Research On Health Care Alliance Practice In Tianchang County Of Anhui Province From The Perspective Of Stakeholders

ObjectivesThe study aims to understand the health care alliance practice measures,achievements and shortcomings in Tianchang county of Anhui province.And analysing stakehoders interests and cognition,satisfacion of reform etc.Then finding the reform power or resistance factors,providing policy recommendations for local policy makers.Contents1.Literature Review and theoretical basis for the health care alliance.2.Analysis of the health care alliance practice measures,achievements and shortcomings in Tianchang county of Anhui province.3.Analysis of the behavior change of key stakholders in the health care alliance practice.4.Discussing the key problems and reasons,and put forward the corresponding policy recommendations.MethodsLiterature review was used to analyze the situation of the health care alliance pracice.Questionaire survey and Personal in-depth interview method were conducted to collect data and know the situation of implementation of the health care alliance reform inTianchang county.Stakeholders analysis were used to understand stakeholders interests,cogniton and satisfaction of reform etc.Descriptive statistical analysis was carried out.Findings1.Implementation status of the health care alliance practice in Tianchang countySpecific measures:In terms of governance,Tianchang established the health care alliance Council to explore the corporate governance structure.In terms of interest distribution mechanism,it took Provider payment reforms and setted Capitation under the budget cap.It promoted the health care alliance reshape a positive incentive mechanism.In terms of organization management,it established a unified and flexible talent management mechanism and carried out medical technology assistance to help primary medical institutions improve medical service ability.What’s more,it built a unified medical information platform and opened to each members in the health care alliance reform.It also explored telemedicine to help primary medical institutions check patient medical examination.It ensured the each mumbers’ provison of medical services and took two-way referral system.In terms of medical service model,it constructed health management network and implemented different health management to different group.Preliminary achievements:The main increase in medical costs has been effectively controlled;the use of Medicare funds rate increased,the burden of patients has been reduced;the medical service quality and efficiency has been improved;and medical institutions enhanced coordination within the county medical service ability improve.In the presence of problems,the county medical resources integration is still not enough,and health personnel allocation still needs to be strengthened;family physician system needs to be further improved;the county health information sharing is not fully achieve.2.Subject analysis of the health care alliance policy in Tianchang countyThe benefits,perceptions,capabilities,and resources of different key stakeholders have a driving or hindering effect on development of the health care alliance policy.The profit and loss of the health sector is positive,with high cognition,high capacity and high resources.It is the main force of the reform.The profits and losses of other administrative departments have risks,their abilities and resources are higher,but the cognition is relatively low,and they are neutral on the policy.The profits and losses of county-level medical institutions are positive,with high cognition,moderate ability and resources,and they support for reform.The profits and losses of the primary medical institutions are positive,the cognition level is higher,the ability and resources are lower,and they support for reform.The profits and losses of medical staff in county-level medical institutions are positive,higher in cognition,lower in ability and resources,and they tend to support reform.The profits and losses of medical staff in primary medical institutions are risky,low in cognition,ability and resources,and they are neutral in reform.The benefit of the patient is positive,although resources,capabilities and cognition are lower and they tend to support the reform.Conclusions1.The conditions of effective integration of the health care alliance policy include:the excellent governance is the basis of the health care alliance;a reasonable profit distribution mechanism is the key to promote the sustainable development of the health care alliance the health care alliance;people-oriented provide integrated services is the fundamental purpose to carry out the health care alliance;The sharing of information resources is an important support for the smooth progress of the health care alliance.2.The impact of major stakeholders on the policy is:The health sector is the main driving force of reform and other administrative departments is an important condition to promote the development of policy;all levels of medical institutions and medical personnel are responsible for the implementation of the policy,the degree of profit and loss influences the promotion or obstruction of the reform policy;residents are the ultimate beneficiaries of policy,but if the policy the execution is not smooth,publicity is not sufficient,it could become a drag factor.Suggestions1.Strengthening the overall coordination ability of the health department and balancing the conflicts of interest among the related parties.2.Improving the health insurance as the core of the incentive mechanism and effectively guiding the supply and demand behavior.3.Increasing the input of primary medical institutions and improving the enthusiasm of medical staff at the grassroots level.4.Raising the level of policy understanding of relevant parties and eliminating the peoples’ concerns about the policy.