Study On Development Strategy Of The County-level People’s Hospital Based On County-Township-Village Integration

ObjectiveBy reviewing the domestic and foreign literature on the development of countyhospitals and the synergism of healthcare service system, along with investigating Chinesecurrent situation, politic circumstance, this paper presents the lateralinteraction betweencounty people’s hospital and other county healthcareorganizations, and the verticalcooperation between county people’s hospital andhealth clinics in towns, analyzes thepatient’s acceptance level and demand oftownship integration, discussing the limitation andproblem with which thecounty people’s hospitals are confronted with when considering theintegrativehealthcare service management for county, village, and country, puts forwardtheeffective strategy for the development of county people’s hospital on thepremise of theintegration of county, village, and country, and provides theoryevidence for strengtheningthe essential role of county people’s hospital inthe rural healthcare service system.Content and Methods（1）Literature review and intelligence analysis. Reviewing the relevant domestic andforeign literature on state-of-the-art of county people’s hospital and the synergism ofhealthcare organization, analyzing the application of synergetic theory in the synergism ofprefectural region healthcare service, and defining the type of the mode of the integrativehealthcare service management for county, village, and country.（2）Empirical research. Investigating through questionnaire survey at health bureau andcounty people’s hospitals in Suichang County and Yuyao County of Zhejiang Province,and in Hukou county and Ruichang county in Jiangxi Province. Random sampling in thepatients with the transfer treatment experience or treatment experience in the health clinicsin towns. Interviewing person in charge of investigating the local Health Bureau, and administrative staff in sample of hospitals. Researching about the current situation ofstrategy circumstance, management system, resources, lateral interaction, verticalcooperation and patient’s acceptance level and demand of township integration in countypeople’s hospital.（3）Quantitative analysis.Applying the statistical methods such as description analysis,paired samples K-S test, chi-square test, correspondence analysis, etc. Analyzing the currentsituation of resources, operation, lateral interaction and vertical cooperation in countypeople’s hospital. Comparative analysis about the local economy, personnel structure incounty people’s hospital, the two-way referral and patient’s degree of satisfaction withthe county, village healthcare organizations. Sifting and analyzing the critical factor andindex that affect the patient’s degree of satisfaction with the two-way referral.（4）Qualitative analysis.Applying the stakeholder analysis. Clearing the interest relateddegree, influence power, standpoint, and the degree of the influence by policy of thestakeholders who are involved in the integrative healthcare service management for county,village, and country strategy. Improving the feasibility and sustainability of policy throughbalancing the interests of all parties.Results（1）According to the synergetic theory, the county integrative healthcare servicemanagement put healthcare resource as the critical order parameter, including healthcarestaff, medical device, healthcare technique, and medical information. Currently, the modeof the integrative healthcare service management for county, village, and country involvescounty, village trust mode, supervision-office separating mode, hospital group mode, andtechnical cooperation mode.（2）The analysis on the strategy circumstance of the county people’s hospital indicatesthat there is a significant difference among the local total output value of different counties.The financial subsidy income in county people’s hospital is relatively low, less than5%ofthe total income. The correspondence analysis on reform of the counties indicates that thedevelopment of hospital and the progress of reform are closely related to the local economyand government compensation system.（3）The projects of county, village vertical cooperation involve technical cooperation,targeted help, two-way referral, and village, country integrative management; The lateralinteraction of county-level healthcare organization includes mutual recognition betweenconsultation of doctors and inspection result, the interaction of large scale equipment andpersonnel exchange. Currently, the reform measures of integrative management contain establishment of clinical examination center, chronic disease diagnosis and guidance center,medical imaging consultation center, the disinfectant supply center, medical materialpurchasing center, fulfilling the integration of county healthcare resource, county-villagetrust mode, organizing the medical association（4）The qualitative analysis about the development of county people’s hospitalindicates that hospital lacks in professional administrative staff: the qualified doctors aged55and upwards account for12%in some hospitals, large mobility, and weak stresstolerance. The academic degree of most qualified doctors in some hospitals is bachelor orcollege for professional training, while the masters and upwards merely account for1%.（5）Analysis on the integration of county-level people’s hospital indicates that theinitiative of hospitals participating in the integration reform and the reform effect are closelyrelated to the government attention, investment, and policy; For the vertical cooperation themain interaction form is that the qualified doctors in county-level people’s hospitalsdiagnose in countries and the personnel in the town health center are arranged for vocationalstudies in county hospitals. However, the time for country diagnosis is relatively short,generally1to2days, and besides, the qualitative interview indicates that the short time fordiagnosis is ineffective for improving the healthcare service of the town health centers.Furthermore, due to the limitation of the hardware in the town health center, it is challengingfor the county-level hospital qualified doctors to conduct some special operation in thecountryside. Additionally, the interaction of the equipment in some hospitals is insufficient,and the main form is that county hospitals present the eliminated equipment to the townhealth center, focusing on the formalism. The scientific research cooperation between thetown healthcare organizations is relatively insufficient, and the number of the cooperativeproject is less than one. Moreover, all the county-level people’s hospitals do not put thetwo-way referrel as the performance assessment standard, and the number of the casesuperducted to county-level people’s hospitals from town health center is larger than that ofthe case superducted from the former to the latter.（6）The analysis on the patient’s demand and assessment of the integration for county,village, countryside indicates that64.5%of the patients are satisfied with the convenientprocedures of the transfer treatment between the county-level hospitals and the town healthcenter: most patients (69.3%) choose their own preferred hospitals,70.7%patients contactthe transfer treatment organization by themselves,59.6%patients are responsible for theirown transfer stuff. The patients hold different opinions towards several aspects of the countyhospitals and town health center, including equipment, treatment environment, convenientservice, healthcare time, doctors’ attitude, smooth communication and clear explanation, healthcare technique and healthcare fee, etc. Generally, patients appraise county-levelpeople’s hospitals, while are unsatisfied with town health center. The top three that patientsare discontent with the county-level people’s hospitals are complicated procedure, expensivefee, and long waiting time.（7）The analysis on the patient’s acceptance to the integration for county, village, andcountryside shows that45.4%patients hold the opinion that whether they will accept theinitial diagnosis in town health center or not depends, when the county-level healthcareorganization qualified doctors regularly diagnose in town health center. Yet,25.0%patientswill not accept the initial diagnosis in town health center. If the above qualified doctorsconduct special operations in town health center,40.0%patients will not accept it.53.6%patients are satisfied with the transfer treatment process. The correspondence analysisindicates that the key factors that affect the patients satisfaction with the transfer treatmentinvolve the healthcare insurance, transfer treatment procedure, how to choose and contactwith the transfer hospitals.（8）Applying the stakeholder analysis method, it shows that as the stakeholder ofintegration policy, the public health department presents an intermediate degree of benefitcorrelation, strong influence power, supporting standpoint, and is insensitive to policy; thecounty-level people’s hospitals presents a high degree of benefit correlation, stronginfluence power, opposite standpoint, and are sensitive to policy; other county-levelhealthcare organizations present a high degree of benefit correlation, intermediate influencepower, supporting standpoint, and are intermediately sensitive to policy; town health centerspresent a high degree of benefit correlation, weak influence power, supporting standpoint,and are sensitive to policy; patients present a high degree of benefit correlation, weakinfluence power, neutral standpoint, and are sensitive to policy.DiscussionThrough qualitative and quantitative investigation, it indicates that there exist someproblems for county-level people’s hospital plays its essential role when considering theintegration for county, village, and countryside:（1）insufficient supporting policy andinvestment from government（.2）leaders’doubt on the integrative county, village healthcareservice management（.3）the vertical cooperation between county-level people’s hospital andtown health center needs improvement.（4）instable lateral interaction between county-levelpeople’s hospital and other county-level healthcare organizations.（5）two-way referrelsystem requires standardization.（6）the distribution of authority and benefit for theintegrative management exists obstruction.（7）county-level people’s hospitals lack in the talent.（8） the information construction of county-level people’s hospitals needsimprovement.（9）low patient’s acceptance to the integration of county, village, andcountryside.ConclusionFor the above problems, this paper put forward several following suggestion, for thepurpose of promoting the further development of county-level people’s hospital under thecircumstance of integration for county, village and countryside:（1）clarify the governmentsupporting policy and financial compensation system;（2）increase the leaders’attention tothe integrative county, village healthcare service management;（3）gradually normalize thetwo-way treatment system;（4）strengthen the quality of the service from county-levelpeople’s hospital;（5）establish the vertical cooperation mode;（6）investigate thecollectivized lateral interaction mode.Innovations and LimitationsResearch innovations: this research starts from a unique angle of view of integrativecounty, village, countryside service management, discusses the development strategy ofcounty-level people’s hospital under the integration, and in the meanwhile, puts forward thesuggestion that county-level people’s hospital should play its essential role to the full for thepurpose of improving the entire rural three-level healthcare service system; aiming at thelateral interaction between the county-level people’s hospital and other county-levelhealthcare organization, it puts forward the vertical cooperation mode; aiming at the verticalcooperation between county-level people’s hospital and town health center, it puts forwardcollectivized lateral interaction mode.Research limitations: due to the limitation of time and fund, considering the constructionsituation of the integration for county, village, and countryside, it chooses Yuyao county,Suichang county in Zhejiang Province, Hukou county and Ruichang county in JiangxiProvince, four county-level people’s hospitals to conduct the typical survey, and therepresentativeness of research result may be insufficient; during the investigation, patientswere under the coordination from the hospital personnel so that part of the data may notcompletely reflect the patients’opinion.