Study On Operational Mechanism In Community Health Services Institutions With Different Ownerships

Objective:The impact of relevant factors, associated with the operational mechanism and the ownerships, on the CHS institutions performing functions were analyzed through comparing how the CHS institutions with different ownerships fulfilled their functions under given operational mechanism models. It aims at providing guidance for reforming and improving the operational mechanism of CHS institutions and putting forward relevant policy recommendations for pressing ahead comprehensive reform of community health.Contents and methods:Policies, theoretical studies, practice progress, field survey and research reports associated with community health services were collected and collated by use of literature searching method, so as to analyze the theoretical outcomes and practice experiences in relation to the operational mechanism of community health.. The field survey and SWOT technology were adopted to study the characteristics of CHS institutions with different ownerships, and analyze the advantages and challenges facing the elements corresponding to the operational mechanism of community health. Chi-square test, Rank Sum test and Multiple Linear Regression analysis were applied to analyze how the factors relevant to different ownerships and operational mechanism models affect CHS institutions performing their functions.Results:Through analyzing the regular monitoring data of 444 CHS centers in six key liaison cities of the Establishment Program of CHS System, aside from studying other materials related to community health, following outcomes were found:1)among all the factors related to the operational mechanisms, implementation of Separation from Revenues and Expenditures Budget Management, CHS institutions being covered by the health insurance agencies, CHS institutions selling medicines with Zero-Margin profits and the ownerships of CHS institutions were significantly associated with the provision rates of essential public health service programs (p<0.05); 2)such characteristics as being independent enterprises, being covered by the health insurance agencies, selling medicines with Zero-Margin profits, implementing Separation from Revenues and Expenditures budget management, number of equipped medicines, number of clinical physicians, and number of beds for CHS institutions were significantly correlated with the service quantity (P<0.05); 3) implementating Separation from Revenues and Expenditures budget management and performance-based payment, and selling medicines with Zero-Margin profits were significantly associated with the working efficiency (P<0.05). Through Multiple linear regression analysis by including all the independent variables that were significantly associated with respective dependent variables, it demonstrated that the number of outpatient visits was affected by the factors as being independent enterprises and implementing Separation from Revenues and Expenditures budget management (F=223.41, P<0.0001); the number of established health records for residents was affected by such factors as the first registered title of community health institutions, and the number of equipped medicines and clinical physicians (F=119.54, P<0.0001); the number of immunization injections was influenced by such factors as being independent enterprises and implementation of Separation from Revenues and Expenditures budget management (F=41.63, P<0.0001); the volume of child care was affected by such factors as being independent enterprises and implementation of Separation from Revenues and Expenditures budget management (F=41.62, P<0.0001); the number of managed patients with hypertension was affected by such factors as the first registered title and selling medicines with Zero-margin Profits (F=50.48, P<0.0001); the average number of outpatient visits per physician was affected by such factor as implementation of Separation from Revenues and Expenditures budget management (F=71.75, P<0.0001); the rate of establishing residents' health records was affected by such factors as the number of equipped medicines and implementation of performance-based payment (F=174.96, P<0.0001); the proportion of planned immunization injection was influenced by such factors as implementation of Separation from Revenues and Expenditures budget management and the number of equipped medicines (F=73.93, P<0.0001). Basing on the ownerships and the key factors related to the operational mechnisms, the status of CHS institutions performing their functions under given operational models were analyzed. The ownerships, attributes of CHS institutions and implementation of Separation from Revenues and Expenditures budget management were significantly associated with CHS institutions performing their functions under the givern operational models (all the P values were less than 0.05). The performance-based payment was not significantly associated with the government-owned CHS institutions (in which, Separation from Revenues and Expenditures Budget management and Balance Allocation policy were implemented too) performing their functions (P>0.05).Conclusions:Whether community health services fulfil their functions is affected by many factors associated with the ownerships and operational mechanisms, and the impact varied across different service indicators. Generally, the type of ownerships had significant impact on CHS institutions performing their functions. The state-owned CHS institutions had better performance in terms of the provision rates of essential public health services and the number of outpatient visits, if compared with those governed by the hospitals and enterprises. However, under some specific operationals models, no significant difference, in terms of medical service efficiency and essential public services delivery, was observed between the govern-owned and hospital affiliated CHS institutions. Implementation of Separation from Revenues and Expenditures budget management could efficiently promote CHS institutions to fulfil their functions. With the similar factors as implementing the Balance Allocation policy and performance-based payment, both the government-owned and the hospital-owned CHS institutions provided better service quantity and efficiency than their counterparts through implementing Separation from Revenues and Expenditures budget management. This demonstrated that, health professionals didn't become lazy and the service efficiency didn't decrease either in both the government-owned and the hospital affiliated CHS institutions after implementing Separation from Revenues and Expenditures budget management. Thus, emphasis should be placed on the government playing the leading role, encouraging social participation, treating all the CHS institutions with different ownerships equally, as well as attaching the importance to improving the policies, enforcing the reimbursement policy, and enhancing institutional performance evaluation and service monitoring and management, so as to enable all the CHS institutions to play their full roles. Besides, it necessitates pressing ahead the comprehensive reforms on community health actively. On basis of improving such policies as public input, human resources system and bonus allocation, Pharmaceutic Zero-margin profits, reimbursement mechanism for public health services, Separation from Revenues and Expenditures budgets management.