The Quality Evaluation And Function Analysis Of Community Health Service In China

Objectives:This study aimed to study the operation status of community health service institutions (CHSIs) from the perspectives of both quality evaluation and function analysis, and to explore the factors that may influence the quality and function of community health service(CHS) on the basis of continuous monitoring the construction status and dynamic development of the CHS system among the key contact cities. Furthermore, we tried to specify the problems and challenges during the CHSIs development, and put forward evidence-based policy recommendations to improve the service quality and function of CHSIs’ in China.Methods:Based on an extensive review of domestic and foreign literature, we continuously monitored dynamic development of CHS system construction among36key contact cities (districts) from2007to2011by site survey."One questionnaire for each institution" laid the foundation to collect more accurate information. According to monitoring data, the quality of CHSIs was evaluated by means of analytic hierarchy process (AHP), and "Structure-Process-Outcome" evaluation model was utilized as the evaluation framework.CHS functions were analyzed from the aspects of basic medical and public health services, and the equity of domestic CHS function were studied by the Gini coefficient and Lorenz curve. Double-entry was used to encoding the study date into Epidata3.0, and statistical analysis was performed using SAS9.2and Excel2007.Results:1、Domestic construction status of the CHS systemThe State Council of China carried out the policy relevant to the city CHS in2006. Under the pushing of government at all levels, CHS policy and measures improved gradually, the service networks have preliminarily formed, professionals’ team was strengthened continuously, and the service function was perfecting increasingly. In2011, the completion rate of CHS centers (CHSCs) and stations (CHSSs) were respectively89.93%and91.90, CHSCs were set up in92.13%of the streets. Government-owned CHSls accounts for about60.32%of the total number of CHSIs, while the nongovernmental-owned accounts for39.68%.2. Evaluation on Health Service Quality of Domestic CHSIsOn the basis of "structure-process-outcome" evaluation model, this research involved15indicators to evaluate quality of CHS.(1) Overall Quality of domestic CHSIsAccording to the results of quality evaluation, domestic CHS quality was gradually improved from2007～2011. By the end of2011, the average coverage of CHSCs and CHSSs were2088.51m2and276.62m2(1987.91m2and244.13m2in2007) which has drastic improvement than those in2008. The percentages of antibiotics prescription were31.09%and33.22%in CHSCs and CHSSs in2011(45.06%and34.88%in2007). The cost of CHS decreased continuously, outpatient expenses were13.88yuan and11.88yuan in CHSCs and CHSSs respectively in2011(64.28yuan and31.76yuan in2008). The costs of medicine were49.65yuan and47.74yuan in CHSCs and CHSSs in2011(66.04yuan and65.84yuan in2008). The problem of high cost of medical service was resolved to a certain extent.(2) Service Quality of CHSIs in Different RegionsThe CHS qualities in eastern, central and western regions in China were different, and the gaps among different regions were obvious. According to the result of quality evaluation, central region had the largest institution coverage which was2146m2of CHSCs on average (1964.54m2in2007). In human resources allocation, CHSCs in central region had the highest quantity of medical staffs in2011whose average quantity was39.19(34.6in2007), CHSSs in western regions was highest in quantity of medical staffs, which was8.42on average (7.94in2008). The use of rational drug indicators decreased continuously in every region. The lowest patient expenses of CHSCs and CHSSs in eastern region whose average costs was14.57yuan and9.12yuan (44.46yuan and23.08yuan in2008). Meanwhile, the costs of medicine in CHSCs and CHSSs in eastern region were also lowest whose costs were47.36yuan and45.89yuan respectively in2011(71.16yuan and68.95yuan in2008).(3) Service Quality of Different ownership of CHSIs In contrast to CHSIs service quality of different ownership, the average coverage of non-government owned CHSIs was higher than that of government-owned CHSIs in2011. The government-owned CHSIs were more effective on implementation of essential medicine policy. The average outpatient expenses in government-owned CHSCs and CHSSs were14.06yuan and13.56yuan in2011, which was higher than12.20yuan and10.76yuan of non-government owned CHSCs and CHSSs..3. Research on Health Service Function of Domestic CHSIs(1) Supply of Basic Medical Service and Public Health Service grew continuouslyThe outpatient and emergency service of each CHSC and CHSS on average generally exhibited upward trend from2007-2011. It were57571.63and10627.66persons per year of CHSC and CHSS respectively in2011, increassed by56.18%and35.56%than those of2007(36861.96and7839.86persons per year in2007). Meanwhile, public health service supply also increased continuously.(2) CHS Functions in different Regions were differentFrom the supply of basic medical service, CHSCs in eastern region supplied outpatient and emergency service74433.84persons per year on average in2011, which was higher than48099.39persons per year in central region and33432.37persons per year in western region (41395.50,26356.74,29317.07persons per year in2007). Meanwhile, The supply of outpatient and emergency service was also the highest in eastern CHSSs in2011. From the statistics of CHSIs public health service supply, eastern region supplied the most in three regions.(3) Service function of Different ownership of CHSIs had DifferencesAccording to the basic medical service statistical indicators involed into our research, only discharge times and hospitalization beds/days of non-government owned CHSCs was slightly higher than those of government-owned CHSCs in2011. With regards to other indicators such as total quantity of outpatient and emergency services, traditional Chinese medicine outpatient services, home visit service, upward transfer patient service and superior hospital downward transfer patient service of government-owned CHSCs were obviously higher than those of non-government owend centers. The statistics of services in CHSSs was different.(4) Analysis of the equity of domestic CHS functionBy the end of2011, the equityof home visit service, hypertension management and diabetes management was at normal status, while the equityof outpatient service, upward transfer patient service and downward transfer patient service were on alert. Gini Coefficient by demographics from small to large ranked as:home visit service (G=0.3079), hypertension management (G=0.3712), diabetes management (G=0.3941), outpatient service(G=0.4655), upward transfer patient service(G=0.4796), superior hospital downward transfer patient service (G=0.5768).(5) Analysis of the equity of domestic CHS function in different regionsAccording to the Gini Coefficient by demographics, the Gini Coefficient floated up or down at about0.4by the year of2011, and stayed nearby the alert line. Gini Coefficient by demographics in different regions from small to large ranked as: upward transfer patient service (G=0.3189), diabetes management (G=0.3596)), home visit service (G=0.3776), outpatient service (G=0.3818), superior hospital downward transfer patient service(G=0.4052), hypertension management (G=0.4209)Conclusions:Domestic CHS system has been established, policies were implemented well. Overall quality of CHS improved continuously, service function was perfecting gradually. The gaps of CHS among different regions were gradually narrowing. The equity of domestic CHS had to be improved. The equity of CHS in different region were different. Quality and function of CHS in China were stimulating each other.Research Characteristics and Innovation:In research contents, our research covered most part of domestic CHS, involved institution information, financing, service supply, essential medicine policies, rational use of drugs and cost, which could reflect China’s CHS systematicly and objectively. In methodology, although there are more similar research quantities, due to general lack of nationwide data, it mainly emphasized on regional or institutional research. By virtue of fives years of consecutive, large sample, and nationwide coverage, this research went deep into CHSIs and acquired large amounts of deep level and high-quality data. The surveyed institutions accounted for almost40%of nationwide CHSIs. The indicators were comprehensive and reliable, remaining at leading position in similar researches, which can provide reference for top-level design. Analytic hierarchy process was applied to health service quality evaluation, which was relatively advanced in similar researches. It computed the classified research on various indicators in health service quality evaluation system via scientific and rational decomposition layer by layer, and obtained conclusion. The method application was appropriate and conclusion was reliable.