ABSTRACT
Introduction:
This study aimed to explore whether the establishment of county medical alliances can improve
satisfaction with the vertical integration of healthcare systems among rural medical and
healthcare service provider managers and service providers. Our study also sought to provide recommendations for the
sustainable development of vertical integration in healthcare systems.
Methods:
A semi-structured
interview with 30
healthcare service providers was employed in this
research, and Nvivo
software was utilized to analyze factors that influence vertical integration. From April to July 2021, a multi-stage random sampling
method was used to select participants. The sample included two leading
hospitals in medical consortia, 15 member units (
healthcare service providers and
medical staff), two county-level
hospitals, and 15 township
health centers/
community healthcare service centers from non-medical consortia.
Questionnaire surveys were conducted with these groups.
Factor analysis was used to calculate
satisfaction scores for
healthcare service providers with the cross-institutional synergistic development of healthcare systems in both medical and non-medical consortia (denoted as M(IQR)).
Propensity score matching was employed to reduce confounding factors between groups. The
Mann-Whitney U test was used to compare
satisfaction differences between groups.
Results:
The overall
satisfaction scores for
lead-
county hospital managers, member institution managers,
medical staff at the
lead-
county hospital, and
medical staff at member institutions were 4.80 (1.00), 4.17 (1.17), 4.00 (1.38), and 4.00 (1.12), respectively.
Lead-
county hospital managers'
satisfaction with cross-institutional collaboration, development capacity enhancement, and structure and
resource integration in the Medical Alliance group showed higher
satisfaction than the Non-Medical Alliance. Similarly,
lead-
county hospital medical staff in the Medical Alliance group reported greater
satisfaction with collaboration efforts, supportive
environment, and development capacity enhancement. Notably, while the Medical Alliance group's
satisfaction scores were higher, the differences between the two groups were not statistically significant for
lead-
county hospital managers and
medical staff. The Medical Alliance group did show statistically significant differences in member institution managers'
satisfaction with collaboration, development capacity enhancement, and structure and
resource integration. Additionally,
medical staff of member institutions in the Medical Alliance group reported statistically significant higher
satisfaction with collaboration, supportive
environment, development capacity enhancement,
healthcare service integration, and
human resource development.
Conclusion:
To facilitate the establishment of county medical alliances, managers of leading county-level
hospitals should adopt a healthcare system integration strategy. This strategy involves evolution from being a member of a single institution to a coordinator of cross-institutional vertical integration of medical and
healthcare services. Additionally, revamping
remuneration and appraisal systems for members of county medical alliances is necessary. This
will encourage cooperation among
healthcare institutions within the three-tiered system and their
medical staff, ultimately facilitating the
provision of integrated services.