Research On Community Health Service Efficiency And Evidence-based Analysis In Shanghai

Community Health Centers (CHCs) have been introduced to China in1997. Sincethen CHCs have made great progress. As China’s medical health reform taking place,the role of city community health services are more and more prominent.In this paper, we established the evaluation index system of community healthservice efficiency according to CHCs’ function. We calculated the differentcommunity health service using unifying standard services. Production function ofcommunity health services in Shanghai was established by econometric methods andstochastic frontier approach. Data envelopment analysis(DEA) was also employed toanalyze the efficiency of community health service in Shanghai.By this way,comparing with CHCs in urban and suburban,we obtained scale efficiency, puretechnical efficiency and so on. In this paper, factors influencing the efficiency ofCHCs were analyzed by using Tobit model. In conclusion party in this paper, we putforward the policy suggestions to promote community health service efficiency anddevelopment of CHCs.From2011to2013, Shanghai has carried out the activity to construct nationaldemonstration CHCs. The data came from54CHCs which had participated in theactivities. The data were mainly three different types:(1) time series data;(2)cross-sectional data;(3) panel data.Through our team’effort, the following results were obtained:First, we established the evaluation index system on input and output of CHCs. AsCHCs have taken great change than ever, it was time to construct new index toevaluate CHCs’ service.Second, we established standard service unit to measure community health service.Because different commumity health service has different labor consuming time,difficulty and risk, each of these services could’t be compared with each other directly.Therefore this study has proposed and established the standard service unit to measureall kinds of service. By this way, we could caculate community health services accuratly. Thus we could use the stochastic frontier model to analyze communityhealth services efficiency.Third, the patient’s trust evaluation index system was set up to evaluate communityhealth services quality. As medical health activities are interaction activitives betweendoctors and patients, the relationships between doctors and patients became hotissues. Consideration of patient’s trust factor would make the evaluation index morerationality and accuracy to community health service.Fourth, in this paper, community health services of Shanghai production functionequation have been established. Through the equation we could essily understand thefactors influencing community health services and the marginal effect as well. Wealso found Shanghai inconsistencies in the development of community health servicesbetween urban and suburbs.Fifth, economic characteristics of the community health services in Shanghai wereanalyzed. We calculated scale efficiency, technical efficiency and Malmquist index ofCHCs in Shanghai. We also revealed development trendency of community healthservices efficiency in the last three years.Sixth, we also analyzed the factors that influenced community health servicesefficiency. We analyzed the factors affecting community health services efficiencyusing Tobit model.On the basis of the results we put forward the following policy suggestion. On onehand, government should increase investment for CHCs. On the other hand,production function equation showed increase returns to scale for community healthservices in Shanghai. At the same time, DEA model also showed increase returns toscale for samples of community health services.So it was a good time for governmentto increase the investment to develop CHCs.We pointed that human resource was the key factor to the development ofcommunity health. As the study showed that the marginal benefit of human resourceswas far greater than the marginal effect of capital investments. Human resources wasthe main factors to promote the development of community health service in Shanghai.Human resources in the suburbs was more important than in urban. Hence, government should pay more attention to cultivate community health talents especialin suburban.We also believed that improving community health practitioners’ welfare and ascientific performance appraisal system were necessary for CHCs.Under backgroundof revenue and expenditure separation, CHCs should carry out effective salarydistribution system to improve the income of community health practitioners andpromote the enthusiasm of staffs so as to improve the efficiency of community healthserviceWe proposed that establishing community health electronic information platformwould help improve efficiency of CHCs. Through health electronic information,CHCs couid improve the efficiency of management and simplify working andcommunication process between doctors and residents.We thought that it was important to strengthen emphasis crowd disease controland health management.With the development of the society, the change of lifestyle,disease spectrum has also changed. So the model of prevention disease shouldfundamentally change. Under the limited health resources, CHCs should pay moreattention to the emphasis people of disease and health management, such as theelderly, women and children.