The Game Study On Main Stakeholders Of Community Chronic Disease Management

1. ObjectivesBy sorting and analysing the available data and literature, using the game theory and relevant theoretics to study the main stakeholders'strategy interactive mode, and the mechanism it impacts the management effect on the process of community chronic disease management, and then, to reveal the causes which lead to the phenomena and problems exist currently in practice of community chronic disease management. On this basis, to make reasonable intervention strategies and policy recommendations for improving the management model and the management effect.2. MethodsThis study bases on the application of theory and data provided by investigations and authoritative sources, improves the analysis framwork by studying of literature, makes use of tools including systematical analysis, structural analysis, mathematical analysis, model analysis etc. Closely integrate the theoretical analysis and empirical research to ensure the reasonable process of research and practical results.3. Results1)The effect of community chronic disease management is impacted by multi-factors, in which the main factor is the activities of stakeholders, that closely connected on resources, influence and interests, impacting the community chronic disease management through game activities and and strategy choices.2)The time preference and the return on investment restrict the government's initiative of investment. The methods that strengthen the performance appraisal, increase financial and technical assistance will improve the government's attention and confidence of chronic disease management. The government should strengthen the responsibility of guarantee people's health status by increasing financial input, establishing financial investment management system, and improving evaluation system and the level of chronic disease management. The effort of community health services (CHS) for chronic disease management is directly effected by the level of compensation and cost for effort. It needs effective incentive measures basis on performance appraisal and a series of activities which may reduce cost coefficient to relieve the concerns of cost of CHS.3)Under the conditions of information asymmetry, the "Lemon Market" model shows the collapse crisis of chronic disease insurance market, based on patients fund-raising responsibilities of their medical expenses, we emphasize the urgent needs of social health insurance. At the same time, the commercial health insurance should also be supported, because of the shortcoming of social health insurance that the"low-level"principle's insufficiency to meet people's higher needs and the possibility to lead political rent-seeking.4)In the game model of treatment, there are different strategy choices between different medical institutions. The dominant strategy of hospitals is"high-effort for serious, low-effort for minor", while the primary healthcare institutions by contraries. As the corresponding strategy, residents'dominant strategy is choosing hospitals when suffering serious diseases. But for minor ailments, there would be a borderline that neither stratgy is dominant. So it needs a rational Schelling-Point to encourage patients to primary healthcare institutions. However, patients rarely clearly distinguish the state of their illness, so it needs to strengthen residents'awareness and cognitive level of chronic diseases, and perfect the two-way referral mechanism to rectify residents'wrong choices of medical institutions.4. ConclusionsDuring the practice of chronic disease management in community, stakeholders perform positive or negative impacts through strategy choosing to maximize their own interests. As "rules maker", government should regulate the stakeholders'strategy activities by designing efficient systems, to ensure the investment's validity and durability, to design a reasonable system to guide the community health service institutions to participate in chronic disease management, to support bringing chronic disease into medical insurance, and to establish a sound primary health service system and referral system, and to guide patients make a reasonable choice when getting ill.5. Policy recommendations1 ) To improve the government's awareness of the importance of chronic disease management, and strengthen the government's responsibility to protect the health of residents;2)Through the rational design of the system to guide the community health service institutions to actively participate in chronic disease management;3)To establish a perfect medical insurance system that based on social medical insurance, with commercial health insurance for supplementary for chronic diseases in order to meet different levels of demand for health services;4)To establish a sound primary health service system and referral system, to guide the residents approaching rational use of medical services;5)Fully mobilize the social resources available, to achieve community-wide chronic disease management participation.