Research On Accessibility Of Basic Medical Service In Qinghai Tibetan Areas

1. Purpose e of the researchInvestigate the current status of basic medical service in Qinghai Tibetan areas, and analyze the problems in the current basic medical service in Qinghai Tibetan areas; Make an analysis and assessment of accessibility of basic medical service in Qinghai Tibetan areas and propose some corresponding policies and suggestions for construction of accessibility framework of basic medical service in Qinghai Tibetan areas based on relevant theoretical analysis of basic medical and health service. Due to the great difficulty of home-entry investigation in Tibetan areas, and the research findings are helpful to the experience promotion in similar regions and the accessibility research of medial service for minority population.2. Research method2.1Documentation review and information analysisRetrieve the origin of accessibility theory of basic medical and health service, concept definition, research progress, application practice and typical cases through relevant domestic and foreign documentations and databases, and take them as the basis for accessibility research of basic medical service in Qinghai Tibetan Areas. Research the uniqueness of basic medical service in Tibetan Areas using the data from the fourth national health service investigation.2.2Theoretical analysisUse the theories of new public service, public product, harmonious society, etc. to provide theoretical support for accessibility research of basic medical service in Qinghai Tibetan Areas2.3Qualitative researchConsult the experts in the fields of management, economics, politics and sociology to get information about the frontier development of accessibility theory of basic medical and health service, and discuss the accessibility methodology to analyze the premises, affecting factors and analysis route of accessibility of basic medical service in Qinghai Tibetan Areas.2.4Quantitative researchHome-entry investigation range:select505residents in Qinghaihu Township, Haiyan County of autonomous prefectures in Tibetan areas round the lake and Haibei Tibetan areas;432residents in Qukuhu Township, Tongren County of autonomous prefectures in core Tibetan areas and Huangnan Tibetan areas;459residents in Hui Township of Shihuiyao and Shagou in non-Tibetan areas and Haidong prefecture, which altogether amounts to1396residents.3. Content of research3.1Comprehensive review of domestic and foreign basic medical service and health serviceMake a research on the comprehensive review of domestic and foreign basic medical service and health service, define the concept of basic medical service, abstract the elements related to accessibility of health service, generalize and summarize the main ideas in various documentations, and preliminarily construct the theoretical framework of basic medical service model suitable for Tibetan areas based on the behavioral model of Anderson health service.3.2Current status of basic medical service in Qinghai Tibetan areasResearch the basic conditions of basic medical service in Tibetan areas, describe and analyze the current status of basic medical service in Tibetan areas by making an analysis on the structural establishment, resource allocation, service provision, etc. in core Tibetan areas, Tibetan areas round the lake, township health center and village health clinics in non-Tibetan areas.3.3Empirical analysis of accessibility of basic medical service in Qinghai Tibetan AreasMake a statistical analysis on basic medical service in Tongren County of core Tibetan areas, Haiyan County in Tibetan areas round the lake and Pingan County of non-Tibetan areas through descriptive statistics and factor analysis approach, analyze and investigate the geographical, economical and cultural accessibility of those three counties from the demander’s perspective, analyze the potential, realized, equality and inequality accessibility determine the factor score condition, assess the accessibility of basic medical service, select out the main components that affect different accessibilities and sort out the most critical factor that affects the accessibility of basic medical service in Qinghai Tibetan Areas.3.4Research on affecting factors and problems in accessibility of basic medical service in Qinghai Tibetan AreasDescribe the factors that affect the accessibility of basic medical service in Qinghai Tibetan Areas in aspects of special geographical position, natural environment in Tibetan Plateau and traditional cultural life, personal health habit, etc. of minorities, and expound the problems that could prevent the improvement of accessibility in aspects of socioeconomic development, disease prevention task, health basic infrastructure, health human resources, acute and chronic disease prevention ability, health and economic burdens for farmers and herdsmen, etc..3.5Construction of improving accessibility of basic medical service in Qinghai Tibetan Areas and policy suggestionsAmend the preliminarily constructed theoretical framework of improving accessibility of health service, propose an accessibility system suitable for basic medical service in Qinghai Tibetan Areas and provide relevant suggestions for government to take perfection measures based on comprehensive analysis of basic medical service in Qinghai Tibetan Areas, for the purpose of providing a decision reference for perfection of accessibility mechanism of basic medical service in Qinghai Tibetan Areas. 4. Main findings of research4.1Theoretical basis and concept definition of basic medical service in Qinghai Tibetan AreasTo research the Theoretical basis of basic medical service in Qinghai Tibetan Areas, we shall firstly focus on ensuring the realization of basic health rights and possession of basic medical service as one of the basic securities of survival rights for social members; secondly on the medical service that medical and health service in Tibetan areas can provide and medical insurance funds can afford; and thirdly on the services that government is able to promise to offer. The concept of basic medical service defined by this research is:the medical service provided to general public in Qinghai Tibetan areas by grass-root medical and health service using appropriate manpower, techniques and basic medicine, under the condition that central and local public finance can provide the security.4.2Analysis on the current status of basic medical service in Qinghai Tibetan AreasThis research makes an analysis on basic medical service in townships and villages level by selecting totally1396residents in Qukuhu Township, Tongren County of autonomous prefectures in core Tibetan areas and Huangnan Tibetan areas, Qinghaihu Township, Haiyan County of autonomous prefectures in Tibetan areas round the lake and Haibei Tibetan areas andHui Township of Shihuiyao and Shagou in non-Tibetan areas and Haidong prefecture, to perform the home-entry investigation. The main situation is as follows:Firstly, the resource availability of health is highest in non-Tibetan areas even though government invests relatively most in the health facilities hardware in core Tibetan areas. Secondly, the rates of participation in the implementation of new-type rural cooperative medical service for the investigated regions reach:99.28%in Pingan County,100%in Haiyan County and100%in Tongren County. And the participation rates of all these regions exceed the national average rural level of89.7%which was obtained from the fourth health service investigation. Thirdly, all the medicine used by township health center and village health clinics in the investigated regions belongs to basic medicine, but the delivery rate is undesirable. Fourthly, the incidence of chronic diseases in the investigated regions reaches13.6%, which is much higher than the national rural value of10.6%, and the circulation system diseases rank the first in chronic diseases. The relatively severer cases in chronic diseases are ischemic heart disease, cerebral vascular disease and hypertension.4.3Construction of assessment index for accessibility of basic medical service in Qinghai Tibetan areasThe domestic and foreign theoretical researches of health service accessibility focus on the geographical and economical accessibility, and constructing the assessment index for accessibility according to different research demands. However, the theory of accessibility of basic medical service in Tibetan areas is nearly zero, and the research of accessibility of basic medical service in minority areas is relatively insufficient. This research preliminarily construct the assessment index for accessibility of basic medical service in Qinghai Tibetan areas based on the empirical analysis of accessibility of basic medical service in core Tibetan areas, Tibetan areas round the lake and non-Tibetan areas.4.4The preliminary construction of improving accessibility system of basic medical service in Qinghai Tibetan areasDetermine the principles suitable for construction of basic medical service in Qinghai Tibetan areas, which are as follows:(1) Priority selection principle. Attach importance to the main health problems that may produce great burdens of disease on residents.(2)Cost effectiveness principle. Select the health service with low costs and high efficiency.(3) Economic accessibility principle. Select the health service that government can undertake and individual can afford according to economical development level and health service demand by residents.(5) Equality principle. Select the project that widely covers, benefits and concentrates on disadvantaged groups, as well as construct basic medical service package in township and village level and basic medical package in village level.4.5Inspiration from the improvement of accessibility of basic medical service in Qinghai Tibetan areas by research findingsIn consideration of the detailed problems in accessibility of basic medical service in Qinghai Tibetan areas in the survey, and based on the analysis on accessibility of basic medical and health service, the following content shall be done to improve the accessibility of basic medical service in Tibetan areas:Increase the medical and health resource, especially the amount of medical and health institutions with ethnic characteristic and appropriate techniques, by adjustment of health resource allocation policy to further promote the development of regional health service; Take the "everyone can enjoy the basic medical and health service" as one of the development goals for health service in Qinghai Tibetan areas, and constantly expand the coverage of basic medical service in Tibetan areas to early realize a full coverage of basic medical service in Tibetan areas; Continue to strive for more investment from central finance to basic medical service in Qinghai Tibetan areas, and promote the security system of health talents in Tibetan areas based on the human resource allocation pattern suitable for socialist market economy and adjustment of human resource and remuneration policy in Tibetan areas; Promote classification diagnosis system, improve the service ability of grass-root health worker, strengthen the medical service of urban medical personnel for farming and pastoral areas, expand the emergency help coverage for poor households in Tibetan areas and explore the construction of "mobile hospital" in Tibetan areas.5. Innovation and value of research and research limitations and deficienciesThis research defines the concept of basic medical service in Qinghai Tibetan areas, constructs the assessment index and model for accessibility of basic medical service in Qinghai Tibetan areas, and first discusses the assessment index of cultural accessibility in health service, to research the accessibility of basic medical service in Qinghai Tibetan areas in two dimensions of medical service demander and supplier, as well as abstract the affecting factors that make the health service in Qinghai Tibetan areas different from that in other regions.Due to limitation of research and investigation staff, time, expenditure, etc., this research will still have some limitations and deficiencies, which shall be gradually deepened and perfected by consequent research.5.1The representativeness of investigated objects needs to be improved.Due to the extensive land in Qinghai Tibetan areas, the difficulty of abstracting samples by this research is several or tens of times higher than that in abstracting samples in non-Tibetan areas. Therefore, the total amount is not deemed to be large, and in terms of cultural accessibility research, this research may not well reflect the influencing weight of religions, etc. on accessibility of health service. So the research of other affecting factors shall be further analyzed when the data collection range is expanded in the future research.5.2Index system may need to be further improved.Due to time limitation, the index system constructed by this research has not gone through the test for its feasibility, so some of its indexes may need to be adjusted in the actual operation.