Research On The Feedback Control Of Performance Of Public Health System In Rural Areas

Purpose:According to the object and direction of rural public health system reform and development in China, this paper is aimed to conduct the feedback control system of performance of rural public health system and explore its implement path based on the management control system, so as to provide theory guide and strategic support for the management practice of feedback control of performance of rural public health.Methods:Research materials can be accessed through literature research and field survey methods. The site survey sample areas contain13counties (cities, districts) from Zhejiang, Henan, Chongqing and Qinghai. The subjects for this investigation were selected randomly from the public health manager and service providers of public health agencies and primary health care organizations. The concept maps method was used to construct the concept model of feedback control system of performance of rural public health system, and the concept model was verified through the analysis of reliability, validity, membership degree and canonical correlations. The structural model was constructed under the interpretive structural model (ISM) method and analytic hierarchy process (AHP) was used to determine the weights of the elements at all levels in the structural model.The structural equation modeling (SEM) method was used to explore and test the relations of control variables of the feedback control system and the performance of rural public health system. The case study method was used to provide evidence support for the running process of the feedback control system for rural public health performance. Results:(1) A concept model of the feedback control system of performance of rural public health system was constructed and verified. The root definition of this system was determined as:a management control system working at bias correcting of control objects by the control subjects through regulating the control variables, taking continuous promotion of rural public health performance as the goal orientation and based on the information feedback of performance assessment. The concept model proposed that this system consist of the elements:control subject, control object, control variable and control procedure, and all elements have positive effect on the construction of this system.(2) A structural model of the feedback control system of performance of rural public health system was constructed. This model includes19elements,3levels of hierarchy. The results of AHP showed that the order of the contribution of system elements for system construction is that:control subject, control variable, control object and control procedure.(3) A analysis framework was proposed for the research of control variables of the feedback control system of performance of rural public health, including5control variables corresponding to15observed variables. The function path of control variables to the performance of rural public health system was determined as theoretic hypotheses H:If the control variables changed positively, the performance of rural public health system will be promoted. And this hypotheses was verified through SEM analysis. According to the level of standardized path coefficient, the order of the degree of their influence on performance of rural public health system was: organization management, payment, resource allocation, regulatory control and behavioral change.(4) The running process of the feedback control system of performance of rural public health system was determined, including3key aspects:information reporting system, the diagnostic procedures and the corrective mechanism. The information reporting system contains:sources of information, measurement tools system and information submit mechanism. The diagnostic procedures of performance consists of the description of performance deviation, the discriminant of key influencing factors, the presentation of performance problems. The corrective mechanism of performance was maed up of the formulation, implementation and adjustment of performance corrective strategies.Recommendation:According to the analysis of the current situation and problems of the feedback control of performance of rural public health system in the sample areas, a series of strategies was proposed as follows:(1) optimizing the system of rural public health organizations under the guidance to public health functions performing(2) to improve the public health system performance management and promote the scientificity of performance appraisal for public health services providers(3) to promote the equalization of basic public health services focus on the social benefits(4) to mobilize the social participation extensively and building the culture of public health.Innovation and shortage:The innovation of this study is mainly reflected in:(1) Based on theories such as management control system and health system performance, this study construct and verify the feedback control system of performance of public health system in rural areas, so as to play the role of theoretical support for performance management of rural public health system, and promote the extension and progress of health system performance theories from the field of performance evaluation to performance control.(2) This study explored the implementation approach and key links for carrying out the performance feedback control of rural public health system, and proposed feedback strategies for performance promotion of rural public health system. These outcomes are benefit for advancing the application of performance management ideas and methods, so as to enhance the level of management of rural public health system.The lack and improvement of this study is mainly reflected in:The site survey data are mainly focused on the concepts, intentions and behavior of specific population. During the formation of the study conclusions, for example, verifying the concept model of the system of performance feedback control of rural public health system through the expert consultation methods, there are a certain degree of inflection from the subjective understanding of participants. Further follow-up studies should analyses the quantitative data obtained by field investigation so as to provide evidences entirely for model construction and the study of implementation approach.