The innovative integration of treatment and prevention is pivotal for enhancing the healthcare system and advancing Healthy China. Guided by a focus on preventive health policies, it fosters collaboration between treatment and preventive services, ensuring seamless linkage across health promotion, prevention, treatment, rehabilitation, and end-of-life care. Conceptually, this shift involves transitioning from unidirectional intervention to comprehensive health management, from provider-driven to participatory decision-making, and from transient doctor-patient relationships to sustained accountability relationships. Structurally, it emphasizes coordination between medical and public health systems, collaboration among healthcare institutions, and multi-stakeholder governance. Institutionally, it optimizes evaluation, financing, remuneration, and talent development systems while leveraging intelligent means for integration and promoting interoperability across personnel, resources, and information.
In this commentary, we elucidate two distinctive characteristics of China's primary health care system relative to the global primary health care framework: a more narrowly defined patient population and scope of services, along with a diminished clinical capacity in primary care. Building upon this foundation, we critically examine and juxtapose the two quintessential theoretical-practical models of the 20th century that are intimately linked with the integration of medication and prevention. They are the "Community-Oriented Primary Care" Model and the "Barefoot Doctor" Model. Additionally, leveraging a series of practical cases observed within Shanghai's primary care settings in the fourth quarter of 2023, we deliberate on viable approaches for adapting and applying these models in China's primary care infrastructure. We further delineate the requisite external conditions for such a transformation and offer targeted recommendations for the deployment of these models across diverse locales.
As an important direction of China's medical and health system reform, medical and prevention integration is of great significance to meet the all-round health needs of the people, and how to establish a scientific and effective medical and prevention integration model is a top priority. Using literature analysis and other methods to collect data, the implementation status and dilemma of China's medical and prevention integration policy were reviewed, and the influencing factors of medical and prevention integration policy implementation were analyzed based on the six dimensions of the Horn-mitte model. On this basis, it is proposed to refine policy objectives, clarify policy implementation standards, increase resource supply, enrich policy implementation methods, explore common interests of medical and defense institutions, improve "coordination mechanisms", and actively guide policy implementers to carry out medical and prevention integration services. It aims to provide reference significance for the high-quality improvement of medical and prevention integration services in the future.
The key task in China's medical and health field during the "14th Five-Year Plan" period is to realize treatment-prevention integration and innovate the mechanism of treatment-prevention integration.
This paper analyzes the implementation mechanism of treatment-prevention integration under the background of integrated service system construction, and provides reference for exploring the path of medical and prevention integration adapting to the strategy of "Healthy China".
Taking 2018 as the time node, relevant literature was searched on CNKI and Wanfang Data Knowledge Service Platform with keywords of "treatment-prevention integration" "medical and prevention coordination" "combination of prevention and treatment" and literatures on case policies, measures and implementation effects of integrated service systems such as medical alliance. Finally, 18 literatures and 15 cases were selected. Based on the rainbow model, system integration, organizational integration, professional integration, service integration, functional integration and normative integration were determined as condition variables from macro, meso and micro levels and supporting factors, and the effect of treatment-prevention integration was determined as result variable. QCA was adopted to explore the implementation mechanism of medical and preventive integration under the background of integrated service system construction.
There were four configuration paths that could effectively improve the effect of treatment-prevention integration, and the four paths were in line with the multi-layer integrated path and the medium-micro integrated path respectively. The following results were obtained: (1) It was more effective to carry out treatment-prevention integration relying on the integrated service system, and there are multiple paths that can effectively improve the effect of treatment-prevention integration under the integrated service system; (2) Service integration plays a fundamental role in improving the effect of medical and preventive integration; (3) The setting of relevant policy indicators for improving the system integration, professional integration and functional integration of treatment-prevention integration is not perfect.
(1) Relying on the construction of integrated service system to promote the improvement of treatment-prevention integration effect; (2) Give full play to the basic guarantee role of service integration; (3) Make reference to the successful experience of multi-level integration cases, set policy indicators at macro, meso and micro levels in a balanced manner, and improve the integration of system integration, professional integration and supporting elements.
