Economic Operation Status And Efficiency Analysis On Community Health Services Of Key Contact Cities

Research PurposesWe aimed to calculate the relative efficiency of CHSIs from both horizontal and vertical, and explore the factors that may affect the economic status and efficiency, on the basis of analyzing the economic operation status and dynamic development process of the past five years on the community health service institutions (CHSIs) among the36key contact Cities. Furthermore, we tried to make sure the problems and challenges during the CHSIs development, and put forward specific policy recommendations to provide a basis for improve the CHSIs operational status and efficiency.Research MethodsOn the basis of system access to domestic and foreign literature, we continuously monitored dynamic development of community health service system construction among36key contact cities (districts) from2007to2011by site survey. The subjects were health authorities of cities and areas, CHSIs as well as prescriptions."One institution on questionnaire" laid the foundation to collect more accurate information. The statistical methods included descriptive statistics and statistical inference, cluster analysis, data envelopment analysis (DEA), Malquist productivity index and Tobit regression. EpiData3.0double-entry was used, and the software includes SAS9.0, SPSS12.0and Deap2.1.Research Results1.Economic operation status of CHSIIn2011, the completion rate of community health service centers (CHSCs) and stations (CHSSs) were respectively89.93%and91.90,92.13%of the streets are set community health service centers, and the community health service network initially built. At the same year, the implementation rate of development of a community list of essential medicines, unified procurement and centralized distribution system, essential medicines zero sales system reached82.06%,92.38%and95.95%, respectively. And rational drug use indicators and prescription costs improved. The total service of CHSIs is increasing, but the proportion of basic health services in all levels of health care services system was not significantly improve. The CHSCs had a basic balance of income and expenditure, and the CHSSs showed a deficit. The financial assistance income proportion increased in CHSIs, and the center and the station were respectively32.98%and16.41%, but the proportion of health insurance income was still low.2. Estimates of economic efficiency and temporal analysis on CHSIsThe efficiency value of the overall evaluation mode was higher than that of the medical service evaluation mode, and the efficiency value of medical services evaluation mode was higher than that of the public health services evaluation mode; The CHSCs efficiency value was higher than that of the CHSSs. In the overall mode, the malmqusit productivity index in the five year was greater than1in CHSCs, and the malmqusit productivity index in CHSSs was smaller than1except in2009; in the care delivery model, the total factor productivity index in CHSCs continuously recession in2010and2011, and the CHSSs only improved in2010; in the public health service mode, the CHSCs’total factor productivity continued to improve, and the CHSSs was declined in2011.3Analysis of economic situation and efficiency analysis about CHSIs of eastern, central and western regions.The CHSCs of the eastern and western regions had a balance between income and expenditure with slightly surplus, and the CHSSs of centers regions had a balance between income and expenditure with slightly deficit. The CHSSs had a deficit status in any of the region. The drug revenue expenditure surplus was higher in the CHSCs of the central and western regions, which was up to20%. The total amount of service and per capita health care providing was higher in eastern part than that of central and western regions; and the relative efficiency of CHSIs in the eastern and western regions were higher that in the central region.ConclusionsCommunity health service network has been built, but still need to be further optimized in terms of policy implementation, staffing and service functions. The CHSCs operated in good condition, while the CHSSs’operation was not optimisitc. In different evaluation mode, different types of institutions and different time, the efficiency and productivity index in CHSIs is not the same. Between different regions, the efficiency of CHSIs was higher in the eastern and western regions than that in the central region.Innovation and limitationsIn terms of sample size, this study used a largest continuous sample of CHSSIs; about the research ideas, this study first estimated the relative efficiency according to the overall mode, medical services mode and public health services mode, and it was also the first time adopting DEA, malquist productivity index and Tobit regression. However, because of the data source, the results of this study were still unable to fully representative of the general situation of the development of the National Community Health Service. And in terms of the efficiency of the public health service, evaluation system was not mature and authoritative.