Multiple realization pathways of county-level medical alliances to improve service capacity:A fuzzy set qualitative comparative analysis^☆

Abstract

Background: The long-standing dilemma of difficulties in the improvement of primary care in China has led to county-level medical alliances reforms in various regions throughout the country.
Objective: To analyze the combination of pathways that contribute to improving the service capabilities of county-level medical alliances, providing a reference for the improvement and promotion of county-level medical alliances.
Methods: CNKI and Wanfang Data Knowledge Service Platform were searched by using "county-level medical alliance" "county health care unit" as keywords from 2020-01-01 to 2022- 11-26 to obtain 662 related papers, a total of 9 papers and 11 cases were selected in the analysis. Based on literature review and policy analysis, variables including scale of planning and implementation, close organizational structure, collaborative management system, information platform integration, regional resources sharing, medical insurance payment reform, and incentive mechanism design were identified as outcome variables. The fuzzy set qualitative comparative analysis was used to identify multiple realization pathways for the service capability improvement of county-level medical alliances.
Results: Four combinations of pathways were found to improve the service capability of county-level medical alliances. Pathway S1:planning and implementation scale * close organizational structure * collaborative management system * regional resources sharing * medical insurance payment reform * incentive mechanism design. Pathway S2:close organizational structure * collaborative management system * information platform integration * regional resources sharing * medical insurance payment reform * incentive mechanism design. Pathway S3:smaller scale of planning and implementation * close organizational structure * collaborative management system * non-integrated information platform * non-sharing of regional resources * medical insurance payment reform * incentive mechanism design. Pathway S4:smaller scale of planning and implementation * close organizational structure * collaborative management system * non-integrated information platform * regional resource sharing * medical insurance payment reform * no incentive mechanism design.
Conclusion: The improvement of service capability of county-level medical alliances needs to focus on close organizational structure, establish management system focusing on the collaboration of departments and member institutions, and promote medical insurance payment reform such as global budget management system of medical insurance funds and diagnosis related groups(DRGs).

Keywords

Medical alliance / County-level medical services / Primary health care / Qualitative comparative analysis / Fuzzy set

Declarations

Not applicable.

Authors' contributions

Yue Xu was responsible for conception and design of the article, implementation of the study, data collection, statistical analysis, interpretation of the results, and writing of the article; Linlin Hu was responsible for conception and design of the article, revision of the article, quality control of the article, and proofreading of the article, and was responsible for revising and reviewing the article; Yuanli Liu was responsible for revision of the article, and was also responsible for proofreading the article.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and materials

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Authors' other information

Not applicable.

Funding

This research was supported by grants from National Natural Science Foundation of China (72034005) and Chinese Academy of Medical Sciences (2021-I2M-1–046).

Competing interests

The authors declare that they have no competing interests.

Acknowledgements

Not applicable.

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