Health Resources And Operational Efficiency Of Township Health Centers In One City

Objectives This study, by analyzing the status of health resources of township healthcenters in one city, was finding out the main problem which has existed in the allocationof health resources and operational efficiency of township health centers. The purpose isto provide references to optimize the allocation of health resources in one city andpromote the development of rural health work.Methods It surveys159township health centers and self-designed questionnaires aredesigned to collect data of health manpower resources, fixed assets, buildingconstruction, medical equipments, income and expenditure and performance of medicalbusiness, etc. Firstly, the questionnaires completed by each township health centers s aresummarized by self-designed programs and then sorted, summarized, described andanalyzed by SPSS16.0statistical software. The content of statistical analysis mainlyincludes: the absolute quantity, average, composition ratio, calculation of growth rateand draw of trend graph; research methods include descriptive analysis, Lorenz curveand Gini coefficient, data envelopment analysis (DEA) model, etc.Results A total of165township health centers were investigated, from which159township health centers provided complete reporting forms. The survey showed that (1)There were a total of5890employees in the159township health centers, in whichtechnical staff accounted for85.13%and met the national standard, management staffaccounted for only4.31%, those logistics skills personnel accounted for10.56%.Technical personnel, doctors and nurses per thousand populations were0.64,0.38and 0.12respectively; doctor versus nurse ratio was1:0.31, which was far below thenational average for the same period of township health centers. Health technicalprofessionals dominated by young, accounted for98.72%, the educational level up tosecondary school education, accounting for70.75%, undergraduate and aboveaccounted for only2.39%.(2) Total assets of township health centers was903.08millionyuan, the hospital business space area was2614square meters. There is serving apopulation of0.88per thousand beds and1651medical equipment which has valuemore than ten thousand yuan, medical equipment configuration did not meet thenational standard.(3) In the last ten years, deducting inflation factors, the average annualgrowth rate of hospital all revenues, income from pharmaceuticals, medical income andfinancial assistance was16.39%,14.63%,15.54%and43.01%respectively; annualgrowth rate of total expenditure, drugs and medical expenses rate was17.11%,14.03%and18.64%,respectively;total revenue is always slightly less than the total expenditure,the10-year cumulative negative balance of914,600yuan.(4) In the last ten years,hospitalization numbers of patients is increasing year by year, the average annualgrowth rate is5.79%, the average annual growth rate of outpatient visits, emergencyroom visits, hospital visits and discharges was5.78%,7.86%,11.71%and12.14%,respectively; homes are actually occupied by the total number of bed days,discharged occupies a total bed days and average length of stay is10,269days,8973days and6days, respectively, are all more than the number of bed days in the townshiphealth centers.(5) The increasing order of township hospitals health resources’ Ginicoefficient by the population distribution: practicing(assistant) doctors (0.1801)<aregistered nurse (0.1882)<beds (0.2158); The increasing order of Gini coefficient bygeographical distribution: practicing (assistant) doctors (0.2370)<a registered nurse(0.2454)<beds (0.5631).(6) Amount of physician in the township health center withhigher DEA scoring was relatively small, while excess rate of equipment and nursewere comparatively high in the low DEA scoring township health centers. In the all centers, technical effective centers accounted for29.93%and non-technical effectivecenters accounted for70.07%. There were100centers in the condition of economies ofscale increasing, and12centers, decreasing.Conclusions (1) Total amount and construction of health manpower resources in thiscity were lacking and quality of health workers requires enhancing. The health technicalpersonnel per thousand populations were relatively low, proportion between doctor andnurse was comparatively high so that more investment was required in the nurseresources. Most of the health workers were young and middle-aged persons.(2) Totalbed resources allocation met the standard of ministry of public health, while bedresources per thousand populations below the national average level. Basic medicalequipment resources also lower than national standard.(3) Proportion between incomeand expenses of town hospitals stayed balance and kept growing during10years andthe speed was faster than the increase of goods price, local GDP and out patients. Drugand medical income were the primary sources of town hospitals income.(4) Outpatients,inpatients and discharged patients of town hospitals showed a trend of increase in the10years period.(5) Health resources distribution of township health centers was overallcomparatively fair, from which population equity was superior to geographical fairnessand enough attention should be paid to the later.(6) Bed resources, physician, and nurseper thousand were least in the overall effective health centers, in which the ratiobetween bed and physician was the highest. The proportion of technical relativelyeffective common health centers was higher than central health centers. Economiesscale was increasing in most of health centers while there were still some centers on thecontrary.