Enlightenment of the Typical Models of Integrated Delivery System Abroad to the Development of Integrated Health Management System in China

doi:10.12114/j.issn.1007-9572.2020.00.344

Abstract

Abstract: Against the backdrop of aging society，changing disease spectrum and furthering the implementation of Healthy China 2030 strategic blueprint measures，China has ushered in a new era of healthy China construction，during which transforming a regional medical consortium into an integrated health management system（IHMS） via upgrading，and the development of IHMS tend to be inevitable. We analyzed the typical models of integrated delivery system abroad at the micro，meso and macro levels with foci on the historical background，specific measures and achievements，and summarized the successful experience. And based on this，we put forward the following recommendations for addressing the challenges faced by the healthcare system and for improving the development of IHMS in China：integrating health-related factors as many as possible to benefit the whole population through the whole life；strengthening the healthcare talent system development with great emphasis on fostering primary care workers；giving priority to the healthcare needs of key population groups and developing interdisciplinary teams；forming high-efficient healthcare delivery modes；enhancing the informatization construction；developing rational and effective incentive mechanisms.

Key words: Integrated medical care system, Integrated health management system, Integrated delivery system, Primary health care, Health care reform

摘要：

随着社会人口老龄化、疾病谱的转变，以及“健康中国2030”战略规划的实施推进，我国迎来了健康中国建设新纪元，医疗联合体（医联体）向健康管理联合体（健联体）转型升级，以及健联体建设成为必然趋势。本文在整合发生的水平对国外整合医疗典型模式进行分析，从历史背景、具体措施、开展成效3方面进行介绍，汇总出其成功经验。同时结合我国卫生服务体系面临的挑战和健联体开展现状，提出如下建议：尽可能整合所有与健康相关的要素，惠及全人群，覆盖全生命周期；以基层医疗卫生机构为主体，加强人才体系建设；关注重点人群，构建跨学科团队；形成高效的医疗卫生服务提供模式；加强信息化建设；建立合理有效的激励机制。

关键词: 　医疗联合体, 健康管理联合体, 整合医疗, 初级卫生保健, 卫生保健改革

XIONG Mei,WU Jia,LIU Lixia, et al. Enlightenment of the Typical Models of Integrated Delivery System Abroad to the Development of Integrated Health Management System in China[J]. Chinese General Practice, 2020, 23(22): 2741-2748. DOI: 10.12114/j.issn.1007-9572.2020.00.344.
熊梅,伍佳,刘利霞等. 国外整合医疗典型模式对我国健康管理联合体建设的启示[J]. 中国全科医学, 2020, 23(22): 2741-2748. DOI: 10.12114/j.issn.1007-9572.2020.00.344.

References

［1］WHO．Integration of health care delivery：report of a WHO study group［R］．Geneva：World Health Organization，1996.
［2］WHO．Framework on integrated，people-centred health service：report by the secretariat［EB/OL］．（2016-04-15）［2019-08-30］．https://apps.who.int/iris/handle/10665/252698.
［3］秦永方．医联体推进难题咋 “破题”［J］．中国社会保障，2018，25（4）：70-71．DOI：10.3969/j.issn.1008-4304.2018.04.038.
［4］李念念，赵允伍，尹红艳，等．医联体发展困境与策略浅析［J］．中国卫生事业管理，2017，34（8）：561-562.
LI N N，ZHAO Y W，YIN H Y，et al．Study on the predicament and strategy of medical alliance［J］．Chinese Health Service Management，2017，34（8）：561-562.
［5］白书忠，徐卸古，王志琳，等．构建健康管理联合体　助力健康中国［J］．中华健康管理学杂志，2017，11（6）：481-484．DOI：10.3760/cma.j.issn.1674-0815.2017.06.001.
BAI S Z，XU X G，WANG Z L，et al．Constructing a health management consortium to promote healthy China［J］．Chin J Health Manage，2017，11（6）：481-484．DOI：10.3760/cma.j.issn.1674-0815.2017.06.001.
［6］陶四海．健联体：以健康为中心［J］．中国卫生，2018，63（9）：21-22．DOI：10.15973/j.cnki.cn11-3708/d.2018.09.005.
［7］王虎峰．打造全新健康构架［J］．中国卫生，2018，63（9）：18-20．DOI：10.15973/j.cnki.cn11-3708/d.2018.09.004.
［8］蔡绍英．武汉黄陂：健康管理提档升级［J］．中国卫生，2018，63（9）：31-32．DOI：10.15973/j.cnki.cn11-3708/d.2018.09.010.
［9］VALENTIJN P P，SCHEPMAN S M，OPHEIJ W，et al．Understanding integrated care：a comprehensive conceptual framework based on the integrative functions of primary care［J］．Int J Integr Care，2013，13：e010．DOI：10.5334/ijic.886.
［10］李梦斐．我国“医联体”发展现状与对策研究［D］．济南：山东大学，2017.
［11］WISTOW G，GASKINS M，HOLDER H，et al．Putting integrated care into practice：the North West London experience［R］．Oxford：Nuffield Trust，2015.
［12］GOODWIN N．Understanding integrated care［J］．Int J Integr Care，2016，16（4）：6．DOI：10.5334/ijic.2530.
［13］PLOCHG T，KLAZINGA N S．Community-based integrated care：myth or must［J］．Int J Qual Health Care，2002，14（2）：91-101．DOI：10.1093/oxfordjournals.intqhc.a002606.
［14］MCHUGH M D，AIKEN L H，ECKENHOFF M E，et al．Achieving Kaiser Permanente quality［J］．Heal Care Manag Rev，2016，41（3）：178-188．
［15］HALVORSSON G C．Sustainable hospitals can help bend the cost curve：Kaiser Permanente's environmental stewardship［R］．New York：The Commonwealth Fund，2012.
［16］MCCARTHY D，MUELLER K，WRENN J．Kaiser Permanente：bridging the quality divide with integrated practice，group accountability，and health information technology．Organized delivery system：case study［R］．New York：The Commonwealth Fund，2009.
［17］MAEDA J L，LEE K M，HORBERG M．Comparative health systems research among Kaiser Permanente and other integrated delivery systems：a systematic literature review［J］．Perm J，2014，18（3）：66-77．DOI：10.7812/TPP/13-159.
［18］ANONYMOUS．Business：another American way，controlling health-care costs［J］．The Economist，2010，395（8680）：67-68.
［19］California Healthcare Foundation．Living with chronic illness：Californians' perspectives on cost and coordination of care［J］．Medical Benefits，2008，25（12）：6.
［20］BERWICK D M，NOLAN T W，WHITTINGTON J．The triple aim：care，health，and cost［J］．Health Aff（Millwood），2008，27（3）：759-769．DOI：10.1377/hlthaff.27.3.759.
［21］RICE T，ROSENAU P，UNRUH L Y，et al．United States of America：health system review［J］．Health Syst Transit，2013，15（3）：1-431.
［22］PIMPERL A．Re-orienting the model of care：towards accountable care organizations［J］．Int J Integr Care，2018，18（1）：15．
［23］PEIRIS D．Can 'meso-tier' healthcare organizations enhance health system performance：lessons from US Accountable Care Organizations（ACOs） and a discussion of the implications for Australia［J］．Int J Integr Care，2017，17（5）：13．
［24］PIMPERL A，GROENE O，MOUSQUèS J，et al．What can we learn from the US experiences on accountable care organizations? Reflections from Germany，the UK，France and Australia［J］．Int J Integr Care，2017，17（5）：331．DOI：10.5334/ijic.3648．
（下转第2756页）
［25］AAFP．Accountable care organizations［EB/OL］．［2019-08-30］．https://www.aafp.org/practice-management/payment/acos.html.
［26］JABBARPOUR Y，COFFMAN M，HABIB A，et al．Advanced primary care：a key contributor to successful ACOs［R］．Patient-Centered Primary Care Collaborative，Robert Graham Center，2018.
［27］MUHLESTEIN D，SAUNDERS R S，MCCLELLAN M B．Growth of ACOs and alternative payment models in 2017［EB/OL］．（2017-06-28）［2019-08-30］．https://www.healthaffairs.org/do/10.1377/hblog20170628.060719/full/.
［28］MCWILLIAMS J M，LANDON B E，CHERNEW M E，et al．Changes in patients' experiences in medicare accountable care organizations［J］．N Engl J Med，2014，371（18）：1715-1724．DOI：10.1056/NEJMsa1406552.
［29］SHORTELL S M，COLLA C H，LEWIS V A，et al．Accountable care organizations：the national landscape［J］．J Health Polit Policy Law，2015，40（4）：647-668．DOI：10.1215/03616878-3149976.
［30］MUKAMEL D B，PETERSON D R，TEMKIN-GREENER H，
et al．Program characteristics and enrollees' outcomes in the program of all-inclusive care for the elderly（PACE）［J］．Milbank Q，2007，85（3）：499-531．
［31］STEWART M，MCNEALY K，DUNTON N．Measuring quality in the United States（US） program of all-inclusive care for the elderly（PACE）［J］．Innov Aging，2017，1（suppl 1）：448．DOI：10.1093/geroni/igx004.1603.
［32］HOSTETTER M，KLEIN S，MCCARTHY D．Aging gracefully：the PACE approach to caring for frail elders in the community［R］．New York：The Commonwealth Fund，2016.
［33］GONZALEZ L．A focus on the program of all-inclusive care for the elderly（PACE）［J］．J Aging Soc Policy，2017，29（5）：475-490．DOI：10.1080/08959420.2017.1281092.
［34］GHOSH A，ORFIELD C，SCHMITZ R．Evaluating PACE：a review of the literature．Office of disability，aging and long-term care policy office of the assistant secretary for planning and evaluation US［R］．New Yorks：Department of Health and Human Services，2014.
［35］SEGELMAN M，CAI X Y，VAN REENEN C，et al．Transitioning from community-based to institutional long-term care：comparing 1915（c） waiver and PACE enrollees［J］．Gerontologist，2017，57（2）：300-308．DOI：10.1093/geront/gnv106.
［36］BEAUCHAMP J，CHEH V，SCHMITZ R，et al．The effect of the program of all-inclusive care for the elderly（PACE） on quality［R］．New Jersey：Mathematica Policy Research，2008.
［37］KEONG C，MUN L，FENG L，et al．Singaporeprogramme for integrated care for the elderly（SPICE）：an integrated model of care to enable frail elderly to be cared for in the community［J］．Int J Integr Care，2012，12（7）：e144．DOI：10.5334/ijic.1005.
［38］GAMMON D，BERNTSEN G K，KORICHO A T，et al．The chronic care model and technological research and innovation：a scoping review at the crossroads［J］．J Med Internet Res，2015，17（2）：e25．DOI：10.2196/jmir.3547.
［39］BONGAERTS B W，MüSSIG K，WENS J，et al．Effectiveness of chronic care models for the management of type 2 diabetes mellitus in Europe：a systematic review and meta-analysis［J］．BMJ Open，2017，7（3）：e013076．DOI：10.1136/bmjopen-2016-013076.
［40］ROBUSTO F，BISCEGLIA L，PETRAROLO V，et al．The effects of the introduction of a chronic care model-based program on utilization of healthcare resources：the results of the Puglia care program［J］．BMC Health Serv Res，2018，18（1）：377．DOI：10.1186/s12913-018-3075-0.
［41］BAUER M S，MILLER C J，KIM B，et al．Effectiveness of implementing a collaborative chronic care model for clinician teams on patient outcomes and health status in mental health：a randomized clinical trial［J］．JAMA Netw Open，2019，2（3）：e190230．DOI：10.1001/jamanetworkopen.2019.0230.
［42］DREWES H W，STEUTEN L M，LEMMENS L C，et al．The effectiveness of chronic care management for heart failure：meta-regression analyses to explain the heterogeneity in outcomes［J］．Health Serv Res，2012，47（5）：1926-1959．DOI：10.1111/j.1475-6773.2012.01396.x.
［43］ELISSEN A M，STEUTEN L M，LEMMENS L C，et al．Meta-analysis of the effectiveness of chronic care management for diabetes：investigating heterogeneity in outcomes［J］．J Eval Clin Pract，2013，19（5）：753-762．
［44］LEMMENS K M，LEMMENS L C，BOOM J H，et al．Chronic care management for patients with COPD：a critical review of available evidence［J］．J Eval Clin Pract，2013，19（5）：734-752．DOI：10.1111/j.1365-2753.2011.01805.x.
［45］AYSOLA J，BITTON A，ZASLAVSKY A M，et al．Quality and equity of primary care with patient-centered medical homes：results from a national survey［J］．Med Care，2013，51（1）：68-77．DOI：10.1097/MLR.0b013e318270bb0d.
［46］SINAIKO A D，LANDRUM M B，MEYERS D J，et al．Synthesis of research on patient-centered medical homes brings systematic differences into relief［J］．Health Aff（Millwood），2017，36（3）：500-508．DOI：10.1377/hlthaff.2016.1235.
［47］KOH T W，TAI E S，WEE H L，et al．Piloting the patient-centered medical home concept：Singapore's initial experience［J］．Int J Integr Care，2013，13（8）：1．
［48］RAHBAR S M，EWALD D，LEMBKE T．Discussion on the implementation of the patient centred medical home model：experiences from Australia［J］．Int J Integr Care，2017，17（3）：134．DOI：10.5334/ijic.3246.
［49］ADAMS A J，CLARK D R，DELANDER G E，et al．Report of the AACP task force on patient-centered medical homes and accountable care organizations［J］．Am J Pharm Educ，2013，77（7）：142．DOI：10.5688/ajpe777142.
［50］REID R．Transforming primary care：evaluating the spread of group health's medical home［EB/OL］．（2015-04-01）［2019-08-30］．https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/tpc/tpc-profile-reid.pdf.

[1]	LIAN Lu, WANG Di, CHEN Jiaying, LIU Wu. Research on Current Situation and Countermeasure of Chinese Primary Care Physicians' Community Rehabilitation Service Ability [J]. Chinese General Practice, 2025, 28(04): 450-456.
[2]	ZHANG Yalin, LIU Lidi, CHEN Zhengyong, LIU Changming, YANG Ziyu, CAO Yi, LIAO Xiaoyang. Medical Service Capacity and Influencing Factors of Primary Health Care Institutions Under Medical Alliance [J]. Chinese General Practice, 2024, 27(34): 4302-4307.
[3]	GU Mei, ZHAO Ning, LI Jin, YANG Jia. The Current Situation of the Building of Human Resources for Public Health in Beijing in the Context of Public Health Emergencies [J]. Chinese General Practice, 2024, 27(31): 3919-3925.
[4]	LIU Huan, ZHU Shifei, CHEN Fayu, WANG Jinghua. The Application of AI in Primary Care General Practitioners' Practice: a Perspective on Skin Disease Diagnosis and Disease Course Management [J]. Chinese General Practice, 2024, 27(31): 3884-3889.
[5]	LI Wanyu, ZHANG Hanzhi, JIN Hua, YU Dehua. Status of Implementation of Active Health-oriented Health Management in Primary Health Care Organizations [J]. Chinese General Practice, 2024, 27(28): 3560-3566.
[6]	LI Liqing, LIU Wenhui, YANG Sule, LIN Huiying. Coupling Coordination and Forecast Analysis of Primary Medical Resource Allocation and High-quality Economic Development [J]. Chinese General Practice, 2024, 27(25): 3164-3170.
[7]	WANG Lin, WANG Yixin, CHEN Tingyan, LIN Shaohai, ZHANG Yonghui. Discussion on the Practice of Narrative Medicine in Primary Care from the Perspective of General Practitioners [J]. Chinese General Practice, 2024, 27(24): 3057-3060.
[8]	GAO Xiaoyi, HU Liping, ZHAO Yue, LIU Lanqiu. Palliative Care Service Development Experience in Singapore and Its Implications for China [J]. Chinese General Practice, 2024, 27(22): 2745-2751.
[9]	WANG Yang, JIN Hua, YUAN Beibei, HUAN Hongmei, YANG Hui, YU Dehua, FANG Hai. Community-oriented Integration of Medicine and Prevention: an Analysis of Theoretical Basis and Contemporary Implementation Pathways [J]. Chinese General Practice, 2024, 27(22): 2689-2699.
[10]	ZHANG Xiaotian, LI Mingyue, LAN Qing, LIU Xiaoyun. How to Advance the Improvement of Primary Health Care Model for Rural Populations with Priority Diseases: an Evidence Brief for Person-centered Integrated Health Management Policy [J]. Chinese General Practice, 2024, 27(16): 1924-1929.
[11]	QIN Jiangmei, LIN Chunmei, ZHANG Yanchun, ZHANG Lifang. The Status and Challenges of Primary Health Care in China [J]. Chinese General Practice, 2024, 27(16): 1917-1923.
[12]	LI Xueying, KANG Xiaoping, CHI Chunhua, WANG Xicheng, SHANG Meixia, ZHOU Guopeng, GAO Chang, PAN Zihan. Basic Design and Implementation Steps for Cross-sectional Studies in General Practice and Primary Care [J]. Chinese General Practice, 2024, 27(13): 1584-1593.
[13]	WANG Fei, TANG Jingqi, SUN Xiaonan, SUN Xinying, LI Jun, MENG Xingxing, WU Yibo. Design and Development of Scales in Primary Care: Practical Steps and Statistical Methods [J]. Chinese General Practice, 2024, 27(13): 1573-1583.
[14]	YU Xinyan, SU Peng, YUAN Xiaojing, JIANG Qingru, YANG Jianyun, ZHAO Xudong, WANG Yifan, ZHANG Haicheng. A Study on the Factors Influencing the Comprehensive Risk of Cardiovascular Disease in Elderly Patients with Chronic Disease in Primary Care [J]. Chinese General Practice, 2024, 27(10): 1186-1193.
[15]	ZHOU Luling, LIU Suzhen, LI Hang. Investigation on the Situation of Primary Health Care Institutions and Home-based Medical Service in Sichuan Province [J]. Chinese General Practice, 2024, 27(04): 433-439.