A Policy Research On The Function And Implementation Of Community Health Services

Community health service (CHS) is the primary health service that covers communities, aims at residents'health, regards family as unit, focuses on individual patients, and remains demand-oriented. By reasonably and thoroughly exploring sanitory resources of a community and adopting appropriate medical techniques, CHS integrates functions of prevention, health care, healing, health education, and the family planning. As a public welfare undertaking, CHS is also a reflection of social and public function of a government. China is in a crucial phase of CHS development now. Cities have started exploring or applying new CHS formatlity. It accumulates necessary experience for a CHS development of national scale.From a theoretical perspective of public goods and government's responsibility, the essay proceeds a case study of the CHS in Huangpu District, Shanghai. Through questionnaires and interviews, the author assesses the present status of Huangpu CHS and its problems, thus emphasizes the importance role that government shall play in CHS development. The author also advocates clarifying CHS content and target group, designs detailed methods for chronic disease management, and delivers some policy advices for CHS development.The essay includes sections as follows:The First Section elaborates the connotation and features of basic theory of public goods and concludes that health service shall be catogarized as quasi-public goods. Thus, government's responsibility shall be sorted in CHS establishment. Some domestic and foreign publications are referred to describe and assess the current situation of CHS.In the Second Section, the CHS models in U.K., USA and Germany are compared and their respective and common principal features are domenstrated. UK undertakes a national health care service system that features in universal and free service. The United States developes diversified health service system, in which market plays as the core mechanism. German health service system features as insurance-oriented. But all assessed health service models adopt the same practice that CHS comes first for all patients. As an preliminary while ideal health service provider, CHS can not only guarantees impartiality, efficiency and effectiveness of health service, but also put increasing medical expenditures under effective control and improve the healthiness of residents.In the Third Section, the author describes and discusses the background of Chinese and Shanghai CHS development. The country's CHS development can date back to the 1950's and a well established national system functioned for decades. As a result of commercialization of Chinese medical service, the well established preliminary sanitary and health care mechanism was restructured from public welfare entities into profit-making market survivors, making medical treatment increasingly more expensive and less accessible to patients. To address the functional absence of CHS, several laws, regulations and files on CHS have come into effects since 1997, and timely forms of CHS have been expored and tested all over China. Shanghai pioneers in China's CHS reform, inventing new ways of CHS practices that were promoted as national standards, such as prepaid medicare insurance or orientational patient referral. However, an unneglectable quantity of problems still remain, including the underperformance of CHS, unqualified or even lack of supporting facilities, health-related departments'unawareness of necessity or their poorly coordinated efforts of CHS development, irrational composition of community medical team, hampered general practitioners training, and lack of rationality in selecting medical services.The Fourth Section is about the development of CHS in Shanghai. In 2005, as one of CHS frontrunners in China, Shanghai appointed Songjiang and Changning as two pilot districts of CHS reform. In the two districts, new medical finance management to separate flows of income and expenditure and a prepaid medicare system was implemented. CHS medical teams composed of general practitioners was organized and six-function-in-one CHS centers were established. The CHS reform was proved effective. As one of the second group of CHS reform, Huangpu district follows up in implementing CHS reform. Also in this section, based on questionnaires towards managers, patients and medical personnels of CHS centers, and interview with government officials of sanitory departments, the author analyzes the sepcialties of Huangpu Dicstrict's economy and residents, assesses its sanitory resources and residents'demand of medical services, and evaluates its CHS development.Based on the outcomes of data-collection and analysis, in the Fifth Section, the author introduces several policy advices, as follows, for Shanghai to further improve its CHS development.To further position the role of CHS centers by defining CHS content and target groups, so as to meet diversified CHS needs.To improve CHS's function of public sanitory, coordinate CHS with urban medicare insurance, and construct a systematic management of chronic diseases, so as to achieve better effects of CHS.To develop localized services to address specific demands of residents.To advance informationalization of CHS, improve database of residential health records, and achieve better efficiency and higher effectiveness.To promote qualification and personnel training, improve skill and professionalism of general practitioners, and upgrade qualification of CHS.To further optimize the treatment process, so as to enhance effectiveness of CHS centers.To rationalize interest distribution, and guarantee a smooth two way referral.To establish, for CHS centers, a performance evaluating mechanism, in which the quantity and quality of health services as well as satisfactory rate of patients are evaluating indicators.