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Study on Two-Way Referral System of Community Health Services in Xi’an

Author: WangZuoYun
Tutor: YuMin
School: Fourth Military Medical University
Course: Social Medicine and Health Management
Keywords: Two - way referral system Community Health Services Hospital
CLC: R197.1
Type: PhD thesis
Year: 2008
Downloads: 919
Quote: 3
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Abstract


Way referral system, the central bond as joins primary care and secondary care, is an important part of the health service system in many countries, the promotion of patient reasonable diversion, regulate the flow of medical services and control medical costs excessive growth, maintaining medical continuity improve the operating efficiency of health service system plays an important role. In-depth development, along with community health services the way referral came into being in our country, to become \However, due to a late start, by the parties to the allocation of resources, information and communication factors, the actual operating conditions are less than ideal, \. The way referral poor access has become an important factor restricting the sustainable development of community health services, is also a key link of the impact of China's urban residents and the employees' basic medical insurance reform effects. Therefore, it is urgent to carry out two-way referral study has important practical significance. The two-way referral of community health service studies qualitative study of the macro level, only a few descriptive analysis of the status of two-way referral. In this study, Xi'an empirical scene, using a combination of qualitative and quantitative research methods to understand the domestic and international community health services referral system development and reform as well as Research literature review; through phased sampling, simple random sampling, systematic sampling, a questionnaire master of Community Health Service needs demand and utilization, as well as residents, community physicians and hospital doctors tripartite cognitive two-way referral system and evaluation; scene investigation parse way referral run through depth interviews with 12 administrative staff. deep-seated problems; statistical model analysis of community physicians and hospital doctors cognitive differences and referral system to explore the two-way referral mechanism to run the main factors. The survey results show, The Xi'an residents'health treatment proportion and prevalence of chronic diseases on the rise, and the high demand for health education and community health services project, the most in need of the top three chronic diseases system project management, common diagnosis, treatment and health checks. Study found that specific obstacles in this stage in the two-way referral run community health agencies functioning is limited, the society does not trust the quality of community health services, referral poor information network, referral lack of evaluation mechanisms, its main source of government not obvious on the leading role of community health services, health insurance policies have not yet emerged to promote the role of community health services, lack of community and hospital interests coordination mechanism, irrational allocation of human resources. This study demonstrated the feasibility of the two-way referral of Xi'an from the system level analysis. Internal coordination is not enough, but with the implementation of the external conditions, and that way referral system is feasible under the existing policy environment. On the basis of the analysis of the gap model, learn from foreign referral beneficial experience, and improve the quality of community health services, improve the management of two-way referral link for the entry point, from the three perspectives of government, community health services, hospitals, proposed to promote Xi'an way referral to the effective operation of the policy recommendations, such as the active introduction of social capital, the establishment of a multi-channel financing mechanism to coordinate for Fangli Yi build constraint mechanism to build a referral network system, and enhance the residents' needs investigation, the extension service functions to intensify propaganda coordination, strengthen referral links and adjust their development strategies, provide some reference for the perfect Xi'an city health system reform. The main innovations of this study: First, the use of health services, health economic theory and correlation analysis method, the supply-side behavior included in the key factors around the service supply-side, demand-side and fund parties three dimensions to build a two-way referral actors relations model. Through systematic analysis and found that the two-way referral actors in a collaborative relationship, including hospitals, community health service institutions and residents tripartite relationship is a two-way referral mechanism for the sustained and healthy development of the central link, the most critical interaction between hospital and community. Government intervention regulation is necessary to ensure the community hospital. The referral system is not alone play a role, it is connected with the health care system for all stakeholders, patients, community health service institutions and hospitals, and run in collaboration with other system. Theoretical framework to establish the impact of the two-way referral to run from the five levels of the policy, doctors, residents, institutions and disease, focusing to reveal micro level referral mechanisms. Such as patient-related factors (age, gender, education level, marital status, monthly income, occupation, health concerns and referral cognitive) associated with the two-way referral, education level, monthly income, occupation and health concerns of two-way referral significant. The doctor's age, gender, years of professional experience, patient philosophy, community and hospital communication degree characteristics affect referral decisions, patient philosophy, community hospitals communicate the extent of two-way referral significant, and the educational background of the doctor's referral decision-making was not statistically learn significant difference. Disease category, severity of illness, hospital specialist level, community agencies, facilities, covered by medical insurance, incentive measures, the referral standard and price leverage to affect the implementation of the two-way referral. The results of this study make way referral management mode as well as community health services clearer idea of ??sustainable development, and provides a theoretical and practical basis for the reconstruction and improvement of the two-way referral system.

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CLC: > Medicine, health > Preventive Medicine,Health > Health care organizations and career ( Health Management ) > Health care systems and institutions > Health care system
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