Research On The Capacity Of Primary Health Care Service In Zhejiang Province Under The New Health System Reform

ObjectiveThe overall objective of this study is to analyse the changes of the capacity of Primary health care service in Zhejiang Province under the new health system reform, and to provide evidence and propose strategies to improve the functions of the primary medical institutions and to achieve the goals of the new health system reform.Data and MethodsQuantitative and qualitative research methods were adopted in this study. Due to the restrictions of personnel and funds, there are two data sources, one is health statistics(2007-2014) of Lanxi city and Xihu district of Hangzhou, another is a special survey.The statistic data is used to analyse the changes of health resources and health service of primary health institutions in Zhejiang during 2007-2014. The data of the special survey is used to supply the quality, training of human resources. The qualitative data are used to do deep analysis of the main influence of the capacity of primary health institution.Main results(1)The changes of health resources before and after the new health system reform After the new health system reform the total assets of primary health institutions increased, but the proportion of it declined. The fiscal subsides accounted for total income increased while the drug income reduced. The number of beds in primary health institutions showed a downward trend. The number of primary health workers increased, but the average annual growth rate was lower than before.(2) The changes of medical services quality before and after the new health system reform After the new health system reform the number of outpatients increased, but the average annual growth rate was lower than before, and the proportion of total clinic visits in primary medical institutions decreased. The number of inpatients and the utilization rate of hospital bed in Lanxi primary medical institutions dropped and showed a contraction in inpatient service.(3)Residents’ satisfaction of basic medical services and their choice of medical treatment There are respectively 79% and 66% of the respondents will be the first choice of grassroots medical institutions in the case of suffering from common diseases, in Lanxi and Xihu District. The main reason is the convenience.The satisfaction of the equipment and instrument is lower than other aspects of the primary health institutions in two regions.(4)Main influencing factors of primary medical service abilityMain influencing factors including the policy of new health system reform, especially the essential drug system and the performance-based pay system, and the primary health human resources.Conclusion and policy implicationDuring the new health system reform, a series of policies has been issued in Zhejiang Province to enhance the capacity of primary health care,including thetalent team construction, financial compensation mechanism, and so on. But the ability of primary care services in Zhejiang Province failed to achieve expected increase, and even has been weakened. Main influencing factors including the policy of new health system reform, especially the essential drug system and the performance-based pay system, and the primary health human resources.Based on the above conclusions, in order to improve the ability of primary care services, we put forward the following policy recommendations:1)Improve thesystematicness and integrity of the health resources allocation 2)exert the linkage effect of health policy 3)Enhance the construction of talents group.