| Part I Health Care Status in Hunan ProvinceObjective:The purposes of this study were to explore the advantages and disadvantages of health care development in Hunan Province by analyzing the development in health institutions, health personnel, health facilities, health financing and health resource utilization from2007to2008, comparing with Zhejiang, Yunnan Province and China average level; to identify the roles of health care development of Hunan in the central provinces in China; to provide a realistic evidence and theoretical reference for the scientific and rational health policy; to provide recommendations on better allocation of health resources with horizontal evaluation of health status in eight provinces by using comprehensive evaluation method.Methods:Descriptive analysis was used to compare the differences in health indicators, such as the absolute number, percentage and the in per capita, among Hunan Province and a random sample of developed province (Zhejiang), underdeveloped province (Yunnan) and the national average level. Document analysis was used to collect the principles and methods on evaluation research in health development, and form a comprehensive conceptual framework for the evaluation index system, combining with the actual situation. Delphi method was used to determine the indicators and the weight of each index to establish the horizontal evaluation system of health development. Meanwhile, TOPSIS comprehensive evaluation was also used to evaluate the health care development in central provinces in China including Shanxi, Jilin, Heilongjiang, Anhui, Jiangxi, Henan, Hubei, Hunan.Results:(1) Analysis results for the health institutions showed that: provincial hospital, clinics (health centers, clinics, nursing stations), disease control specialist hospital (stations) in Hunan province were more than those of Yunnan and Zhejiang Province; community health service centers (stations) and clinics in Hunan Province were more than those of Yunnan Province, while less than those of Zhejiang Province; the numbers of Maternal and Child Hospital (MCH) and Centers for Disease Control (CDC) in Hunan Province were more than those of Zhejiang Province, while less than those of Yunnan Province; nursing homes in Hunan were less than those in Yunnan and Zhejiang Province. The number of Health Authority was more than that of Zhejiang, while less than that of Yunnan Province. However, due to a large population in Hunan Province, the numbers of the hospital in all levels and types of hospital in every million people were still have large gap to improve.(2) Analysis results for human resources in health showed that:the health administrators in Hunan Province were more than those in Yunnan and Zhejiang Province. The health technical personnel were less than those in Zhejiang Province, while more than those in Yunnan Province in2007-2008. Overall, the number of health workforce per1,000population was higher than Yunnan, while lower than Zhejiang Province and national average level. Numbers of Health care providers in Hunan Province were lower than those in Zhejiang, Yunnan and national average level. These results suggested that there was a relative shortage of nurses in Hunan Province. The allocation of physicians and nurses was not reasonable and could not meet the public demand. The proportion of health technical personnel in Hunan Province was lower than those in Zhejiang and Yunnan provinces, while the percentages of administrators were the highest one, suggesting a lack of health technical personnel in Hunan Province.(3) Results of health facilities showed that:in2007-2008, the number of beds in community hospitals and MCH was more than those in Zhejiang and Yunnan Province. The hospital beds in Hunan were more than those in Yunnan Province, while less than that in Zhejiang Province. Community health center (stations) numbers were more than Yunnan and Zhejiang Province in2008. In2007-2008, medical beds, hospital beds and community hospital beds per1000population were lower than those in Zhejiang, Yunnan Province and national average level. In2007, the ratio of bed nursing in Hunan was higher than that of the national average level, while lower than Yunnan Province. In2007, the bed nursing ratio in Hunan was higher than the national average level, while lower than national level in2008. All these results showed there was low stock in medical beds in Hunan health care system.(4) Health financing results showed that the provincial government and health agency expenditures, revenues and other income declined in recent years, but the proportion of business revenue has continued to increase to91.25%in2008, surpassing the developed provinces such as Zhejiang. While the proportion of Hunan government spending in2008dropped to7.94%, even less than that of under developed provinces such as Yunnan province. All these information suggested that there was shortage of input for health in Hunan provincial government.(5) Health services analysis results showed that:in2007-2008in Hunan Province, outpatient clinic visits, hospital admissions, inpatient surgical visits, hospital discharges increased by8.28%,13.45%,14.32%,14.72%, respectively, due to the improvement of economy, enhancement of self-care sense and population growth. These percentages were still lower than those of Zhejiang, but higher than those of Yunnan Province. In2008, except admission and discharge diagnostic accordance rate in Hunan lower than those of Zhejiang Province, all the other diagnostic accordance rates in Hunan were higher than those in Zhejiang and Yunnan Province. Compared with the national average level, except pathological examination and clinical diagnostic accordance rate slightly lower, others were slightly higher than the two provinces, indicating a high level of medical diagnosis in Hunan Province. Regarding the hospital beds use results, times of bed turnover, utilization, beds workday and average patient length of stay were better than national average level, but the bed occupancy rate was lower than Zhejiang Province. This suggested the quality and efficiency of Hunan health care system were good, but still has some room to improve.(6) We consulted16health-related experts in research, teaching, administration, and clinical to establish the comprehensive evaluation index system for the health care status development. Three first-level indicators,10secondary indicators and103three-level indicators in health investment, services processes and health outcomes were developed.(7) Development of integrated health services in Hunan Province is relative low. TOPSIS analysis in the central eight provinces showed that the top four provinces in the health development were Hubei, Jiangxi, Heilongjiang, Jilin; after four were Shanxi, Henan, Hunan and Anhui, Hunan Province was on the list.Conclusions:(1) There were continued increasing in health resources input, reasonable allocation and health resources utilization in Hunan Province.(2) In Hunan Province, there were still relative low level in hospital beds resources, human resources and ownership per1,000population; physician-nurse ratio and bed-nurse ratio were unreasonable; the medical expense was pretty high and the medical care burden was relative heavy; the bed utilization was relatively not high.(3) Hunan Province ranked No.7in public health development in eight central provinces including Hunan, Shanxi, Jilin, Heilongjiang, Anhui, Jiangxi, Henan and Hubei, showing the poor integrated development of health.Policy recommendations:(1) Establishing multi-level health care system for seniors and reducing prevalence chronic diseases;(2) Encouraging multi-stakeholder involvement and broadening health financing channels;(3) Optimizing the allocation of health resources and improving the efficiency of health resources;(4) Vigorously promoting primary health services and improving supporting measures to promote their sustainable development;(5) developing human resources and integrating health human resources structure. Innovations:(1)31provinces have been divided into in three regions including developed, moderately developed, underdeveloped provinces. We analyzed the development of Hunan health status by comparing with a randomly extracted developed region and an underdeveloped region.(2) In this study, health institutions, health personnel, health facilities, health financing and health resource utilization were comprehensively, systematically evaluated on the health status development of Hunan Province.(3) We preliminary developed the comprehensive evaluation index system and evaluation model in health status development, and proved its feasibility by the empirical research in the central provinces in China. Part II Trend of Health Care Development in Hunan ProvinceObjective:The purposes of this study were to explore the overall development trend and problems in Hunan health care system since1997through a comprehensive, systematic collection of health information system of Hunan Province from1997to2008; to establish the health indicators of predictive model in Hunan health care system to understand the future direction of the main indicators, and explore the relationship among economy, culture, education and health care development; to provide policy recommendations on health development plans for government and regional health administration department.Methods:SPSS13.0, Microsoft Excel2007and Matlab7.1were used in this study. Descriptive analysis was conducted to explore the basic conditions and variation of health development in Hunan Province since1997. Weighted RSR was used in the longitudinal comprehensive study on the health resource allocation, utilization of health resources and health services outcomes. The prediction of the number of beds, number of institutions, the number of health care workers and doctors were performed by using residual gray prediction model, orthogonal polynomial fitting and the weighted average portfolio model. Spearman correlation analysis was used to explore the association between the socio-economic, cultural, educational and health indicators.Results:Studies have shown that Hunan Province has been developing a comprehensive health service system including medical care, prevention, research and other functions after ten years of development.(1) The total amount of health resources in Hunan Province was significantly improved. Government investment in health care system continued to increase at all levels:from1997to2008, the average annual growth rate of the numbers of health institutions, beds were0.17%,3.05%, respectively; average annual growth rate of number of health personnel, health workers, doctors, nurses were1.15%,1.25%,1.93%,3.41%, respectively; the average annual health expenditure growth rate was21.24%. Meanwhile, the numbers of beds per1000population, numbers of health workforce per1000population, per capita health spending and physician-nurse rate were on the rise. But there was still shortage in total health resources in Hunan Province:In2008, beds, health technicians, doctors, nurses per1000population were below the national average level. Meanwhile, there was a certain gap between the current proportion of doctors and nurses from the "guidelines for allocation of health resources in Hunan Province (Draft)" with allocation ratio of1:1between medical practitioners and practice from1997to2008.(2) The overall efficiency of health resources utilization in Hunan Province has continuously increased. From1997to2008, there were growing trends in bed turnover, occupancy rates, bed work days, indicating the increasing efficiency in the medical beds use. The increasing number of hospitalization and steady declining in average length of stay for those discharged also demonstrated the continuously efficiency improvement of health professionals. However, the utilization of health resources was still not high:the bed occupancy rate and bed working days in Hunan Province were below the national average level.(3) The residents’health status has continuously improved in Hunan Province. The maternal mortality was showing an fluctuating downward trend and infant mortality was declining gradually. In2008, maternal mortality and infant mortality reduced to30.45%,8.51%, respectively.(4) The overall strength of health in Hunan Province showed a ascend trend. Among them, then overall strength of health in2008was the best (WRSR value of0.9670), while1999was the worst (WRSR value0.2360).(5) With the economic and social development, there was a certain amount of room for the growth health indicators in Hunan Province. Residual gray prediction model, orthogonal polynomial fitting and the weighted average portfolio model for health services indicators have predicted that:according to current trends, by2013compared with2009, the number of beds will increase by70.77%;64.95%increase in the number of health personnel; health workers increase66.90%;91.07%increase in doctors; nurses will increase113.07%;7.19%increase in the number of hospitals; maternity and child care hospital will increase5.02%;93.35percent increase on the number of clinics; the number of patients will increase115.76%;40.02%increase in the number of hospital beds turnover. Although there will be an increasing proportion of nurses and improvement of ratio of physician and nurse, but until2013, the upside down of proportion of physician-nurse will not be changed, and the proportion of the irrationality of physician-nurse will continue to exist in Hunan Province.(6) Spearman correlation analysis showed that there were correlations between economic, cultural indicators and indicators of health funds, health expenditure per capita, turnover of beds, occupancy rates, bed working days, maternal mortality, infant mortality, hospital number, the number of maternal and child health agencies, number of beds per1000population(p<0.05). No correlations were found between economic, cultural indicators and health workforce per1000population (p>0.05).Conclusions:(1) Hunan Province has made remarkable achievements in the health services development with increasing total health resources and health resource utilization, improving health status of the province’s residents.(2) The total amount of health resources, per1000(10,000) per capita were still low, and the health resource utilization, resource allocation structure was irrational in Hunan Province.(3) The development of health care in Hunan Province has been impacted by the economic, cultural and educational levels at some extent. Policy recommendations:(1) Coordination of social and economic development, increasing the total amount of health resources, and improving the utilization of health resources.(2) Optimizing resource allocation structure.Innovations:(1) We used various comprehensive indicators, in-depth analyzed trends of health development in Hunan Province by using a12-year data. We first explored the relationship between health and economic development, and between culture and education.(2) The residual gray prediction model, orthogonal polynomial fitting and the weighted average combination models were first used in the prediction of Hunan Province health care development.(3) We established comprehensive evaluation (vertical) index system of Hunan Provincial health development, and confirmed its feasibility by empirical studies. |
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