| Research purposesTo learn the number, composition and distribution of community health service(CHS) institutions by different holders , and comparing their characteristics in personnel, facilities, income and expenditure, service and its quality. Analyzing the advantages and disadvantages of the CHS institutions by different holders , to put forward suggestions for further clearing direction for the development of CHS, improving community health service system in China.Research methodsThis study used some qualitative and quantitative research methods. Literature research and qualitative interviews were used to learn the main policy of CHS and the operation of CHS institutons by different holders; through the SWOT analysis to learn strengths, weaknesses, opportunities and threats of CHS institutions by different holders. The main data analysis methods were descriptive analysis, H test, chi-square test, TOPSIS method. EPIDATA 3.0 was used to set up databases, and SAS9.0 was for statistical analysis.Results1.Most of the community health services were held by government. About 77.10% of centres and 69.18% of stations were held by government. The regional distribution of CHS intitutions by different holders had a significant difference (Center:χ~2 = 236.6728 P <0.0001; Station:χ~2 = 1158.5381 P <0.0001).2. The implementation of all-stuff employment system was good, and more than 70% CHS institutions carried out the system. There was a significant difference among CHS institutions by different holders in the proportions of attending medicare (Center:χ~2 = 65.2596 P <0.0001 Station:χ~2 = 33.1056 P <0.0001). At the centre level, the proportion of the CHS institutions held by governmen attending medicare was the highest(91.10%); but at the station level, the CHS institutions held by enterprises had the highest percentage (60.52%).3. There were 131,546 people on-post in the 29 key communicating cities (districts) , of which the CHS institutions held by government, enterprises and social groups or individuals respectively accounted for 71.87%, 18.64%, 7.47 %. Among the CHS institutions by different holders, a CHS center and a station held by enterprises had the most people on-post, and the number were respectively 38 (median, the same below) and 8. The CHS centres held by social groups or individuals had the least people on-post (30), and the CHS station held by government had the least (4). The doctor nurse ratio in the CHS institutions owned by Government was lowest(only 1:0.59), but the job trainting was developed good (about 46.22% people participating pactitioners job training, 56.24 % nurses attending the commnity nurse job training). Comparing the education and professional title level of doctors and nurses, the level of education and professional title of doctors and nurses in the CHS institutions operated by enterprises was better than the CHS institutions by other helders.4. The governmentt invest was insufficient. The proportion of finacial subsidies for the CHS institutions by social groups or individuals was the lowest; the proportiong for centre was 7.45%, and for the station was 1.41%. The CHS institutions suffered serious losses. The loss ratios of the CHS institutions run by enterprises was high, and the ratio of centre was 47.27%, that of the station was 47.13%.5. In the provision of services, the CHS institutons run by government took more public health tasks. More CHS institutons run by government provided immunization services, child health care, pregnant health care, family planning consultation than the CHS institutons run by other helders. But at the station level, the CHS institutons run by government took less emergency service, traditional Chinese medicine and outreach services than other .6. The overall satisfaction of the residents was good. The residents serviced in the CHS institutions operated by government had higher satisfaction than that in the CHS institutions by other helders.Conclusions and SuggestionsBased on the results of the study, draw the following conclusions: (1) the pattern of government-based, multi-helders coexistence has formed, but the distribution of CHS institutions of different holders was different in region; (2) policies related community health service were being implemented, but CHS institutions of different helders has different degree of implementing the policies; (3) the technology structure of staff in CHS institutions was irrational, the quality was low, and the training should be strengthened; (4) there was a difference in the government input among CHS institutions by different helders, and the economic situation was not ptimism for the CHS institutions; (5) "Six in One" function has been carried out, but the CHS institutions by different holders still faced different problems and challenges; (6) there was some problems in the quality of service issues, and health service quality management should be improved; (7) the overall satisfaction of residents was high, and the residents serviced in the CHS institutions operated by private had higher satisfaction than that in the CHS institutions by other helders.Policy suggestions: (1) transform the government functions, and strengthen supervision and management, so as to promote the development of CHS; (2) promoting the development of qualified personnel by increasing the training, and optimizing the structure; (3) to provide fair competitive environment by improving the compensation mechanisms; (4) change thinking, clear position, and give full play to the function of community health services; (5) strengthen prescription management, implement the system of separation between revenue and expenditure, so as to improve community health service quality.
|
PDF Full Text Request