Evaluation Study On The Health Service Capacity Of Rural Areas In China

Objective: Based on capacity evaluation theory, system management theory andsynergetics theory, the study established the evaluation indicator system of healthservice capacity of rural areas and carried out the empirical study on J Province thatprovided the theory reference and the basis for health management department andproposed countermeasures to improve health service capacity of rural areas.Methods: The descriptive analysis and quantitative comparative analysis wereused to understand the current status of health service and key factors affecting thefunction in the infrastructure building, the construction of human resources, financialresources and health service provision about county general hospitals, township healthcenters and village clinics; According to the literature review, expert interview and theDelphi method, the evaluation indicator system of health service capacity of ruralareas was establish; Percentile weight and coefficient of variation method werecombined to calculate the weight of every indicator; the reliability of the indicatorsystem was tested by calculating Cronbach’s coefficient, and the validity of theindicator system was assessed by correlation analysis; Topsis and RSR are combinedto evaluate the6county general hospitals,24township health centers and48villageclinics within the scope of J province.Results:1.In2013,the number of beds per thousand population of county generalhospitals in J province was1.17, the ratio of doctor and nurse was1:1.06, the trainingstaff in the total number was1.13%, drugs proportion accounted for25.55%, numberof referral to township health center was0.43%of the number of patients discharged,the proportion of hospitals running health information system reached19.28%, theoccupied area per bed in37.35percent of hospitals was lower than the nationalstandard in China, the bed utilization rates in69.88percent of hospitals were lowerthan the national standard in China; The number of beds per thousand population oftownship health centers in J province was1.17, the proportion of health technical personnel in78.97percent of hospitals were lower than the national standard in China,the ratio of doctor and nurse was1:0.60, general practitioners in licensed (assistant)physicians was5.19%, drugs proportion accounted for18.48%, the average bedutilization rates was32.20%, average each township health center held the13.5regular meeting in2013；The village clinics of the acreage of buildings up to standardwas79.14%,71.52%of village clinics equipped with less than50kinds of basic drugs, the number of village doctors per thousand agricultural population was1.52,11.77%of village doctors were licensed (assistant) physicians, the average person times fortreatment annually was2583, the average drugs proportion accounted for33.01%, theratio of the basic public health service project carried out was no more than50%, thetimes of annual per capita attending the meeting didn’t reach60%of heldingmeetings.2.Evaluation indicator system of health service capacity of rural areas wasestablished which was consist of inputs and outputs including county general hospital,township health center and village clinic. Inputs of county general hospital includedthe three dimensions,6first level indicators and25second level indicators. Theoutputs included three dimensions,7first level indicators and22second levelindicators; Inputs of township health center included the three dimensions,6first levelindicators, and22second level indicators. The outputs included three dimensions,16first level indicators and35sceond level indicators; Inputs of village clinic includedthe three dimensions,8first level indicators and22second level indicators. Theoutputs included three dimensions,12first level indicators and24sceond levelindicators.3.After ordering by Topsis method, the A4was evaluated to be the best among6county general hospitals that had the Civalue of0.449, the A6was evaluated to be theworst that had the Civalue of0.221. The B1was evaluated to be the best among24township health centres that had the Civalue of0.426, the B11was evaluated to be theworst that had the Civalue of0.087. The C15was evaluated to be the best among48village clinics that had the Civalue of0.574, the C43was evaluated to be the worstthat had the Civalue of0.133. After classifying by RSR method,33.33%in6countygeneral hospitals and24township health centres were evaluated to be good degreerespectively,31.25%in48village clinics were evaluated to be good degree. By the correlation analysis, the difference among groups was statistically significant(p<0.05).Conclusion:1.Evaluation indicator system of health service capacity of rural areas wasestablished and the operability and usability of this indicator system were verified.2.Rural health service system in J province was lack of effective integration, andoverall capacity of service need to improve in the further study. Health humanresources were inadequate, the structure was unreasonable, professional level wasrelatively low and mechanism of continuing education need to improve; Infrastructurewas less developed, the basic equipment and essential drugs were insufficient;Financial investment to the township health centers and village clinics wereunsufficient in some parts of the areas, especially investment for personnelexpenditure; Infrastructure of informatization was less developed and talents werescarce; The quality and efficiency of health service were deficiency, There was acertain gap that can not meet the demand of rural residents.3.Countermeasures to improve health service capacity of rural areas wereproposed including the system level, organizational level and the individual level.