Evaluation Of The Policies And The Effect Of Comprehensive Reform Of Primary Health In Guangdong Province

ObjectiveIn order to further push the reform out of the deep water area,this paper interprets the Guangdong comprehensive reform policies of primary health care,this paper evaluated the relevant policies and effects of the comprehensive reform of grassroots health in Guangdong Province.MethodsBy using content analysis method,45 policy documents on comprehensive reform of primary health care issued by Guangdong Provincial Party Committee,provincial government and its subordinate departments from January 2011 to December 2020 were selected,then,a three-dimensional policy text analysis framework from the perspective of policy tools was built to understand,explore and summarize the basic content,relevant background and characteristics of comprehensive reform policies of primary health care in Guangdong province.The "Three E criteria" of policy evaluation was adopted to evaluate the effect of comprehensive health reform policies at the primary level in Guangdong Province: Considering the temporal and spatial lag between institutional supply and reform effect,this paper analyzed the allocation of primary health resources during 2012-2021 from three dimensions of human,material and financial resources by comparative analysis method,and evaluated the effect of the comprehensive reform policy of primary health in Guangdong Province from the perspective of effectiveness and equity.The three-stage DEA model was used to select the number of health institutions,the number of employees on duty and the number of actual beds as the input index of primary medical and health resources,the number of discharged patients,the number of total patients and the number of health check-ups as the output index of primary medical and health services,and the three indicators of local GDP,population density and government health expenditure as environmental variables.To eliminate the influence of external environmental factors such as social,economic and policy factors and random noise on the input-output efficiency of primary health services,and calculate the service efficiency of four types of main primary health care institutions in Guangdong Province during 2012-2021,and evaluate the effect of the comprehensive reform policy of primary health care in Guangdong Province from the perspective of efficiency.Results1.263 coded policy texts cover all the contents of the three types of basic policy tools and their secondary tools,and the proportions of supply-oriented,demandoriented and environment-oriented policy tools used are 39.16%,28.52% and 33.08%,respectively,and the distribution is relatively balanced.In the X dimension,the supplyoriented policy tools have the most items on talent training,followed by capital investment,the number of items in infrastructure equipment construction,public services,functional positioning and information support is relatively close,and the technical support involves less.Among the distribution of demand-oriented policy tools,the proportion of organizational coordination items was the largest,accounting for46.67%,and the proportions of three types of items of medical insurance payment,drug procurement and service promotion were close.In terms of the distribution of environmental policy instruments,institutional mechanisms accounted for the largest proportion,more than half(56.32%),and the frequency of use of regulatory and financial support was the lowest among all types of secondary policy instruments(6.90% and 3.45%).In the Y dimension,medical activity policy tools accounted for the largest proportion,accounting for 34.04%,followed by public health,accounting for37.66%,and medical activities and medical insurance activity policy tools accounted for a similar proportion,19.15% and 17.02%,respectively.In the Z dimension,the most involved is primary medical and health institutions,with 135 responses,accounting for51.33,policy tool items involving the government and its subordinate departments accounting for 24.33%,involving medical personnel accounting for 20.91%,and policy tool items involving pharmaceutical enterprises,patients and their relatives have fewer responses,accounting for a total of 3.42%,less than 5%.2.The analysis results of relevant indicators of human,material,and financial resources in primary health care in Guangdong Province from 2012 to 2021 suggest that since Guangdong Province entered the second stage of comprehensive reform of primary health care in 2011,it has focused on the grassroots and continuously strived to improve the service level of primary medical and health institutions : The province’s total grassroots health human resources have grown steadily,the number of registered nurses has almost doubled compared with 2012,and the grassroots health talent team has been supplemented and constantly growing.However,in 2021,the ratio of grassroots doctors and nurses in Guangdong Province will still be seriously inverted,and there is still a big gap from the 1:1.25 required by the Ministry of Health;the number of health personnel per 1,000 population of grassroots health service institutions is also lower than the corresponding verification standard,reflecting the grassroots health talents.The bottleneck is still constrained and has not been effectively resolved.In addition,in promoting the standardization of grassroots health institutions,dismantling and reforming village clinics that do not meet the standards,the number of village clinics has been greatly reduced,and 6,000 public and private standardized village health stations are still under construction and not fully put into use.In the throes of reform,the accessibility of medical care for rural residents has decreased.In terms of financial resources,in the past ten years,the investment in grassroots medical and health institutions at all levels of finance has increased to 37.97 billion yuan in2021,and the proportion of personal health expenditures in total health expenditures has remained below 26%.3.Regarding the service efficiency of the four types of grassroots health institutions,when the influence of environmental factors and random noise is not considered,the overall operating efficiency of the four types of grass-roots medical and health institutions is relatively high,the level of organizational management and medical and health technology is relatively good,and the level of resource allocation is relatively high.are at a high level.The results of the second-stage SFA-like analysis show that external factors will have an impact on the investment redundancy of urban and rural primary medical and health resources,and all types of primary medical and health institutions can be placed under the same environment and luck by eliminating their influence.After the elimination,the order of the average net comprehensive efficiency and net pure technical efficiency of the four types of primary medical and health institutions remains unchanged,and the order of the average net scale efficiency changes.It can be seen that after excluding the influence of environmental factors,the overall operating efficiency,organizational management and medical and health technology level of grassroots medical and health institutions are still relatively good,and the level of resource allocation is relatively good.ConclusionThis study evaluated the policies and effects of the comprehensive reform of primary health care in Guangdong Province from 2012 to 2021,and concluded that the main characteristics of the comprehensive reform of primary health care in Guangdong Province were to improve the system and mechanism of primary health care,innovate and practice the government-led policy system,and create an all-round policy environment to protect the health care.The main achievements are as follows:1.The increase of human resources for health care at the community level is significant;2.The material resources of grassroots health care have been improved in quality and efficiency,with less redundant input and high allocation efficiency.3.The financial resources of grassroots health care have been greatly invested,and the financial subsidies for grassroots medical and health institutions and talents have been greatly increased.The efficiency of community-level medical and health services has improved significantly,and the vitality of community-level medical and health institutions has been released.At present,the following difficulties are encountered: 1.The total number of medical and health personnel at the grassroots level is relatively insufficient,the increment is obvious,and the allocation is not reasonable;2.The efficiency of grass-roots health services still presents the characteristics of imbalance between urban and rural areas.3.The allocation standards of grass-roots health resources need to be further scientific and standardized.This study puts forward the following three policy suggestions for reference: 1.Continuously improve the scale and supply capacity of grassroots health human resources and optimize the structure of grassroots health personnel;2.2.Actively coordinate the planning of health resources at the county level,build a multidimensional policy system and accelerate the construction of the county medical community;3.Strengthen the development plan of community-level health services and set reasonable standards for the allocation of community-level health resources.