| BackgroundThe allocation of health resources, means a country or region, will be how to carry out the allocation of health resources to different areas, regions, departments and the crowd. Allocation of health resources, together with the allocation of resources with other economic, as usual there are two means, that is, administrative and market. With a modern economic system, the current world health resource allocation approach, no one is purely administrative or market, but what is more important is the mixed-mode mechanism. Regional Health Planning, combined with the mechanism of government and market, has been supported by the majority of developed countries.In this paper, we have introduced the conditions of the regional health planning approach to the allocation of health resources in the developed countries such as France, the United Kingdom, Sweden, Australia, Japan, Singapore and the USA. We have come to a conclusion that although the countries in the allocation of resources have some problems, but at least so far, have not found more effective way to allocate health resources.In the 1980s, by the World Bank's H3P, the Health Ministry of China implemented the "regional health development projects" pilot work in Jinhua, Jiujiang and Baoji city. In 1997, the CPC Central Committee and the State Council published the decision of health reform and development, which explained the implementation of regional health planning on a relatively perfect. In 1999, the State Planning Commission, Ministry of Finance and Ministry of Health jointly issued the paper of the development of regional health planning guidance, which defined clearly on the implementation of regional health planning background, objectives and principles, contents and methods of planning and the preparation of the corresponding policies and measures.To the end of 2001, China's 31 provinces (cities, districts) has completed the allocation of health resources in the development of standards, corresponding to more than 200 cities also completed the establishment of regional health planning, health resources in their respective areas and gradually started adjustment.Qinghai, as a sparsely populated region of China's western region, in 2000, completed the allocation of health resources in the development of standards, the states or cities have completed their respective regional health planning at the end in 2000, the implementation began in 2001. By the end of 2005, the regional health planning of Qinghai has been concluded.The topics as "study on the allocation of regional health resources in Qinghai ", was the "the 11th Five-Year" plan focused on health issues in Qinghai Province.This subject Commissioned by the Office of Health of Qinghai province will carry out the system evaluation on the status of the allocation of health resources and the implementation of regional health planning from 2001 to 2005. On the basis of summing up experiences, we will predict the criteria to the allocation of health resources for Qinghai province in the 11th 5-year plan.The doctoral thesis involved, mainly in the evaluation on the allocation of medical health resources and the implementation of regional health planning in Qinghai Province during the 10th 5-year plan.ObjectiveThis study was designed to, being accordant with the actual situation in Qinghai province, through qualitative and quantitative evaluation, carry out the status assessment on the allocation of health resources during the 10 5-year plan, identify problems and explore the reasons, for the purpose of providing the information basis for the Qinghai government in the 11th health plan.MethodsThe main methods of this study included the policy analysis, health statistics method, comprehensive evaluation method, as well as focus group interviews and the ROCCIPI technical analysis method, combing the use of quantitative and qualitative study. Specific applications were as follows:1. Policy analysis method. Using the policy analysis method, we have made an analysis on the papers which issued by the Ministry of Health, government of Qinghai province and the health department of Qinghai province. The data from the criteria from the above mentioned documents with the actual allocation of medical health resources in Qinghai in 2005 were compared.2. Health statistics analysis method. Using the calculation formula for health services needs, we have calculated the demand data for various medical health resources in Qinghai in 2005. We have compared the calculation numbers and the corresponding data from the criteria in the regional health planning in Qinghai in order to verify the correction of the regional health planning. We have compared the data of the allocation of medical health resources criteria in the regional health planning in Qinghai and the actual data of the medical health resources allocation in Qinghai province, in order to verify the implementation of the regional health planning.3. Fairness evaluation method. Using the Gini coefficient method, we have conducted a quantitative comparison on fair allocation of medical health resources in Qinghai Province in 2001 and 2005.4. Comprehensive evaluation method. With the help of TOPSIS comprehensive method, we have carried out the evaluation on the allocation of medical health resources in Qinghai Province in 2001 and 2005 in order to do the comprehensive evaluation at efficiency and quality level.5. Focus group interviews. We have used focus group interviews to find the problems on the allocation of medical health resources, as well as regional health planning encountered in the conduct explored, with a view to identifying the causes and solutions to the problems.6. ROCCIPI technical analysis method. ROCCIPI is a method by which we can carry out an analysis to a social problem from the angles as follows, rule, opportunity, capacity, communication, interest, process and ideology. We have used ROCCIPI technical method to find and explain the reasons for the problems of the implementation of the regional health planning combining expert appraisal methods, to carry out the feasibility study on the recommendations made by the project.Main Results1. Through the status analysis on the allocation of medical health resources in all levels of medical institutions, we have got a conclusion as follows. The status of the allocation of medical health resources in province-level general hospitals can meet the state's requirements. Its impact on the development of the most important problem is high-level medical personnel cultivation. As for the state (to the city) level general hospitals, with the exception of health human resources understaffed, other basic configuration can meet the basic standards, but as for Haidong district hospitals, its medical health resources were low and should be complementary. For community health center, the status allocation of the medical resources can meet the state's minimum configuration requirements, the main problems is their institution number was too small. The main problems of the development of the county hospitals and the township hospitals were understaffed health human resources. There were some problems in the development of the village clinics, including housing construction area and the basic facility, etc. But the most important problem of the village clinics was rural doctors' low income.2. By the comparison between the calculation numbers from the formula for health services needs and the corresponding data from the criteria in the regional health planning in Qinghai, and the content analysis on allocation of the medical institutions and the large medical equipment, we have verified that the regional health planning in Qinghai was scientific, and it is consistent with the actual situation of Qinghai.3. By the comparison between the data of the allocation of medical health resources criteria in the regional health planning and the actual data of the medical health resources allocation in Qinghai province in 2005, we have got a conclusion that implementation of the regional health planning in Qinghai was not very good.4. As for the fairness evaluation, we have concluded that the fairness degree on the allocation of all types of medical health resources in the distribution of population either in 2001 or in 2005 in Qinghai Province was very good, especially for beds and medical personnel; the fairness degree on the allocation of all types of medical health resources except the medical institutions, was very bad.5. With the help of TOPSIS comprehensive method, we have concluded that the utilization efficiency on medical health resources in 2005 has been improved, but the quality has declined, compared to 2001.Innovation1. So far, we have not found the relative system evaluation report on the evaluation about the implementation of China's first regional health planning as the unit of a province. We have not found the relative literature about the evaluation on the allocation of medical health resources during the period of 2001 to 2005.There is no official authority on China's regional health planning implementation of the evaluation system.2. Based on the attendance rate and average net income per attendance in the village clinics in Qinghai province, we have calculated the theory numbers of the reasonable village population that can achieve the corresponding income if it was only clinic considered. Government, according to the actual concrete numbers of the village population and the doctors in rural areas, should carry out the income subsidies to the village doctors and take different incentives in different areas to ensure that village doctors in the public health service can have initiative.3. As for the community health service centers and village clinics in the public health services, we have suggested that the government should supply the corresponding traffic tools and transport subsidies according to their reasonable service radius, in order to ensure that these two organizations can carry out the public health operations.4. With the help of the demand formula on the allocation of health resources, we have verified the paper of the regional health planning in Qinghai was scientific. Through the comparison between the criteria in the regional health planning in Qinghai and the actual data of the medical health resources allocation in Qinghai province in 2005, we have got a conclusion that implementation of the regional health planning in Qinghai was not very good .5. By the ROCCIPI method, we have made an analysis on the crux that the regional health planning in Qinghai was not to be implemented. We have concluded that it was necessary to strengthen regional health planning legislative proposals. |
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