Research On Performance Control Mechanism Of Public Health System In Rural China

[Purpose]Based on the theories of mechanism designing and management mechanism systematically, this research investigated the innate law of rural public health system forming. In the meanwhile, the running process of rural public health system was analyzed based on the three key links (input, operation, and output) of rural public health system. Second, the key factors that effect public health performance were obtained from three different angels which are capacity, pressure and motivation of performance forming. Furthermore, this research also included the confirmation of control subjects, control objects, and main means of rural public health performance control. These findings will lead to control mechanisms of public health performance, which will improve the performance of rural public health, accelerate the pace of rural health service, and technically support the realizing of a well-off society in an all-around way and new socialist countryside.[Methods]The evolution and key points of public health system reformation in rural China were investigated with the analysis of the evolving process of related policy, and the key factors of public health control were obtained from the study of typical cases and the site investigation of rural public health system. Besides the collection and the weight of key factors that affect rural public health performance control were clarified with the use of expert consultation method and analytic hierarchy process. Moreover, the subjects, objects and main means of rural public health control were confirmed by the means of word frequency analysis, while the economic characteristics and basic process of rural public health performance control were respectively analyzed by the use of mechanism designing theories and management controlling theories. Finally, the mechanism of rural public health system performance control was constructed based on SDG modeling. All the data come from the study of site investigation and expert consultation.[Results](1) Since2003, the related policies were consecutively introduced by the State C ouncil, ministry of finance, ministry of health/National Health and Family Planning C ommission, etc. In terms of the amounts, Ministry of health/National Health and Fam ily Planning Commission rank the first, the State Council comes the second. These po licies covered the comprehensiveness, manpower, financial supports, material resourc es, organization and so on.(2) The running process of rural public health system contained three dimensiona lities: input, operation, and output. Input included manpower, financial supports, mate rial resources and externalities. While operation related to effectiveness, quality and a ccessibility of public health service. Output could be divided into3different aspects r esults of health improvement, equity in health care and social assessments.(3) The primary factors that affect the rural public health performance control we re manpower resources, financial resources, material resources, organizational system and externalities. While the secondary and tertiary factors respectively conclude14an d30items.(4) The key factors that effect public health system were capacities, motivations, and pressures. Manpower, material resources, financial resources and techniques were classified into capacities. And the motivations included the material, the immaterial a nd the informational. While the pressure factors include the controlling subjects (government and public health service institution), the controlling means (policies, projects and rules), and pressure comes from the public.(5) The control subjects of rural public health system performance were the government, health service institutions, and health administrative departments. And the control objectives consisted of town, village and country service institutions. Besides, the control means included policies, projects and rules.(6) The basic process of rural public health performance control system included the expecting state setting by control subjects, the individual expecting rewards design ing by control objects, the matching of expecting state and rewards and the leading for objects to aims of control.(7) The economic characteristics of public health service institutions included un equalised probabilities, key controlling factors, controllability, self benefit losing, cruc ially liability coefficient of institution. And those of the governments were failure pro babilities and liability indexes of government. Besides those of the residents consisted health loss and controllability.(8) Liability index and liability index b burdened by liability objects in primary c ontrolling effectors were included in economic characteristics of controlling objects. And the economic characteristics of controlling objects ek were controllability C and benefit loss L.(9) The unequalized probability of the rural pulic health system controlling aims approached0which means the selection of critical control point and the controlling fo rce drew near to the optimization leading to the optimal control of the system.[Conclusions](1)When the country is making a policy, the effectiveness result should be tracked in time, and the policy should be adjusted which based on the effectiveness results.(2)The objective of performance management of rural public health system is fairness and accessibility, and the final target of it is equity of public health services.(3)The key link of performance control of rural public health system is that evaluating the original state and the final state of the system.(4)Establishing performance control mechanism of rural public health system, which could definite the constituent and interrelation of the system factors. It wouldoptimize the allocation of resources efficiently and improve the performance of public health system.(5)When confirming the key effectors of rural public health performance control, it’s the system state should be considered for screen as the interaction of these key factors were mutually transformational. Only reaching the steady state, the transformation between the pressures and the motivations realized the maximum of the existing capacity of this steady state.[Innovation and Limitation]The innovations of this study:(1)For the multiple analysis angles of theory function and practice orientation, we explored the performance control mechanisms in rural public health system, which were decomposed into quantifiable control factors.(2)The mechanism of our study was not singly started with one angle, but was analyzed from multiple angles of the time process, the theory workflow, and acting force, etc., which comprehensively and detailed dissected the performance control mechanisms in rural public health system.(3) After splitting the control factors, we established the performance control mechanisms in rural public health system, which provided a practical tool for the improvement of rural public health performance.(4) We discussed the corresponding performance control mechanisms for each key control point respectively, put forward the control countermeasures, and quantized the strength of its effect on system performance, which showed a strong operability and practicability.The limitations of this study:The most inadequacy of this study was the deficiency for practical examination of the model, but only completed a theoretical derivation. Because a certain intervention period was needed in testing the control result, it was failed to collect the quantitative data after the control. As a theoretical part of the research for performance control mechanisms in rural public health system, this study provided a theoretical support for the later practice research. An intervention project was designed based on this theory, which was used to conduct an intervention in sample area, and the relevant data was received, thus, the mechanism was verified and modified ultimately.