The Study On The Department System Reform In The Maternal And Child Healthcare Institutions At The County Level In China

Objective:To study the current situation of the department reform in the maternal and child healthcare(MCH)institutions at the county levels in China,analyze the effect of the department reform in the MCH institutions at the county levels from the aspects of institutional income,individual services in the hospital and community healthcare services in the district,and summarizes specific measures of the department reform,as well as the problems encountered in the reform.Methods:1.Literature research:through reading,sorting out,and summarizing the relevant literature and documents of "the department reform" and "standardized construction"of the MCH institutions,it provided theoretical basis for formulating research plan of the department reform.2.Investigation on direct reporting of institutional monitoring network:the data of the MCH institutions at county level in 2015 and 2019 in China were derived from the direct report system of monitoring network of the MCH institutions established by the National Center for Women and Children’s Health,China CDC.(1)This paper analyzed the relevant situation of the MCH institutions at county level in 2019,including the basic situation and resource allocation of the reform institutions in the eastern,central and western regions.(2)According to the data of institutional income,individual service in the hospital and community healthcare services in the district in 2015 and 2019 between the reform group and the control group,the effect of the department reform was analyzed by the difference in difference method.3.The field investigation:according to the monitoring data of the MCH institutions and daily work information,the institutions that have been reformed were selected as typical institutions in the east,central and western regions for on-site investigation,including five MCH institutions in Huantai County,Linzi District,Xinmi City,Mei County,Liuyang City.The field survey adopts two ways:Questionnaire survey and semi-structured interview,and the qualitative data collected were sorted out and analyzed by the thematic framework method.Through on site investigation,we can understand the current situation,specific measures,the existing problems and deficiencies of the department reform.Result:The current situation of the department reform of the MCH institutions at the county level in China is as follows:There are 1834 MCH institutions providing inpatient services at county level in China,of which 345 were carried out the department reform,accounting for 18.8%.Among them,Chongqing’s most department reform institutions accounted for 35.1%.The proportion of reform institutions in the central region(20.1%)was higher than that in the eastern and western regions(18.6%and 18.0%).The four indicators of health technical personnel,fixed assets,business housing area and the number of actual beds in the reform institutions decreased in turn in the eastern,central and western regions.2.The effect of the department reform of the MCH institutions at county level:Through the analysis with the difference in difference method,(1)The net effect of the department reform increased the total income of the MCH institutions at county level by 17.331 million yuan,and the business income increased by 13.234 million yuan.(2)The number of types of the MCH services provided by reform group institutions was higher than that of control group in 2019.The net effect of the department reform increased the number of outpatient visits of the MCH institutions at county level by 32751,and the net effect of the department reform increased the number of discharged patients by 821.5.(3)The net effect of the department reform increased the average number of outpatient and emergency patients per practitioner per day,while decreased the average number of hospital beds per practitioner per day,but there was no statistical significance.(4)The net effect of the department reform made the number of basic health technicians trained and the number of basic level people days increased due to the community work of maternal and child healthcare,but there was no statistical significance.the proportion of critical illness assessment,maternal death assessment and death assessment of children under 5 years old(or newborn)in the reform group was higher than that in the control group in 2019.3.Field investigation results:The department reform is necessary and feasible.The specific measures of the department reform included restructuring the department and office setting,standardizing the setting of the internal medicine department and clarifying the functions and tasks;establishing the cooperation mechanism within and among departments,establishing the connection mechanism between community healthcare and individual service in hospital,establishing the complex talent training mechanism,establishing the internal performance evaluation system based on "the department",and establishing the cooperation mechanism between jurisdiction management and hospital healthcare quality management.It promoted the integration of healthcare and clinical,promote the development of hospital services,and improve the quality of healthcare services in the jurisdiction through the department reform.The training cycle of compound talents was too long to meet the needs of reform,and the shortage of public health funds had negative effects on the implementation of the reform.Conclusion:The MCH institutions at county level had defined the internal organizational structure,standardized the internal medicine department and established suitable systems and mechanisms through the department system.The effect of the reform had gradually highlighted,including promoting the integration of healthcare and clinical,and improves the service ability;and promoting the business management of the district.promoting the performance of public health functions,and improving the quality of the MCH management of the jurisdiction.In the process of reform and development of the MCH institutions at county level,there are still some problems,such as lack of compound talents,the relevant systems and mechanisms for the reform of the department system were not sound enough,and the lack of public health funds to restrict the performance of functions.It needs the joint efforts of the government and the MCH institutions to promote the standardized construction and healthy development of the MCH institutions.