| Research PurposesTo develop community health services is important to Chinese health care system reform, and is also the best starting point for China's government to maintain the population health. Since the introduction of community health services in China, the services functions and qualities have been improved continually and taken on a good prospect. However, objectively speaking, due to the constraints of economic levels, the development of community health services is uneven in different regions. Overall, the community health resources are more in the high-income cities with abundant health resources, but the situation in low-income cities is opposite, although less health resources for the low-income cities. The infernal circle is neither conducive to the sustainable development of community health services in china nor conducive to the whole population to achieve health equity. But to date such evidence from large samples has remained scarce on this issue.In addition, as for the research contents, the majority of studies were currently on needs and utilization of the community residents, but there was a lack of studies on the resource allocation, supply efficiency, service quality, satisfaction of community health services. As for the research methodologies, the results were most described with simple comparative methods, but the combination of various mathematical statistics and comprehensive evaluation methods were little used. Therefore, most studies were superficial and could not play a supporting role for decision-making departments of community health services.To aim at above-mentioned problems, on the one hand, based on the results of situation analysis and comprehensive evaluation on community health services in different cities, this study was intended to search for the main problems and further to explore the management and operation mechanism of community health services adapted for different cities with different economic levels. On the other hand, this study also aimed to provide the reference and recommended methodological basis for further research on community health services, in order to continuously improve theoretical level of community health services research and to reinforce the practice basis of the construction of community health services system. Ultimately, it is to formulate the functional framework of community health services system in China and to promote the balance of community health service development.Research MethodsA variety of methods were used in this study:①the descriptive and analytical methods were used for situation analysis of community health services in different cities with different economic levels, mainly on the resource allocation, service quality, supply, utilization and satisfaction;②Lorenz curve and Gini coefficient were used to evaluate the fairness of community health resources allocation in different cities with different economic levels;③literature study, expert evaluation, coefficient of variation, correlation coefficient, and cluster analysis methods were used to screen the indicators of comprehensive evaluation on quality of community health service;④principal component analysis was used to determine the weights of indicators;⑤data envelopment analysis was used to study the supply efficiency;⑥the weighted topsis method, the weighted RSR method, and the two combined fuzzy methods were used to comprehensively evaluate the quality of community health services in different cities with different economic levels;⑦fuzzy comprehensive evaluation method was used to evaluate the community residents'satisfaction;⑧the combination methods of single factor analysis, Logistic regression analysis and optimal scaling regression analysis were used to indentify the influencing factors of utilization and satisfaction of community residents.Research ContentsTo evaluate the development status of community health services in different cities with different economic levels, we conducted the survey on the community health facilities of 26 key contact cities. The research contents included:①status of resource allocation:including the average level and the fairness of the allocation of community health resources, such as human, financial, and material resources;②quality of community health services:including screening of indicators, determination of weights and comprehensive evaluation of services quality;③the supply situation:including the supply situation of the basic medical and public health services in community health facilities, and the supply efficiency;④the utilization and the influencing factors:including the social-demographic characteristics of community resident, and as for the community residents, the times to go to the community health facilities last year, the type of services in community health facilities, the attendance type in the community health facilities, and the influencing factors of utilization status;⑤the satisfaction status and the influencing factors:including the satisfaction on sub-item services, the overall satisfaction of community residents and the influencing factors of satisfaction status.Research ResultsThe study results showed that the community health facilities of different cities with different economic level played the complementary role to improve the urban health system, to make up for the deficiency of health resources and to improve the community residents'access to medical services. The main results of this study included:①there were no significant differences in the average level of community health services resources (P<0.05). The doctor-nurse ratio was opposite to the ideal ratio; the structure of educational levels and professional title was irrational; and revenue and expenditure situation was also not ideal; but the allocating fairness of community health resources by population was in good situation.Except the Gini coefficient of total fixed assets in community health centers was above 0.30, the rest Gini coefficient of the community health resources were below 0.30 which indicated in the best condition.②the services of quality in community health centers from superior to inferior as follows:high-income cities, middle-income cities, low-income cities; the services of quality in community health stations from superior to inferior as follows:high-income cities, low-income cities, middle-income cities.③overall, it is more scientific and reasonable of services concepts and services manners of community health facilities in high-income cities in providing basic medical and public health services with more accurate positioning of service functions, while the community health facilities in middle and low-income cities were still focus on economic benefits and still insisted on the scale model that violated the nature functions of community health services; the relative supply efficiency of community health centers in all five high-income cities were 1; among 11 middle-income cities, relative supply efficiency of community health centers in Nanchang, Wuhan, Tianjin, Yinchuan were 1; among the 10 low-income cities, relative supply efficiency of community health centers in Lanzhou, Xining, Yangquan were 1; in every type of city, relative supply efficiency of community health stations in only one city (Hangzhou, Nanchang, Jiaozuo) were 1, respectively.④utilization and satisfaction of residents in different cities with different economic levels were different (P<0.05), and the influencing factors were also different. The community residents'satisfaction score in high, middle, low-income cities were 75.38 points,73.93 points, and 76.01 points, respectively, all between in the "satisfactory" and "general" situation.Policy suggestionsCommunity health services, as a complicated social project, must base on the government's support and co-ordination of various sectors, and must enhance the resources and connotation construction and improve the quality of services. Only in this way, can community health services benefit the public and address the problem of "to access medical treatment is difficult and expensive".From the research findings, this study proposed the following policy recommendations:①the local government must provide a good policy environment for community health facilities, meanwhile should pay much more attention on strengthening the regulation targeting to negative factors;②community health facilities should be organized and established according to local conditions, avoiding blind expansion phenomenon;③community health facilities should be focus on quality improvement, as well as collaboration with other medical and health facilities.The innovation of the study1. As for the research perspective and ideas,26 key contact cities were divided into three different categories in accordance with the economic level in this study for the first time, and we conducted a comprehensive, systematic, objective and in-depth research on the resource allocation, quality of services, supply, utilization and satisfaction condition of the community health facilities. Particularly in the quality analysis, this study reflected the various dimensions of the quality of community health service.2. As for the research methods, we compared the community health services in different cities with a variety of mathematical statistics and evaluation methods with aim at providing the methodological basis for the future in-depth research on community health services.The limitations and the further study suggestionsAs a result of restrictions on raw data, the research subjects were all the key contact cities with good work basis and strong sense of innovation, so the overall level of development status of community health services was ahead of the national average level. Although the findings of these cities could provide the references for the present system construction of community health services network, in order to enhance the popularity of the findings and the comparability with the international perspective, there should be further studies on the community health services in cities with weak work basis and poor development situation, which would be the subject of research focus of the next step.
|
PDF Full Text Request