Understanding the Integrated Health Management System Policy in China From Multiple Perspectives: Systematic Review and Content Analysis.

BACKGROUND: The integrated health management system (IHMS), which unites all health care-related institutions under a health-centered organizational framework, is of great significance to China in promoting the hierarchical treatment system and improving the new health care reform. China's IHMS policy consists of multiple policies at different levels and at different times; however, there is a lack of comprehensive interpretation and analysis of these policies, which is not conducive to the further development of the IHMS in China. OBJECTIVE: This study aims to comprehensively analyze and understand the characteristics, development, and evolution of China's IHMS policy to inform the design and improvement of the system. METHODS: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to collect 152 policy documents. With the perspective of policy tools and policy orientation as the core, a comprehensive 6D framework including policy level, policy nature, release time, policy tools, stakeholders, and policy orientation was established by combining the content of policy texts. These dimensions were then analyzed using content analysis. RESULTS: First, we found that, regarding the coordination of policy tools and stakeholders, China's IHMS policy was more inclined to use environment-based policy tools (1089/1929, 56.45%), which suggests a need for further balance in the internal structure of policy tools. Attention to different actors varied, and the participation of physicians and residents needs further improvement (65/2019, 3.22% and 11/2019, 0.54%, respectively). Second, in terms of level differences, Shanghai's IHMS policy used fewer demand-based policy tools (43/483, 8.9%), whereas the national IHMS policy and those of other provinces and cities used fewer supply-based tools (61/357, 17.1% and 248/357, 69.5%, respectively). The national IHMS strategy placed more emphasis on the construction of smart health care (including digital health; 10/275, 3.6%), whereas Shanghai was a leader in the development of healthy community and healthy China (9/158, 5.7% and 4/158, 2.5%, respectively). Third, in terms of time evolution, the various policy tools showed an increasing and then decreasing trend from 2014 to 2021, with relatively more use of environment-based policy tools and less use of demand-based policy tools in the last 3 years. The growth of China's IHMS policy can be divided into 3 stages: the disease-centered period (2014-2017), the e-health technology development period (2017-2019), and the health-centered period (2018-2021). CONCLUSIONS: Policy makers should make several adjustments, such as coordinating policy tools and the uneven relationships among stakeholders; grasping key policy priorities in the context of local characteristics; and focusing on horizontal, multidimensional integration of health resources starting from the community. This study expands the objects of policy research and improves the framework for policy analysis. The findings provide some possible lessons for future policy formulation and optimization.

Perceived knowledge, attitudes and practices regarding the medical consortium among medical staff in Sichuan, China: a cross-sectional survey.

BACKGROUND: In China, fragmented and inefficient health care systems are common while quality resources are limited. To promote an organized, efficient system, the government launched a medical consortium policy to vertically integrate health care through the collaboration of different levels of medical care. Logically, medical staff's knowledge, attitudes and practices (KAP) regarding the consortium are critical for its development. The objective of this study was to explore the KAP regarding the medical consortium among medical staff in a medical consortium in Sichuan Province, China. METHODS: A cross-sectional survey was conducted. In total, 690 medical staff members in 3 cities of Sichuan Province, China, were interviewed from November 2018 to December 2018. The questionnaire consisted of 18 items, including 4 items related to perceived knowledge, 4 items related to attitudes and 2 items related to practices, and was rated on a 5-point Likert scale (one = strongly disagree/do not know, five = strongly agree/know). RESULTS: The effective response sample was 640 copies of the questionnaire, and most medical staff members (92.50%) knew about the cooperation with other hospitals in the medical consortium. Medical staff scored differently on each item in the questionnaire, with the highest score being the item 'agreeing with the ward rounds and clinical teaching and training organized by the leading hospital' (4.54 ± 0.76), and the lowest score being the item 'frequency in participating in ward rounds and clinical teaching organized by the leading hospital' (2.83 ± 1.36). In addition, the effect of demographic characteristics on KAP was evaluated by stepwise multiple regression analysis, and a significant positive correlation was found between all the studied variables by Spearman's correlation (p < 0.05). CONCLUSIONS: This study showed that the attitudes toward and knowledge of the medical consortium significantly contribute to practices, satisfaction with the support work performed by the leading hospital and agreement of improvement after joining the medical consortium. Thus, to improve medical staff's KAP and satisfaction, publicity and educational programs in medical consortia are necessary, and the leading hospital should attach importance to the informatization construction and demand of different medical staff members. CLINICAL TRIAL REGISTRATION: There are no clinical trials in this study.

The Pathway of China's Integrated Delivery System: Based on the Analysis of the Medical Consortium Policies.

With the deepening of China's health-care reform, an integrated delivery system has gradually emerged with the function of improving the efficiency of the health-care delivery system. For China's integrated delivery system, a medical consortium plays an important role in integrating public hospitals and primary care facilities. The first medical consortium policy issued after the COVID-19 pandemic apparently placed hope on accelerating the implementation of a medical consortium and tiered health-care delivery system. This paper illustrates the possible future pathway of China's medical consortium through retrospection of the 10-year process, changes of the series of policies, and characteristics of the policy issued in 2020. We considered that a fully integrated medical consortium would be a major phenomenon in China's medical industry, which would lead to the formation of a dualistic care pattern in China.

GIS-based method to delimit spheres of influence for a medical consortium: Experience of a pediatric medical consortium, Shanghai.

BACKGROUND: To improve the utilization efficiency of health care services, the concept of a "regional medical consortium" has attracted more attention during the most recent round of health care reform in China. Shanghai, a municipality of China, has made many efforts to promote its regional medical consortium project. In this paper, the pediatric medical consortium of Shanghai will serve as an example to introduce the main tasks and groundwork of the Shanghai medical consortium and will underscore Shanghai's exploration of the vertical integration of medical resources. METHODS: This study delimits the service areas of leading hospitals, which can help determine the spheres of influence of top hospitals geographically. With this information, regional hospitals or community hospitals can find alliance hospitals and leading hospitals more easily. These efforts can be realized using ArcGIS for spatial data analysis. RESULTS: According to the locations of leading hospitals and actual patient distributions at these hospitals, the natural areas of influence of leading hospitals are illustrated. Then, hospitals other than leading hospitals can select allied hospitals in the same area of influence. In this way, connections in a medical consortium will be tighter, and hospitals will be better able to meet the actual demands of patients. CONCLUSIONS: In this paper, we introduce a geographic method to delimit the spheres of influence of hospitals based on actual health-seeking behaviors of patients by analyzing the spatial distribution of hospitalization probability. Within the boundaries of a sphere of influence, a geographic connection between the leading hospital and the general hospital is established automatically. Based on this geographic connection, leading hospitals should provide technological support to general hospitals located in their sphere of influence, while the general hospitals should provide spare medical resources in return. Thus, the medical consortium can be formed geographically and operate more smoothly.