Study On The Responsiveness Of Health System In Shanghai

Background:Health system provides not only medical technological services but non-medical services, but for the long time attention was mainly focused on medical services and meeting the legitimate expectation of health users was ignored. Patient satisfaction surveys have been conceptually flawed and methodologically weak. There has been a tendency to focus on issues important to managers or clinicians rather than on the topics which are most important to patients. These surveys have often been used simply as marketing tools. It is difficult to identify problems with specific processes of care by asking global rating questions and few surveys have been designed to produce actionable results. If we want to centre quality improvement efforts on the needs and wishes of patients, we must first understand how things look through their eyes. World Health Report 2000 put forward a new method measuring health system performance from the perspective of health users.World Health Organization proposed the measurement of responsiveness as one ofthe three intrinsic goals of health system performance measurement in World Health Report 2000. Responsiveness is how well the health system meets the legitimateexpectations of the population for the non-health enhancing aspects of the health system. It is not only the average level of responsiveness in a country that is of interest, but issues of distribution with regard to different socio-economic and demographic groups as well. Responsiveness has two main aspects: respect of persons and client orientation. The first incorporates issues such as dignity, autonomy, confidentiality and communication, while the latter relates to prompt attention, quality of basic amenities, choice of care provider and access to social support networks during care. WHO conducted health systems responsiveness surveys in Shandong Province (1999) and nationwide (2000-2001) and did comparative analysis with its member states. In the World Health Report 2000, level and distribution of responsiveness of Chinese (Shandong Province) health systems ranked88-89 and 105-106, respectively, among its 191 member states.Objectives: This paper intends to evaluate the assessment framework of responsiveness of health systems and redress the concepts, elements and methods to make it more adaptable to the context in Shanghai, China. Based on the framework proposed by WHO, level and distribution of responsiveness of Shanghai and its rural health systems and responsiveness of public health system are assessed to identify the problems in Shanghai health system and its sub-systems such as medical system and public health system. Policy suggestions on the improvement of responsiveness are to be put forward to provide evidences for policy-making.Methods: Both quantitative and qualitative methods were used in the surveys conducted in Shanghai and its four districts. Methods were mainly used as follows:1. Postal survey, household face-to-face survey and key informant survey were conducted to understand the level and distribution of responsiveness and identify the problems in Shanghai health system and its subsystems. Vignettes were added in the questionnaires and CHOPIT model was analyzed to adjust the difference of respondents' expectation.2. Panel discussion and focus group discussion were held to explore the problems in responsiveness of Shanghai health system and the way to improve responsiveness.3. In-depth interviews with health staff were held to have a rough understanding of the views of health professionals on responsiveness of health systems and their satisfaction with health facilities.4. Customer Theory was used to analyze the difference of responsiveness evaluation from the perspective of internal and external customers to Shanghai health system and its subsystems.5- SWOT analysis was used to analyze the influence power of different customers and their opportunities and threats to health facilities and their staff.Results:1. It found out th...