Shanghai Comprehensive Reform Model For Community Health Services Research And Performance Evaluation

In recent years, the concerns that "medical treatment is difficult and expensive" have become a problem concentrated on continuously by society. Therefore different research institutions, have presented many sets of medical reform programs, and to solicit the views from the variable social classes, and the basic framework on medical reform has been formed, meanwhile there exist many controversies on the concrete implementation. Different from debates with a variety of opinions about the medical reforms, however, the community health service has developed into one of the basic reform strategies which get a high degree of recognition by sectors of society.In accordance with the instructions from the State Council on the development of urban community health services, which clearly stated that all regions should actively explore the establishment of a scientific and reasonable operation of income and expenditure management system in community health services, standardize the revenue and expenditure management, and apply community health service comprehensive reform pilots etc. In 2005, such pilots were established in the Changning District and Songjiang District of Shanghai to implement revenue and expenditure management program, pre-paid medical insurance system and income distribution mechanism. In 2006 and 2007, the State Council require the cities to carry out work of community health services, building a new urban medical service system that there are reasonable divisions of labor, the close cooperation, reciprocal compensation, two-way referral between city hospitals and community health services. Subsequently, the relevant sections of the State Council issued nine consecutive documents about community health service, and developed community health services deeper, indicating that the Chinese community health comprehensive reform has begun to enter a period of progressive development.Firstly this paper described community health development process and achievements of comprehensive reform in Shanghai and summed up innovatively the comprehensive reform of the Shanghai community health development model - "1236" model. Secondly, the paper analyzed the results and performance evaluation of community health comprehensive reform in Shanghai from 2004 to 2008 empirically. By building the concept of community health service system dynamics model and logical model, we found that some main problems about the comprehensive reform : sufficient input quantities in the whole system but unbalanced in part; legitimacy lacking on the allocation of health resources within the system; residents's higher overall satisfaction and lower part dissatisfaction on community health services.What's more, there are also various bottleneck affecting factors in the process of comprehensive reform of community health services, such as policy, personnel and security of compensation factors etc.Lastly this paper issues some answers to above problems from such six various aspects in the policy, functions, personnel, finance, performance evaluation and networking to develop this comprehensive reform in Shanghai so as to provide some reference value for China's health care reform.