Evaluating The Development Of Rural Medical Service In Shanghai

Background:With the development of rural economic in Shanghai and the change of diease spectrum among rural residents,the medical and health service demand in rural area changed and increased.However,medical and health service in rural area was weak with comparison to that in urban area.The research and policy makers should solved these emergent problems of difficulties and measures of current medical security system and medical service system in rural area.A system evaluation of medical and health service in rural area should be done and a suitable developing strategy of medical and health service in Shanghai rural area should be put up on the base of evaluation.Objective:By the means of historial comparison and the comparison between Shanghai rural and urban regions,this study aimed at the current situation and existing problems of health service demand,utilization,medical security and organization and keyed on the focusing issues and weak links.It put up with the countermeasures to improve Shanghai rural health service to promote the coordinated development of Shanghai rural health service and health service between rural and urban regions.Methods:This article studied health health service demand of Shanghai rural residents by referring to the 1993,1998 and 2003 Report of National Health Services Survey of China and 2003 Report of Shanghai Health Service Survey.It studied medical security and cooperative medical system by referring to some data supplied by Shanghai Cooperative Medical Management Office,some data from the study on 2005 Raising Financing Necessity and Feasibility of Cooperative Medical System in Pudong New Area and some data from 2005 Health In-home Survey among Residents in Chongming,Jinshan,Qingpu and Minhang Region of Shanghai.It studied the development of Rural Township Hospitals in Shanghai by referring to Health Cause Statement in Pudong New Area,the investigation of 16 rural township hospitals and experts interview of the directors in 16 rural township hospitals in Pudong New Area. After analyzing the whole collective data by the coordination of qualitative and quantitative methods,it described and analyzed Shanghai health service and came to a conclusion.It studied health organizations at village level,including 13 towns,270 village,222 public health centers and 454 rural doctors by vertical and horizontal comparison.Results:1.The results indicated the main problems in Shanghai rural health included the low medical security level of rural residents,low service ability of medical net at base, which resulted that rural residents in Shanghai were apt to stay ill without treatment and even choosed the senior medical units.The increasing disease burdens led to the main problems of the poverty due to illness.56.2%of poverty families dued to illness or injuries.2.The medical security level of rural residents was low,because it included such items.The financing level was low,about one-fifth of urban level and half of town level on per capital finance.The financing burden was high,about twice as high as urban level and with the same of town level.Reimbursement level was lower than that of urban level and the same of town level.The fixed financing and system factor emphasizing on serious disease caused the phenomenon of robbing the rich to help the poor.3.The service ability of basic medical and health net was low,which included such reasons.The human resource was lack in rural town health service centers,with an annual decline in the proportion of middle and senior titles from 19%in 1991 to 17%comparing to 24%of community health service centers in urbans.The hardware in rural town health service centers lagged behind the construction of urban community health service centers.The study in Pudong New Area indicated that the fixed assests and professional equipment assests of every town health service center were 6.85 million and that of urban community health service center were 15.71 million.The quality of rural doctors was lower and older.Only 49.6%were on the secondary and higher education level.66.6%owned formate professional qualifications and its average age reached 48.6 years old.The basic causes of low service ability in town health service centers were lack of financing investment from government and imbalance.Conclusion:The study indicated that the government should implement the responsibility and strengthen the basic medical investment on municipal,district and town levels to develop rural health in Shanghai.The basic ideas involved five aspects, including reducing the burden of rural residents by the main government financing input and group support to increase the financing level;reducing the phenomenon of robbing the poor to the rich by spindle cooperative medcial compensation mode of low pay ratio on low cost,high pay ratio on middle cost and low pay ratio on high cost;promoting twon health service centers standardization by management system reform of town health service centers and implementation of town health services managed by distrct governments directly to balance the equity of govermeantal input; implementing the wage on jobs and payment on base of work by accounting for income and payment of town health service centers respectively;and strengthening the hardware of village health rooms and training of rurual doctors by retaining the group of rural doctors and implementing integrated management on town and village level.The details of above policy ideas could be found in body.The laekness and demonstration of study involved the followings.Rural medical service related to provider,demander,payer and manager ly four aspects.Because of the workload study,the article aimed at the study of provider, demander and payer,and the manager study by interviews.The payer of study was cooperative medical system.On the base of theory,the payer should include resident individual,town medical insurance,governmental medical aid,charity funds and donor community and so on.The papers did not study on other aspects because of the target study.The providers were town hospitals and village clinics in the paper.On the base of theory,the providers should include county medical units,such as county peopple's hospitals,Chinese medicine hospitals and maternal and child health centers.Because the experts all advised that town hospitals and village clinics were the key of Shanghai rural medical service providers,the article aimed the two types of units.As the policy application research,the article focused on looking for the problems and putting up with strategy,which perhaps led that the choice of indicators was not comprehensive.Please the readers to criticize and correct me.