Study On Performance Evaluation Of Community Public Health Services In Wuhan City

Research PurposesCommunity health services system is an important component of urban communities building,it plays an important role in the urban two-tier health services system.The performance evaluation of community basic medical and public health services can find the existing problem,and provide further policy recommendations for the development of community health services system.In order to provide basis for government's supervision,assessment of community health services and the management of the guants,promote the establishment of good-effectives,sustainable and long-term investment mechanism,this study was aimed to use economics method to make a comprehensives assessment of investment performance and efficiency of community health services,make a comprehensive analysis on subsidy policy of community health services,sum up the implementation of ploicies and successful experience,assese the effectivess of community health services,find the existing problem and explore the solutions and adjustment measures.Research MethodsThis study adopts principle and technology of sociology and economics to make research from the supply side,demand side.Literature searching was used to summ up the ideas and concepts of commnity health services performance evaluation and provides theoretical basis for the study;field investigation was also used to survey the resource allocation,staff efficiency and the use of services in community health services institutions;SWOT analysis was used to make an systematic analysis of the internal conditions and external environment of community health services institutions;and further assess the strengths,weaknesses,opportunities and threats during the development;assessing the balance between the resource allocation and the use of services through the input-output analysis;finally,using data envelopment analysis to calculate the relative efficiency score of community health services and compare the ralstive efficiency of different district.Research ContentsIn this study,community basic medical and public health services in Wuhan City was seens as evaluation objects,and community health services was evaluated from the supply side and demand side,the main contents includs:(1) reviewing and summing up the theory of performance evaluation of community health services,and providing theoretical basis for the performance evaluation of community basic medical and public health services;(2) basic status of community health services centers in Wuhan City,including the nature of institutions,personnel,investment,the implementation of relate polices,financial,services and so on;(3) assessing the efficiency of resource allocationg in community health services institutions,analysing the change of services quantity,the growth of outpatient and residential,items and quantity of public health services,and the efficiency of investment;(4) assessing the efficiency of staff in community health services institutions,understanding the distributiong of working hours,and analysing the realization of community health services function;(5) assessing the social benefits of community health services institutions,understanding stakeholders' view on community health services,such as residents' satisfaction and responsiveness of community health services.Research resultsThe results of this study are as follows:(1) the community health services network in Wuhan City has been completed,community health services institutions in seven downtown areas covered nearly all the regional population,the percentum of center whose business premises meet or exceed mational standards had reached 87.09; (2) as of Sep 30,2007,the total number of staff in community health services centers in Wuhan City was 5535,clinicians accounted for 28.18%,nurses accounted for 24.46%,public health physicians accounted for 4.03%,the ratio of clinicians to nurses was 1:0.88;(3) the operating conditions of community health services centers in Wuahan City had been gradually improved,In 2007,profit institutions accounted for 87.88%,the finacial investment increased year-by-year,but the proportion was still relatively small(14.83%～21.4%),the special subsidies in government investment accounted for 32%～56%,public health financial input was the main part of sepcial subsidies,accounting for 65.74%～70.28%,operating income was the main source of revenue,accounting for 80%or more,pharmaceuticals revenue in the ratio of operating income was more than 60%;(4) most community health services centers has launched the services which represent the characteristics of community health services function,the provision of services had a larger growth;in 2006,the growth rate of outpatient was 30.45%,in the term of public health services,the setting of family files and family planning had an large scope growth,the growth rate were 54.02%and 49.12%,the growth rate of maternal systems management was 18.81%, the growth rate of rehabilitation was 31.52%,other services had a smaller growth rate; (5) staff had an higher degree of recognition on their own work,54.14%of staff had an potimistic idea on the development of community health services institutions,but most of staff expressed dissatisfaction with the current income which can not be achieved with the workload corresponding to the level of income;(6) residents' awareness of basic medical was higher than public health services,the most high awareness is medicine which reaching 96.45%,the satisfaction with convenicence and service attitude was higher,but the satisfaction with price and technology leverl was relatively poor;(7) more than 90%of the residents choosed the community health services institutions because of the near distance and the convenience,the proportion of residents who went to community institutions because of cheaper expense and shorter waiting time was lower than 35%,the rate of good medical technology only accounted for 8.83%. Policy suggestionsBased on the results of the research,the conclusions and recommendations could be put forward.(1) community health services system should be strengthened,the policy support system should be improved and the match policy should be carded out effectively;(2) financial input should be further increased,financing channels should be expanded and basic medical and public health services should be developed effectively;(3) community health services personnel training and job training should be strengthened,and improving the business level of staff;(4) the functions,quality and standard of community health services should be farther improved in order to improve the satisfaction of resident;(5) the publicity of community health services should be intensfied and the channels should be expanded.