Analysis On Resource Allocation Of Primary Health Institutions In Poor Areas Of China

Background:Data for 2014 showed that there is still seventy million impoverished population in rural China.The full realization of a well-off society is only 5 years time from 2020.So the work of poverty alleviation is very urgent.In November 2013,the general secretary Xi Jinping put forward the concept of "precise poverty”.Under this situation,whether the health poverty alleviation could highlight the key points and precisely exert force is important to conduct the in-depth study about the allocation of health resources in poor areas.It relates to whether the investment quantity,structure,and efficiency of health resources and the direction and goals of health resources optimization for poor area is scientific and reasonable in the future,especially for the scientific establishment of the"13th Five-Year" health poverty alleviation project planning and for achieving "to full realization of a well-off society in 2020"has important practical significance.Therefore,this study was carried out.Purpose:Through investigating and analyzing the health resource allocation of nationwide poverty county level hospital,county level centers for disease control and prevention,county level maternal and child health care institutions and township health centers,This study applies health statistic methods to intend to evaluate and explore how to optimize the health resource allocation in poor areas and provide theoretical methods and policy suggestions for precise poverty in the future.Method:1.Literature research was used to retrieve the relevant literature about the health resource of allocation methods,evaluation index,fairness and allocation standard.Questionnaire about health resource allocation for four kinds of primary health institutions was designed.2.Field investigation was carried out in poverty areas to understand the basicsituation of health institutions,housing construction,funds,equipment,personnel,service ability,and operation condition by using the questionnaire of health institutions.Interview was carried out to find questions.Field investigation was used to access the health resource allocation relevant data of four types health institutions in poor areas in China.3.Multi-round Delphy expert consultation methods were used to establish the evaluation index system and its weight of health resource allocation of four kinds of primary health institutions.4.Using the descriptive analysis method to analyze the personnel,equipment,housing,economic operation and service ability of the four kinds of primary health institutions in poor areas.5.Based on the evaluation index system of health resource allocation of four kinds of primary health institutions,the poor areas of the 22 provinces were evaluated and sorted by the combination of TOPSIS method and RSR method.6.Based on the evaluation index system of health resource allocation of four kinds of primary health institutions,the poor areas of the 22 provinces were analyzed by hierarchical cluster analysis.7.Based on the Evaluation index system of input and output according to the resource allocation of health institutions,The advantages and disadvantages of the allocation efficiency of health resources of four types health institutions in poor areas of the 22 provinces were analyzed by data envelopment analysis.Results:1.General descriptionThe problems,which include imbalance in the health care and department personnel quantity allocation,low ratio of doctors to nurses,low ratio in key equipment ownership,high proportion in dangerous house,and chronic shortage in facilities such as garbage disposal,indoor toilets,sewage disposal and so on,generally exist in the primary health institutions in poor areas.2.The analysis results of the health resource allocation of nationwide poverty county level hospital2.1 Based on the comprehensive evaluation results of TOPSIS,according to the resource allocation level,poverty county level hospital of the 22 provinces were divided into three categories.The first category: the level of resource allocation is poor.There is Hainan province and Jiangxi province.The second category: the level of resource allocation is general.There are 17 provinces of Henan,Guizhou,Guangxi,Yunnan,Anhui,Sichuan,Hebei,Hunan,Shaanxi,Xinjiang,Inner Mongolia,Gansu,Hubei,Chongqing,Jilin,Ningxia,and Heilongjiang.The third category: the level of resource allocation is relatively good.There are 3provinces of Qinghai,Shanxi and Tibet.2.2 Based on hierarchical cluster analysis,22 provinces of the county level hospitals were divided into 4 categories according to different standards to support.The first category: Poverty alleviation efforts are the largest in 7 provinces of Henan,Hebei,Hunan,Jiangxi,Guangxi,Hainan,and Anhui.The second category: Poverty alleviation efforts are the larger in 4 provinces of Hubei,Chongqing,Guizhou and Yunnan.The third category: Poverty alleviation efforts are general in 4 provinces of Gansu,Jilin,Shanxi and Xinjiang.The forth category: Poverty alleviation efforts are the smaller in 7 provinces of Shanxi,Tibet,Heilongjiang,Inner Mongolia,Qinghai,Sichuan and Ningxia.2.3 From the results of DEA analysis,The county level hospital resource allocation technology efficiency of the 9 provinces of Gansu,Hebei,Heilongjiang,Hunan,Inner Mongolia,Ningxia,Shanxi,Sichuan and Yunnan is not high.3.The analysis results of the health resource allocation of nationwide poverty county level centers for disease control and prevention3.1 Based on the comprehensive evaluation results of TOPSIS,according to the resource allocation level,poverty county level centers for disease control and prevention of the 22 provinces were divided into three categories.The first category: the level of resource allocation is poor.There are 3 provinces of Jiangxi,Inner Mongolia,Hebei.The second category: the level of resource allocation is general.There are 13 provinces of Gansu,Guizhou,Shanxi,Guangxi,Anhui,Heilongjiang,Xinjiang,Jilin,Hunan,Ningxia,Yunnan,Sichuan and Qinghai.The third category: the level of resource allocation is relatively good.There are 6provinces of Henan,Hubei,Shanxi,Chongqing and Hainan,and Tibet.3.2 Based on hierarchical cluster analysis,22 provinces of the county level centers for disease control and prevention were divided into 4 categories according to different standards to support.The first category: Poverty alleviation efforts are the largest in 10 provinces of Guangxi,Hainan,Gansu,Shanxi,Jiangxi,Inner Mongolia,Qinghai,Ningxia,,Tibet and Hebei.The second category: Poverty alleviation efforts are the larger in 6 provinces of Sichuan,Yunnan,Heilongjiang,Guizhou,Jilin,and Xinjiang.The third category: Poverty alleviation efforts are general in 2 provinces of Anhui and Shaanxi.The forth category: Poverty alleviation efforts are the smaller in 4 provinces of Hubei,Chongqing,Hunan,and Henan.3.3 From the results of DEA analysis,The county level centers for disease control and prevention resource allocation technology efficiency of the 14 provinces of Gansu,Guangxi,Hainan,Hebei,Heilongjiang,Hubei,Hunan,Jiangxi,Inner Mongolia,Qinghai,Shanxi,Sichuan,Tibet,and Yunnan is not high.4.The analysis results of the health resource allocation of nationwide poverty county level centers for maternal and child health care institutions4.1 Based on the comprehensive evaluation results of TOPSIS,according to the resource allocation level,poverty county maternal and child health care institutions of the 22 provinces were divided into three categories.The first category: the level of resource allocation is poor.There are 2 provinces of Xinjiang and Gansu.The second category: the level of resource allocation is general.There are 17 provinces of inner Mongolia,Anhui,Ningxia,Yunnan,Heilongjiang,Shaanxi,Qinghai,Hebei,Guizhou,Sichuan,Jiangxi,Jilin,Hunan,Tibet,Guangxi,Shanxi,and Henan.The third category: the level of resource allocation is relatively good.There are 3provinces of Hainan,Chongqing,and Hubei.4.2 Based on hierarchical cluster analysis,22 provinces of the county maternal and child health care institutions were divided into 4 categories according to different standards to support.The first category: Poverty alleviation efforts are the largest in 3 provinces of Ningxia,Shanxi,and Xinjiang.The second category: Poverty alleviation efforts are the larger in 6 provinces of Hunan,Jilin,Shaanxi,Hebei,Gansu,and Tibet.The third category: Poverty alleviation efforts are general in 6 provinces of Inner Mongolia,Yunnan,Qinghai,Guizhou,Sichuan,and Hainan.The forth category: Poverty alleviation efforts are the smaller in 7 provinces of Henan,Hubei,Jiangxi,Anhui,Heilongjiang,Guangxi and Chongqing.4.3 From the results of DEA analysis,The county maternal and child health care institutions resource allocation technology efficiency of the 6 provinces of Gansu,Guangxi,Guizhou,Hebei,Heilongjiang,and Sichuan is not high.5.The analysis results of the health resource allocation of township health centers in Poverty County5.1 Based on the comprehensive evaluation results of TOPSIS,according to the resource allocation level,township health centers of the 22 provinces were divided into three categories.The first category: the level of resource allocation is poor.There is Heilongjiang Province.The second category: the level of resource allocation is general.There are 18 provinces of Guizhou,Inner Mongolia,Hunan,Sichuan,Xinjiang,Gansu,Shaanxi,Jilin,Jiangxi,Hebei,Yunnan,Anhui,Guangxi,Chongqing,Ningxia,Henan,Shanxi,and Qinghai.The third category: the level of resource allocation is relatively good.There are 3provinces of Hainan,Hubei,and Tibet.5.2 Based on hierarchical cluster analysis,22 provinces of the township health centers were divided into 3 categories according to different standards to support.The first category: Poverty alleviation efforts are the larger in 8 provinces of Jilin,Shaanxi,Gansu,Inner Mongolia,Qinghai,Xinjiang,Ningxia,and Heilongjiang.The second category: Poverty alleviation efforts are general in 8 provinces of Hunan,Jiangxi,Shanxi,Sichuan,Anhui,Yunnan,Guizhou,and Hainan.The third category: Poverty alleviation efforts are the smaller in 6 provinces of Guangxi,Tibet,Henan,Hubei,Hebei,and Chongqing.5.3 From the results of DEA analysis,the township health centers resource allocation technology efficiency of the 18 provinces of Xinjiang,Gansu,Inner Mongolia,Anhui,Yunnan,Heilongjiang,Shaanxi,Qinghai,Hebei,Guizhou,Sichuan,Jiangxi,Jilin,Hunan,Tibet,Guangxi,Shanxi,and Hubei is not high.Conclusion:1.The health resource allocation level of nationwide poverty county level hospital,county level centers for disease control and prevention,county level maternal and child health care institutions and township health centers in 22 provinces in China are very different.2.Based on the resource allocation evaluation of nationwide poverty county level hospital,county level centers for disease control and prevention,county level maternal and child health care institutions and township health centers,the 22 provinces of China's poor counties are divided into 3-4 different categories.3.In the 22 provinces of China's poor counties,the proportion technical efficiency of provinces,where nationwide poverty county level hospital,county level centers for disease control and prevention,county level maternal and child health care institutions and township health centers is not high,were 41%,64%,27%,82%.4.TOPSIS method has no special requirements to data distribution type and sample quantity,it could conduct the effective comprehensive evaluation to the resource allocation of health institutions in poor areas,and the result is intuitive.5.Cluster analysis can effectively classify the primary health institutions in poor areas according to the quality of resource allocation.And it is convenience to set different standards to support different types of health institution.6.Cluster analysis can effectively classify the primary health institutions in poor areas according to the quality of resource allocation.And it is convenience to set different standards to support different types of health institution.7.Health statistics analysis methods of health resource allocation,such as Topsis method,clustering analysis,and data envelopment analysis,have better applicability.The analysis results can be used as an important reference for the health administrative departments to formulate relevant health policy.They are also important ways to implement “precise poverty” in health system.