Study On The Equalization Of Basic Public Health Services In Rural Areas Of China

The goal of this paper was to do research on the rural equalization of basic public health services in China. The research belonged to the category of public management theory about government supply and public demand of residents. The theory and practice of the rural equalization of basic public health services in China was analyzed from various angles in this paper, which has important theoretical and practical value.Ⅰ. Research goalThe value orientation of equalization of basic public health services supply has been confined by analyzing its background, process and intension proposed by Chinese government. According to public goods theory, new public management theory and public service supply and demand theory, the content of the equalization of basic public health services supply in China has been defined. On this basis, the existing state of basic public health services supply, demand and utilization in China's rural areas is discussed in detail, and the main problems are disclosed. The research will provide policy basis for the promotion of equalization of rural basic public health services.Ⅱ. Research method1. Documentary analysis method:the literature and government documents about public services and equality were explored by the databases of Medline, Proquest, Elsevier Science (SDOS), China Journal Net, as well as government departments. A word frequency analysis method was introduced to look over the keywords contained in the connotation of equalization for the equalization of public services at home and abroad the field of literature from2006to2010.2. Sampling survey method:a multi-stage sampling method was introduced. First of all, China's provincial administrative divisions were divided into four levels according to the Human Development Index. One province in each level was extracted, and the sampling results were that Zhejiang province, Henan province, Chongqing province and Qinghai province. Then, three counties in each province were selected as a sample. There were a total of12sample counties. And then, samples county townships were divided into three categories according to the far away from the county. A township was extracted from each type of the counties. There were a total of36townships as a sample of villages and towns. Finally, the villages in the sample townships were divided into three categories. A sample village was extracted from each type. There were a total of108sample villages. In each sample village, one hypertensive patients, one maternal, one under the age of a child's guardian, an elderly aged65and above for the survey were referred by village doctors. The investigation was completed by the first survey object and then referral to the same object in the same village, and so on.3. Delphi method:the36senior public health workers (with a practitioner qualification, has long been engaged in public health-related work for more than10years) were invited to carry out expert advice with two times according to the preliminary design of the county (district) level equalization of basic public health services evaluation system. Then, the suitability and consistency of the indicators were assessed. The degree of importance of the various indicators was rated. And then, the standard values of the indicators were assigned to construct the evaluation index system of equalization.4. Material analysis method:Take the analytic hierarchy process (AHP) as the foundation, the triangle fuzzy number was introduced to replace the original definite value. Each target weights in the indicator system were determined using the developed software. Then, the spot investigation materials were inputted into database by using the EpiData. And then, the spot investigation materials were reorganized, classified and quantified. SPSS 12.0was used to carry on the card side examination and the multi-factor non-condition logistic regression analysis.Ⅲ. Research result1. Connotation of basic public health service equalization. From the economic point of view, basic public health service equalization was required to establish the perfect government collective services financial system. The sector collective services disparity should be reduced by improving finance transfer payment system among all levels of the governments in order to causes the level of the government's basic collective services to be roughly close, particularly guaranteed that the financial resource weak owe the developed area to have the enough financial resource to guarantee the government basic function the fulfillment. From the public management point of view, the nature of the basic public health service equalization was a civil right problem of the resident basic service demand and supply. From the relations between "equalization" and "fairness", the difference in both mainly lied in the attention stratification plane. The equalization had more attention on health service movement domain than the fairness. And the centralism manifests in the service development and the implementation whether can realize the even equalization. Based on this, the research on basic public health service equalization was defined to one kind of balances about the basic public health service supplies, the demand and external environment interaction. The actual content was gradually implemented according to our country different period economic development level, the resident healthy demand and government finance ability.2. The basic public health services evaluation index system for countries is designed. The evaluation index system includes three specific goals, seven assessment dimensions and fifteen assessment parameters. Meanwhile, some areas are selected as typical samples, and the effect of equalization in these areas are evaluated. It has been concluded that the effect of equalization of basic public health services supply in the sample areas has a good level, which the comprehensive evaluation index value is0.746. But there exists an imbalance in the fields with different equalization targets.3. The countryside public health service demand and government supplies relational model was constructed. And the present content of basic public health service project was divided into the foundational public health service, the core public health service, the support public health service. The foundational public health services were referred to individual services provided by the present content of basic public health service. The core public health service was referred to the colony service items linked up with outpatient service diagnosing and treating. The support public health service was referred to service items with the outpatient service inspection diagnosis, the treatment links up. At the present stage, government should provide foundational public health service for the countryside residents.4. The household suvey and analysis on the beneficiary population of the state's basic public health services in China's eastern, western and northwestern rural areas were implemented, which included932patients with hypertension,270lying-in woman,877guardians of children aged0-6, and1088elderly persons. It was shown that the use of basic public health services for rural residents had the characteristics of nonequal. For example, there were significant differences whether national immunization programs for children is implemented or not (x2=26.516, P<0.001). Considering the different types of the guardians (χ2=4.428, P=0.035) and satisfaction (x2=8.897, P=0.003), Children's services utilization was different. In the influence factors of resident services utilization, common factors included the guardian class, follow-up forms, and satisfaction, personalized factors included gender, education level and their own behavior factors. After project financing of basic public health services was resolved basically, providing services for the needs and characteristics of the different target groups is an important starting point in the process of equalization of rural basic public health services.IV.Research innovation1. Rural basic public health service equalization was studied from the unique angle of view, that is, take the citizen demand as the center. The inner relationship between the countryside resident demand and the countryside public health service supplies was disclosed by considering the government supplies and farmer demand condition.2. A triangle fuzzy analytic hierarchy process was proposed to build basic public health service equalization indicator system for the selected sampling area. The advantage is that expert may grade more accurate, and operation is stronger.