| [Purpose] To learn more about public-private partnership(PPP) situations of essential public health service(EPHS) between township hospitals and private village clinics in rural China, to analyze the key reasons existing in PPP process and the key factors affecting the PPP effect according to the situational analysis, to construct effective PPP mechanism to improve the present PPP model of EPHS in rural China based on the former research, for the purpose of providing policy references to supplying efficient, economic and equal EPHS in rural China.[Methods] Literature research and word frequency methods were used to define the connation of PPP of EPHS in rural China; by using questionnaire survey, key figures interviews, descriptive and mathematical statistics analysis method, the current status of PPP of EPHS in rural China has been analyzed; by using the method of personnel individual in-depth interviews and questionnaire-survey analysis, the problems existing in the process of PPP of EPHS in rural China have been summarized, and using the descriptive statistics analysis method to explore the influencing factors of public-private partnership; by using osculating value method and hierarchical descriptive statistical method, the performance of the PPP of EPHS has been evaluated according to longitudinal and transverse comparison; Guided by the theory of mechanism design, combining with the literature research and the empirical research results, using logical analysis method, the model of PPP of EPHS between township hospitals and private village clinics in rural China has been designed.[Results]1.The connation of PPP of EPHS in rural China has been defined:It refers to the township hospitals and the private village clinics, on the basis of rural health service integration management, under the planning and organizing of administrative department and the professional guidance by the maternal and child care service center and the centers for disease control and prevention, are allocated health resources reasonably, divided the EPHS subsidies scientifically according to their responsibility by signing liability form or contract agreement between town and village, during the process of PPP, professional guidance, supervision management, skills training, communication, performance appraisal are being operated on sticking to the principle of risk-sharing and benefit sharing, the goal of PPP is to form effective public-private cooperation mechanism, to ensure effective supply of rural EPHS, to improve the level of EPHS performance in rural areas, and to promote the equalization process of EPHS in rural areas.2.The current situations of different three stages of pre-PPP, while-PPP and post-PPP were analyzed, and there is a fact that88%of township hospitals and90%of private clinics are willing to cooperate to supply EPHS, the cooperation intension of providing EPHS between public and private health agencies is strong; and they are satisfied with the effect of PPP (the average score is4.19), but there exists significant diverse in the satisfaction with the service project and service content; it is also found that the PPP of EPHS is in the early stage; there exists a lot of problems occurring in the process of PPP, such as responsibility division of labor is not clear, funding allocation is not reasonable, the health human resource allocation is not balanced, service capability is not enough, lack of incentives, lack of systematic training system, fluent communication, effective supervision and risk-sharing mechanism which have a huge influence on the effect of PPP.3.The key factors influencing the PPP of EPHS have been discussed, it is discovered that the most important influencing factor is the policy supporting (81.82%)and effective PPP mechanism (66.67%), then is the reasonable distribution of economic benefits and responsibility division of labor (64.77%), and the third is transparent communication (43.85%, mutual trust and risk sharing among partners (34.09%, the last is in the process of cooperation training, incentive, supervision and inspection and in the process of cooperation.4.The performance of PPP of EPHS in rural areas has been analyzed and evaluated, it is discovered that the performance level of EPHS in the time of PPP is higher than that in no PPP status, and that the performance effects of EPHS between the cooperation of township hospital and private village clinics is superior than that between township hospitals and public village clinics, which proves that PPP of EPHS in rural areas can improve public health service performance more efficiently according to vertical and horizontal comparison, it also implies that PPP of EPHS in rural remains a certain advantage and needed to be improved constantly. 5.The incentive mechanism, training mechanism, communication mechanism and supervision mechanism which were designed to improve the model of PPP of EPHS in rural areas were constructed, and the comprehensive PPP model diagram of EPHS were also designed, moreover, the effective running model supporting measures have been put forward.[Conclusions] At present, the PPP model of EPHS in rural China is a kind of more efficient and more advantaged model in supplying EPHS, however, there exists some problems to be improved to perfect the PPP model, such as in the division of duties, budget allocation,incentive measures,training methods, communication channels, supervision strategy. Therefore, in order to make the cooperation relationship between public sector and private sector can develop smoothly, effectively and sustainably, it is particularly essential to design an effective mechanism and provide a set of measures which to guarantee the mechanism running effectively. At the same time, we should expanded and public-private partnerships subjects and standardize the cooperation process by signing contractual agreements.[Innovations and limitations]1.The connotation of PPP has been elaborated comprehensively and detailed from three aspects by using literature metrology method, methods of word frequency analysis and the analysis of common words and on this basis, the connotation of PPP of EPHS in rural China has also been defined from the PPP subjects, PPP process and PPP results, which can provide certain theoretical reference on the research of model PPP in public health service in the future, so it has a certain theoretical value.2. A set of division of duties scheme between township hospitals and private clinics which is subdivided into the secondary target and is adjusted to the actual situation of rural areas, has been designed.And this can provide certain reference to planning national essential public health service project;3. Besides, the incentive mechanism, training mechanism, communication mechanism and supervision mechanism and the comprehensive PPP model diagram were constructed in this thesis, which can provide some practical guidance in solving problem appearing in the process of PPP, so it also has some practical value.4. Due to limited time and human resource, this study did not investigate the residents satisfaction situation on PPP of EPHS, and did not design indexes from the angles of the effect and benefit, fairness and economic to evaluate the effect of PPP. In the future, we will do further investigation and study. |
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