Research On Development Status And Ountermeasures Of Community Health Institutions Held By Different Sponsors In Nanning

BackgroundPrimary health care is the most basic health care work,is widely regarded as the cornerstone of the health system.It makes residents improved access to basic health services demand,pay more attention to the early management of disease prevention and health problems.It makes the improvement of people's health get better,and to reduce health inequalities.At present,the basic model of community health service development are actively researched in many regions.Because of the large difference on local economic and social development level,the models of the community health service present diversity."Government-establishing","Hospital-establishing"and"Social-establishing(held by enterprises,social organizations and individuals or other organizations,besides the government and the public hospitals)" are the three main community health services models.The "Government-establishing" model are independent legal institutions.They are completely formed and proved full funding by local government.These institutions are the public welfare institutions.The "Hospital-establishing" model is the hospital through the government allocated,the way such as acquisition,merger.These institutions are affiliated hospital of a department or a clinic.The characteristics of”Social-establishing " model is invested by social capital.The operating management of these community health service institutions are social organizations.In recent years,the majority of studies were on needs and satisfaction,human resource management,community health service demand evaluation.Some scholars thinks that the services provided by the community health service institutions could be greatly influenced by their ownership,management mechanism and operation model.There were significant gaps in terms of ownership,management mechanism and operation mode among different sponsors of community health institutions.There was a lack of studies on service function implementation of community health institutions held by different sponsors,especially the basic medical service and the basic public health services.The studies on health resources allocation,the basic public health and basic medical service function implementation,service efficiency of different types ofcommunity health institutions played a supporting role for decision-making departments of community health services.ObjectivesThis study has made a comprehensive evaluation on the health resources allocation,the basic function implementation,the health services efficiency,through systematic review and summarize the domestic and foreign related research achievements of community health service model,combined with the survey data in nanning city.It was tried to search for the main problems existing in the running process on community health service institutions held by different ownerships.From the perspective of advancing the implementation of hierarchical diagnosis system,it puts forward the relevant reform Suggestions.The specific objectives incloud1.To analyze the health resources allocation and relevant policy implementation.2.To made a comprehensive evaluation on the basic public health and basic medical service function implementation of community health service institutions held by different sponsors.3.To analyze the health service efficiency on community health service institutions held by different ownerships.4.To analyze the situation of the development on community health service institutions held by different ownerships.5.To put forward the policy recommendations based on the perspective of the implementation of hierarchical diagnosis system.MethodsThis study determined research plan and designed technical route and the questionnaire through the literature review and expert consultation.This paper analyzed the status and existing problems of community health service institutions in Nanning city from the multiple perspectives by using qualitative and quantitative research and on the basis of the literature and data.The research data sources include literature review,statistical yearbook,questionnaire survey and qualitative interviews.This study collected related information on general information,allocation of health resources,health policy implementation,health services implementation and health services input-output situation by means of survey tools.The analysis methods in this study included the nonparametric test,Rank-sum Ratio(RSR),Data Envelopment Analysis(DEA),and so on.This study analyzed data by using Excel 2010,SPSS20.0,SAS9.4,DEAP2.1.Results1.The status of health resources allocation and relevant policy implementationThe study found that there were no obvious differences in demographic characteristics among three types of community health service institutions.There existed certain differences in the implementation of two lines of revenue and expenditure,All-system of Contractual Employment,The national basic drug system,and Designated national health insurance unit.The preferences of medical supplies of community health service institutions held by society exist in hospital and under observation.Business occupancy area among three types of institutions were standard but not reasonable.The basic medical equipment among three kinds of institutions were imbalance,needed to standardize and perfect.There were differences in revenue and expenditure among three types of institutions,and it is necessary to strengthen management to avoid financial risk.The health human resources allocation of community health institutions held by different ownerships were not reasonable,needed to adjust.Overall,the development of three kinds of institutions can unite and promote each other,but need to strengthen guidance and supervision.2.The analysis and comprehensive evaluation on service function implementation of community health service institutions held by different sponsorsThe study found that there were no significant gaps in terms of basic public health service among different Sponsors of community health institutions.The function implementation of primary meical care services in community health service centers held by society was better than the ones held by government and hospitals.The main reason restricting development of community health centers was unable to attract the source of patient effectively.Suggest to deepen the reform.3.The analysis of efficiency of community health service institutions held by different ownershipsThe study found that there were significant gaps in terms of the coefficient of variation of input indicators among different Sponsors of community health institutions.It was suggested to intensify equalization allocation of grass-roots health resources.The comprehensive efficiency of health service in community health service centers held by society was higher than the ones held by government and hospitals.It nended to enhance the vitality of organization operation.The input redundancy ratio of three kinds of community health centers was high.It should be promoted connotative development and delicacy management furtherly.Conclusions and political recommendationsThis main conclusions of the research were:(1)The community health service institutions held by different sponsors could implement the relevant national policy,and provide effective primary meical care services and basic public health services to the community residents.(2)The public welfare attribute in the ones held by government is stronger,the function implementation is in place,but the operation efficiency was not high.(3)The community health service institutions held by hospitals was easier to get technical support than other ones,had the technical resources and referral advantage,but the territorial government is earthly standard game between the government and the hospital.(4)The operating mechanism of community health service institutions held by society was more flexible,the comprehensive efficiency of health service was higher than other ones,but fickle kinds obviously.(5)The problem of community health institutions was unable to attract the source of patient effectively,the input redundancy ratio of three kinds of community healthh institutions was high.The policy recommendations of this research were following:(1)Promoting the construction of community health service in Nanning,it should strengthen the government's leading role,expand the proportion of government community health service institutions.(2)Actively encourage and guide the social subject pluralism participation,innovate community health service supply model.(3)Strengthen evaluation and performance management,and promote function implementation in community health service institutions.(4)Focus on the grassroots health workforce development,and strengthen community health personnel supply.(5)Carry out the policy recommendations based on the perspective of the implementation of hierarchical diagnosis system,and allocate community health resources reasonably.