Research On The Policy Effect And Implementation Mechanism Of County Medical Community

There is a serious shortage of grass-roots health personnel in China,with insufficient service capacity and small business volume,which seriously restricts the health needs of rural residents.The County Medical Community integrates medical resources at county,aiming to restructure the rural medical service system,improve the service capacity at the grass-roots level,and enhance the health care utilization of residents.The purpose of this thesis is to study the policy implementation effect of County Medical Community on the demand side and supply side,and analyze the reasons influencing the effect of County Medical Community,including if there is economic basis,whether the implementation mechanism can be established,and what institutional constraints are faced with.The chief research contents and methods are as followed: First,based on the consumer random utility theory and discrete choice model,the DID empirical analysis method is used to study the impact of County Medical Community on residents' health service utilization on the demand side.Second,focusing on the effect of County Medical Communities on the suppliers,many field investigations are conducted in 82 towns and townships of 14 counties in 7 cities of 6provinces to grasp the specific practices,characteristics,and effects of three different types of County Medical Communities: loose,semi-tight and tight.Third,based on the industrial organization theories of scale economy,scope economy,transaction cost and so on,this thesis investigates the economic basis of the existence of county medical community,studies the implementation mechanism of County Medical Community from the perspective of stakeholders,and analyzes the restrictive factors from the institutional view.Fourth,the paper summarizes the development process,characteristics,and effects of organizational integration in developed countries such as Britain and America.The results show that: First,the County Medical Community has no significant impact on the demand side and cannot clearly improve the accessibility and satisfaction of residents.The County Medical Community has little influence on the supply side and cannot remarkably improve the capacity of health care and business volume at grass-roots level and cannot solve the problem of grass-roots talent shortage.Second,judging from domestic cases,the degree of integration is low,and the integration effect of various types of county hospitals is not obvious.The loose institutions are mainly competitive,and the cooperation becomes a mere formality.The semi-tight form faces the separation of ownership,management right,and beneficial right;The tight type is difficult to break through the constraints of the system and mechanism,and its autonomy is limited,being hard to achieve a community of interests.Thirdly,the main reasons for the unremarkable effect of County Medical Community are lack of economic foundation,hard to achieve economies of scale and scope,the governance structure of transaction is suitable for bilateral governance structure,and the substitution of transaction is more than complementarity.The effective implementation of County Medical Community requires the establishment of crossagency collaboration mechanism,benefit sharing mechanism and perfect agent mechanism,which are currently difficult to achieve.Constraints contain structural and institutional obstacles,various policies restricting grass-roots development,low degree of integration,difficulty in transferring patients,poor effect of doctors' sinking,etc.Fourthly,in view of international cases,integration is the direction of health system reform in various countries.Integration emphasizes the basic role of primary health care and individual participation.However,the overall effect of the integration is not ideal,the integration path is not clear,and the successful experiences are difficult to replicate.It is hard to break through institutional and financial barriers,crossdepartment management is difficult,and most stakeholders are skeptical of the integration,unable to profit from the integration.In the future,the County Medical Community should be cautiously implemented;Reform the financial,personnel,medical,medical insurance,pharmaceutical,information sharing and other policies that hinder grassroots institutions;the capacity of the grass-roots should be improved,township hospitals should be classified and managed,more investment should be increased at the grass-roots level,the income of rural doctors should be improved.