Research On The Mechanism Of Basic Public Health Services Projects On Stable Cooperation In Rural

?Purpose?The purpose of this research is to analyze the mechanism of basic public health services on stable health cooperation in rural.Guided by multi-level theoretical integration mode,identify the dynamic role and function of the stable collaboration in rural,analyze the influencing factors of the stable of rural health collaboration and the relationship between the factors,and build a model of stable collaboration in rural.Explore relationship between basic public health services and influence factors of rural stable collaboration,clarify the target,path and mode of basic public health services on the stable of health cooperation in rural.In order to promote the reform of primary health care service system as the goal,provide theoretical support for the improvement of basic public health service projects.?Methods?(1)Data collection method:(1)Literature research:This study has researched social exchange theory,organization system theory,social ecosystem theory,and field theory,analyzed the research domestic and foreign literatures about stable collaboration,rural health collaboration and rural integration,and thus defined the connotation of rural stable cooperation.As well as this study has sorted out the policies,reports,documents and materials related to the basic public health services,focused on the analysis of the value of the basic public health services to the service providers.(2)Filed investigation:In Hubei Province,Henan Province and Chongqing City,a questionnaire survey was used to evaluate the rural stable collaboration and influencing factors.The semi-structured in-depth interview method was used to analyze the relationship between the basic public health services and the key factors of rural stable collaboration.Delphi expert consultation method was also used to screen affecting factors of the rural stable collaboration of health administrative departments in county and residents,score the value of interaction between influence factors of the rural stable collaboration,and screen indicators for evaluation of the implementation status of basic public health service projects.(2)Data analysis method:(1)Statistical analysis method.Epidata was used to input,sort and analyze of data.?~2 test was used to analyze differences of personnel characteristics of rural health cooperative stable.Multiple ordered logistic regression model was used to analyze influence factors of the rural stable collaboration of township hospitals and village clinics.Spearman consistency correlation analysis was used to analyze relationship between the basic public health services and influence factors of rural stable collaboration.(2)DEMATEL was used to analyze interaction between influence factors of the rural stable collaboration.(3)System Dynamics:This study has constructed the mechanism model through using Vensim PLE software,building flow rate tree model,minimum basic model and system flow chart among variables,and combing the action path of basic public health service projects on the rural stable collaboration.(4)Typical case analysis:This method was used to verify and optimize the mechanism of basic public health services.Through the analysis of two township hospitals in the same county,two county-level cities in the same province and one county-level city in the past ten years as a typical case.?Results?(1)The results of dynamic subject identification and dynamic function analysis in rural health cooperative field:the dynamic subject included township hospitals and village clinics(the core location of the field),county health administrative departments(the middle location of the field)and residents(the edge location of the field).The dynamic function of township hospitals included ability improvement,resource integration,effective management and concept guidance.The dynamic function of village clinics included service ability,obedience to management and social relations.The dynamic function of county health administrative departments included policy design,county management,coordination and command,and cultural advocacy.The dynamic function of residents was cooperation and recognition to township hospitals and village clinics.The four driving forces were interrelated and influence each other,which had an effect on the rural stable collaboration.(2)The results of evaluation of the stable of rural health collaboration and analysis of its influencing factors:65.60% of rural personals was moderate degree of health cooperation stable.The cooperation stable of township hospitals was better than that of village doctors(?~2=62.188,P<0.001).The results of analysis the influence factors showed that 23 factors could effect on rural stable collaboration.Among them,cultural promotion,health knowledge dissemination and cooperation system design of social factors,could effect on service ability,organization benefits,management level(or subject to management level),service specification and service cooperation of organization factors,interpersonal trust,institutional trust,institutional coordination,doctor-patient relationship of relationship factors,and cooperation income,cooperation cost,benefit guarantee and residents'health of individual factors.Institutional pressure could directly effect on rural stable collaboration.The factors of organization,relationship and individual could interact,and influence on rural stable collaboration.(3)The results of implementation and relationship of basic public health services between rural stable collaboration:there were correlation between the basic public health service project and 12 factors affecting the cooperative stable of rural health,included health knowledge dissemination,institutional pressure of social factors,service ability,organization efficiency,management level,compliance with management level,service standards of organization factors,interpersonal trust,institutional trust,doctor-patient relationship of relationship factors,and cooperation income,residents'health of individual factors.From the results of qualitative analysis,the key factors that service projects can play a role in rural stable cooperation are extracted,and 12 targets of basic public health service projects are determined.(4)The results of mechanism of the basic public health services on rural stable collaboration:In the basic public health service projects,service provide could effect on five factors:health knowledge dissemination,system pressure,benefits of institutions,personnel cooperation benefit,and residents'health.Service support could effect on seven factors:health knowledge dissemination,system pressure,organization management level,service specification and service ability,village obedience to management,and personnel cooperation benefit.Performance appraisal could effect on six factors:systems pressure,organization management level,service standard and organization benefit,village obeying management level and personnel cooperation benefit.Fund management could effect on four factors:system pressure,village obeying management level,organization benefit and personnel cooperation benefit.The factors could intact each other,and influence interpersonal trust,institutional trust,and doctor-patient relationship.Therefore,through 8,24,129 and 40 action paths respectively,the complex mechanism of rural stability and cooperation was formed.?Conclusions and Suggestions?Conclusions:At present,the rural stable collaboration is generally in the middle level.Basic public health service projects affect the key elements of rural stable collaboration in four levels of society,organization,relationship and individual through service provision,service support,performance assessment and fund management,so as to influence on rural stable collaboration.Therefore,the optimization of basic public health services can promote the improvement and maintenance of rural stable collaboration.At the social level,it can play a role to coordinate the relationship between residents and health workers through the dissemination of health knowledge,improve health level and literacy of residents,and follow with the formation of social macro system pressure.At the organizational level,it can play a role to improve the service ability and overall efficiency of institutions through the increase of management penetration and county-level service regulation.At the individual level,it can play a role to protect benefits of health workers.At the relationship level,it can play a role to improve trust level of personals between county and village,trust to county-level departments,and residents trust to health workers through influencing the factors of organization and individual level.Suggestions:At the social level,promote the"institutionalization"process of basic public health service projects,adjust the system pressure perception of health personnel.At the organizational level,promote"basic medical care"by"public health",optimize the design of basic public health services and improve the overall efficiency and service ability of primary health care institutions.At the relationship level,improve the cooperation relationship,promote the connection between the development of basic public health service projects and primary health reform.At the individual level,taking into account the interests of both the supplier and the demander,strengthen the supervision of the implementation of basic public health services and the application of results.?Innovation and Deficiency?Innovation:(1)Innovation of research perspective.In order to promote the reform of rural primary health,improve the basic public health service project,it is an innovative research on the value of basic public health service from the perspective of system,which makes up for the lack of previous research on the provider value of basic public health service.(2)The innovation of research theory.This paper constructs a multi-level integration theoretical model covering society,organization,relationship and individual as the theoretical guidance of the study,and infers the dynamic role of each subject in the field of rural health cooperation based on the field theory.On this basis,the realization model of rural stable collaboration is constructed.(3)Innovation of research methods.In the previous studies,it mainly summarized the practical experience about value of the basic public health service project on health service system.In this study,DEMATEL,Spearman consistency correlation analysis,system dynamics and other quantitative and qualitative research methods were used to construct the basic public health service project mechanism from four dimensions of service provision,service support,performance evaluation,and fund management.Deficiency:Typical cases were used to analyze the mechanism of basic public health service projects,but the typical cases can not represent the situation of other regions of the country,so there were certain limitations.Based on the limited availability of data samples,the research method of expert consultation was adopted to analyze the influencing factors of promoting stabile cooperation in rural between the county-level health administration department and the residents in the jurisdiction.A small sample size inevitably leads to bias.In the institutional samples of the study,the sample mainly are organizations of implementing rural integration,and the lack of analysis and research on the institutions of not implementing rural integration,the representativeness of the samples is not enough.