Transition Study Of The Rural Health Services' Implementation And Utilization

1. Study Objects and SignificancesChina's rural health services network of county, township and village levels is constructed based on the health system responsibilities and the principle of complementarity, linked different levels of health services institutions in different structure and function. Research group 2000 study showed that functional implementation of the rural health institutions at all levels exists fuzzy of functional orientation, bias of the overall network function, poor in implementation of preventive health care and other issues.Faced with this chaotic state, since 2000 the government introduced a series of policy files, increased investment in health resources and other measures to strengthen the implementation of rural health institutions'function.In 2008 research group re-investigated study areas of 2000 investigation. The study focused on the implementation and utilization of health services, to evaluate the extent of implementation of health sector functions, specify where the gaps lie, and explore related reasons, provide further functions implementation strategies.2.Research Methods and Data SourcesIn this study, take the"macro model of the health system"and"policy-making scientific procedures"as the guiding methodology. Used policy arrangement, data access methods to analyze the background environment of health services in rural areas; Based on two surveys data, used statistical description methods to make a detailed summary of comparison on the implementation and utilization of health services; Developed the method of gap analysis to identify the gap between current function and standard of the implementation of the rural health function; Used composite indicator of medical health care capacity and preventive health care capacity, analyzed the factors and it's change; Adopted fishbone diagram method, cleared the causing for "Attention to medical services, neglect preventive health services" and the relationship between the reasons, put forward corresponding strategies.The main data collection methods include literature review, secondary data extraction and on-site health services survey. Two on-site investigations including the implementation and utilization of health services, survey of health personnel, rural citizen's cognition and evaluation. And conducted a rigorous quality control in all aspects. Data entry by Epidata and Excel, statistical analysis by SPSS.3.Study Results(1) Background of rural health services implementation and utilizationIn 1990s'rural health work was in a chaos state. Since 2000, the rural health work has been attached great importance, important policy documents were introduced, county-level prevention and health care system has been initially formed, considerable part of the rural citizen return to the rural medical institutions. However, problems still exist in rural health services.(2) Changes of rural health services implementation and utilizationRural health services implementation and utilization in 2007 has been greatly improved compared to 1999. Implementation and utilization of medical services at all levels are on the rise, in different regions showing different surgical services trends. Implementation of preventive health services rate increase significantly, but the monitoring and evaluation results still are not ideal.(3) Gap analysis results of rural health services implementation and utilizationSorted out the theory and methods of gap analysis, clarified its feasibility for the evaluation of health services and the operating procedures. The results showed that rural health care functions implementation stay at a higher level, the implementation of preventive function has improved greatly. But the preventive services mearly focused on carry out rate, requirements for evaluation and monitoring does not meet the standards or lack of norms for evaluation.(4) Comprehensive indicators and cognitive and behavior of health service providers and rural citizen.Township hospitals ability of medical technology affected by number of beds, surgical rate and the rate of test items. Preventive service capacity factors, the financial investment impact reduced, influence of human qualities increased. Awareness of health service supply and rural citizen on preventive services obviously raised, the immunization services got the highest degree of recognition and implementation.(5) Reasons for the affects of rural health services implementation and utilization and recommendations Issues of "Attention to medical services, neglect preventive health services" has not been resolved yet, the micro level policy on the functional orientation is not clear enough; Service suppliers did not pay enough attention on all preventive services; Residents awareness other than the anti-immunization security services is still low; Rural residents are more active on immunization services while requires for notification on other items.4.Conclusion(1) Rural health function at the macro-level is clearly positioned, while the micro-level function is not clear, particularly in the functional specification of preventive health services are still rather vague.(2) In recent years, rural county, township and village levels institution services are in rapid development, rural health construction started to bear fruit. Issues of "Attention to medical services, neglect preventive health services"had eased, but still exists.(3) Medical services in rural health institutions implemention maintain at a high level, the implementation of preventive services has been greatly improved. Preventive services coverage meet the requirements, but did not provide adequate services.(4) Impact of rural medical and protection capacity index weight changed. Degree of attention on protection affects other network agencies'degree of implementation. For health services providers and rural residents, awareness of preventive services improved, but exists the tendency of emphasis on immunization services and ignore other preventive services.(5) Micro-level policy specification in the functional position is not clear enough, which constrained policy implementation and effectiveness; The supplier pursuit of implementation rate rather than service effectiveness; Rural residents'awareness and access to preventive services are still relatively low that affected the implementation and utilization of the services.