship structure and the cooperation dilemma of different practice subjects about this collaborative model.At the same time,we explored the necessity and possibility of ensuring the stability and orderly cooperation of different subjects.Based on this,we proposed the concept of "institutional cooperation" mode and the conditions for its realization in urban medical care integration institutions.Finally,a corresponding adjustment strategy was proposed for the problems existing in the practice process.From a nationwide perspective,it is an indisputable fact that different entities participate,although the specific modes of operation of urban medical institutions are different.The logic of these actions of the participating entities cannot be completely consistent,and may inevitably affect the mode of cooperation,processes and results between them.As far as the form of expression is concerned,the basic carrier of the integration of urban medical care in China are medical institutions,pension institutions,or a combination of both.In any cases,we may all regard it as an organization.In the view of the new institutionalism,any organization will always have to face the dual pressures of the technical environment and institutional environment.All of their phenomena-including the evolution of specific operating modes-are the result of coping with these two environmental pressures.As a special product of the social transition period in China,the urban medical-care integration had a late start and experienced three basic development stages,including the beginning stage,the pilot stage and the integrated promotion stage.In this process,a multiplayer participation pattern was gradually formed with the involvement of national and local governments,medical and elderly care institutions and the aged groups.However,each subject had different positions and characters in this system,and they pursued different goals and suffered from different environmental pressures:the state regulations followed the balance logic of institutional arrangement and the symbolic logic of national will,however,the local government management behavior obeyed the division logic of bureaucratic rights and responsibilities and the coping logic of pressure conduction.In addition,the cooperative behavior between institutions complied with the cooperation logic of resource sharing and functional complementation and the conflict logic of rule constraint and interest divergence,but the aged group consumption behavior conformed to the consumption preference logic of passive effect and active effect.Among them,the logic of national regulation and control,the logic of departmental management,and the logic of organizational cooperation directly promote the transition of the specific operation model of urban medical care integration,while the consumption preferences of the urban elderly group play an indirect role.However,it should be pointed out that although the short-term consumption preferences of urban elderly groups have little effect on the changes of the medical care integration model,with the awakening of consumer awareness,the consumer preference factors will play an increasingly important role in the development of medical care integration.In other words,various components or subsystems of urban medical-care integration were interconnected and embedded under the interaction of different action logics,including the national government,local governments,medical-care institutions,and the aged groups.This behavior facilitated the pattern evolution and the development of medical-care integration from disperse to united and from a single phase to multiple phases,and also reflected the specific process of institutional changes.However,as a relatively independent and complex operation system,the urban medical-care integration could not be operated well,unless the dynamic mechanism,the integration mechanism,the guarantee mechanism and the incentive mechanism were all excellently combined.From the perspective of Guangxi,the concrete operating modes of urban medical care integration mainly include extended mode and collaborative mode.In practice,the coexistence of the two has not fundamentally changed.In recent years,the number of urban healthcare institutions in the region has continued to increase.The corresponding policy systems and institutions have gradually established management standards and systems.As a result,the level of health care for the eldly generation has been improved significantly.However,many problems emerged from this situation,such as vague goal orientation,simple development strategy,delayed policy text,obvious division between departments,stiff cooperation method,expensive transaction cost,low consumer acceptance,and immature market development.Currently,there are two main patterns of urban medical-care integration:the extension pattern based on the internal function development of institutions and the cooperative pattern based on the inner-embedded institutional relationships.In general,the cooperative pattern has advantages in the fields of efficiency,sustainability,stability and legitimacy,therefore many institutions have been gradually changing their choices from extension pattern to cooperative pattern.It can be said that in a long period of time in the future,the collaboration model will become the mainstream mode of operation of urban healthcare integration.The problem is that the cooperative pattern means the participants of medical-care integration are more diverse,and makes the relationship structure more complex.Nowadays,the practical subjects of Guangxi medical-care integration mainly compose of local governments,medical institutions,eldly care institutions,urban communities and aged groups.Among all of these subjects,the medical institutions and eldly care institutions are implement subjects.However,different groups have different positions and goals in actions:the local governments aim to release the current pressure and explore a long-term mechanism,the medical care institutions contribute to protect the main function and coordinate the multidimensional relationships,the urban communities make effort to provide the elderly care service and built the medical-care integration carrier,and the aged groups pay attention to improve the elderly care experience and control the cost.As a result,this difference inevitably makes the action logics and strategies different,and then further makes the participants showing different features in the interactions.It is mainly manifested in the two-way empowerment of government and medical institutions,the mutual benefit of medical institutions and pension institutions,the coupling and coordination of medical institutions and urban communities,and the supply and demand interaction between medical institutions and the elderly.The diversification of the action targets of the urban medical care and integration participants and the differentiation of the interest structure lead to the cooperation among them in various difficulties,including competition dilemma,coordination dilemma,specialization dilemma and legal dilemma.Among them,the competitive dilemma is mainly manifested in the unhealthy medical care integration mechanism,resulting in excessive competition,unreasonable allocation of resources,easy to cause monopolies,competition for profitability,easy to breed speculative behaviors,and political competition which is easy to make the relevant government departments mutually constrain;The dilemma of coordination is mainly manifested in the fact that asymmetric resource dependence may weaken the willingness of medical institutions and pension institutions to cooperate,higher transaction costs,difficulty in cooperation between medical institutions and pension institutions,differences in legal basis,and inequality in pressure,reducing medical institutions and endowment institutional consistency capacity to act,asymmetric information leading to moral hazard cooperative medical institutions and pension institutions;The dilemma of professionalization is mainly manifested in solving cross-banking problems and the severe shortage of professional talents;The dilemma of legitimacy is mainly manifested in the fact that there are still many policy bottlenecks in the practice of medical care integration.The practice of medical care and integration is plagued by different values.These dilemmas are not only detrimental to the stable,orderly and efficient operation of medical institutions,but also are not conducive to the development of medical care and integration.The author believes that the "institutional cooperation" of urban medical institutions is the way to solve the above difficulties.As mentioned above,from the perspective of structural functionalism,the collaborative model can be seen as a complex action system.Different subjects and their actions are subsystems of the system.The balance of the entire system depends on the various subsystems.The structure of mutual embedded complementary functions.From the perspective of the new institutionalism,if the supply institutions of medical care integration services-mainly medical institutions and pension institutions-are seen as a formal organization,then other subjects can be seen as its operating environment and the interaction between them.It will inevitably lead to changes in the organization,including the evolution of the specific mode of operation.Therefore,no matter from which perspective,the urban health of China support the integration of multiple subjects and orderly development are inseparable from the power of collaborative participation and jointly promote.Although the cooperation model is relatively a preferred model,because this model involves cooperation between different organizations,such cooperation behavior will not occur spontaneously,and different factor conditions will also affect the stability of cooperation.Therefore,it is necessary to build an "institutional" cooperation framework which is relatively rational,relatively systematic,easy to operate,and easily recognizable by all parties.The "institutional cooperation" pattern contains three different aspects:the clear and complete policy regulations,the stable and ordered institutional actions,and the uniform orientation of social identity.In principle,to promote the development of institutional cooperation pattern of urban medical-care integration,a series of social conditions should be created,mainly including a same goal shared by all participants,an embedded institutional structure,a standard cooperation pattern,a complementary resource network and a balanced interest distribution.Under the current circumstances,.more feasible intervention strategies are based on the institutionalized cooperation of medical and healthcare institutions,supported by four key mechanisms for the evolution of the medical and healthcare integration model,and actively adapting the urban public healthcare property and profit orientation.The relationship between government,government guidance and market leadership,institutional environment and cultural concepts,and medical institutions and elderly care institutions can not only meet the future development direction,but also effectively solve the above difficulties.The author believes that with the continuous development of economy and society of our country,the urban medical care integration will gradually evolve to a higher level professional cooperation model such as long-term care on the basis of "institutionalized" cooperation.