| Objective: To investigate the implementation of compact county-level medical communities in pilot areas,and understand the basic situation of compact county-level medical communities.Health resources allocation efficiency evaluation of the pilot areas,and analyze the factors affecting the efficiency,this paper discusses the implementation situation and existing problems of Guangxi Compact county medical community,and puts forward relevant improving strategies and suggestions.This paper summarizes the experience and deficiency of Guangxi county-level medical community construction,and provides new research evidence for Guangxi Compact county-level medical community promotion.We will promote the construction and improvement of county-level medical communities in Guangxi,build an integrated medical and health service system with high quality and efficiency,and establish an orderly,effective and convenient medical service pattern.Methods:This study is based on the compact county-level medical and health community pilot monitoring index system(trial)issued by the National Health Commission,through the National Compact County Medical Community Construction pilot monitoring platform derived in Guangxi 39 compact county medical community pilot areas in 2018-2019,the construction of Compact county medical community in Guangxi was investigated.SPSS17.0 software analysis of 2018-2019 in 39 tight county medical community pilot areas of health care resources and medical services data,the data mean,maximum,minimum,median,growth rate,growth volume and other statistical indicators were analyzed.By using CCR model and BCC model of DEA,this paper analyzes the efficiency of health resource allocation in tight County medical community pilot areas in 2018 and 2019.The Malmquist index in DEA model is used to analyze the efficiency change from 2018 to 2019.Tobit regression model is used to analyze the factors that affect the distribution efficiency.Results:(1)statistical description and analysis of monitoring index system:(1)the number of health resources in the pilot area of close county medical community was improved.From 2018 to 2019,the number of beds per thousand population in the county increased from 3.96 to 4.29 per thousand,and the number of health technical personnel per thousand population in the county increased from 4.15 to 4.47 per thousand.The number of general practitioners increased by 765 in 2019 from 2018 to 2477.(2)The pattern of orderly medical treatment still needs to be improved.In 2019,the proportion of inpatients in the county decreased from 70.3%in 2018 to 70.22%.In 2019,the county medical treatment rate will drop to 89.54%,less than 90%.There was a slight downward trend in the proportion of outpatients in primary health care institutions and the proportion of primary and Western medicine in the county level,which were46.27%and 6.77%respectively in 2019.The proportion of patients transferred from the leading hospital increased from 0.3%to 0.55%.(3)The county medical service ability has been improved.In 2019,21 regions will lead the hospital to reach the recommended standards for county level comprehensive or TCM hospitals.The proportion of patients discharged from the leading hospital increased from 36.48%to 40.19%.In 2018,there were 168 regional assistance technology projects in 39 regions,and 366 in 2019.(4)The effective utilization of medical and health resources is not significantly improved.From 2018 to2019,the proportion of medical service income of leading hospital in total medical income increased from 44.29%in 2018 to 45.82%,but the proportion of medical service income of basic medical and health institutions in total medical income decreased from 56.94%in 2018 to 45.03%in 2019.In 2018,doctors in39 regions of basic medical and health institutions were responsible for 18.04times of diagnosis and treatment,and only 16.61 in 2019.From 2018 to 2019,the bed-use factor of the primary medical and health institutions in the county medical community rose from 62.38%to 65.19%.(5)From 2018 to 2019,the average cost of discharged patients in the medical community showed an increasing trend,which increased from 4009.46 yuan in 2018 to 4182.28 yuan.The average cost of discharged patients from hospitals led by the Medical Community varies greatly.The highest cost in 2019 was 55,285.99 yuan and the lowest was 3016.12 yuan.In 2019,the average cost of discharged patients in the community basic medical and health institutions is 5863.2 yuan,and the lowest area amount is 598.2 yuan respectively.(6)The satisfaction level of the compact medical community is at a high level,and the satisfaction of most areas reaches more than 90%.(2)In terms of efficiency evaluation:The overall health resource efficiency of the pilot areas in 2019 has been improved.Efficiency analysis showed that the average overall efficiency pilot areas increased from 0.725 to 0.775 in 2018;the average pure technical efficiency increased from 0.811 to 0.825;the scale efficiency has increased from 0.895 to 0.940.The effective area of DEA is one more than that in 2018,reaching five.According to the DEA-Malmquist dynamic efficiency analysis,22 of the 38 pilot regions have increased their total factor productivity,mainly due to the increase in technical efficiency.The pilot areas have the problems of excessive investment in health resources and insufficient utilization of health resources.In many areas,the relative health resource efficiency is at a low level,and the lowest areas only exert an efficiency of less than 50%.(3)In terms of efficiency factors: Tobit regression results show that the external factors such as resident population and GDP per capita have little effect on the efficiency.Only at the test level of = 0.1,GDP per capita has a negative effect on the scale efficiency.Internal characteristic factors are the main influencing factors of efficiency.The number of beds,the number of health technicians and the number of outpatient and emergency visits at county level affect the overall efficiency,the pure technical efficiency and the scale efficiency.Conclusion:In the process of the construction and implementation of the county medical community,the basic medical service capacity has been improved to a certain extent,and the hierarchical diagnosis and treatment has achieved positive results,but the orderly medical pattern has not been formed,and the two-way referral is not perfect.The development of the medical community in various regions has obvious differences,and the traditional Chinese medicine medical service in the medical community is urgent need to strengthen,the internal coordination mechanism within the medical community and the relevant government management departments of the medical community is not smooth.The efficiency of health resources in the pilot areas has improved,but the utilization capacity is still insufficient.The medical community’s external factors have a small impact on efficiency,while internal factors have a greater impact on efficiency.The satisfaction of the county medical community is at a relatively high level,which is recognized by patients and medical staff.In order to further advance the development of the medical community,the following measures can be taken to improve the quality and efficiency of the development of the close medical community:(1)Further deepen the reform of"delegation,regulation,and service"in the medical field.(2)Focus on special departments to improve primary medical service capabilities.(3)Speed up the implementation of"Internet plus medical health",and technology drives medical development.(4)Strengthen the connotation construction and shape the development advantages of county medical community.(5)Strengthen the construction of talents and ease the plight of the shortage of grassroots talents.(6)Advance the management level of the medical community and ameliorate the efficiency of the medical community.(7)Strengthen the propaganda of the county medical community,change and improve the residents’concept of medical treatment,and improve the health awareness of the people. |
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