A Study On Rural Community Health Service Reform In Dingqiao Town

BackgroundsWith economic development and transformation of medical model, come the transit of population structure, disease spectrum and health demand. People need prevention, health care, recovery, etc, other than treatment. To adapt to these changes, the community health service (CHS) is developing. It intents to resolve the main health problem and meets the essential sanitary needs. CHS has six functions: prevention, health care, medical treatment, recovery, health education and family planning. It is effective, economical, convenient, integrated and continuous. However CHS is at it' s infant phase, especially in Chinese countries. There are still many problems in CHS need to be resolved.Till now, a study on rural CHS is still on the status of description, lacking of general assessment. In 2001 CHS was put into practice in Dingqiao town. Four main measures are taken: associating with the cooperative management system of health organization in town and country, with the medical insurance system, with the reform of township hospital and the training of general practitioner. Thus many valuable original data and experience were accumulated, and were used in this studyObjectivesThe aim of the study was to summarize the method of Dingqiao CHSreform and residents demands for health service, to evaluate the anastomosed degree between demand and utilization, to assess the achievement of CHS reform by compare the result after and before reform. Finally, some suggestions were bring forward for implementing CHS better.MethodsParts of residents in five countries, all staffs of CHS organizations and some occasional patients were investigated. Five questionnaires were designed. The residents completed the health questionnaire which including residents general characters, health problems, demand for health service and utilization of health service. The CHS organizations managers completed the CHS reform questionnaires including the medical resources, health service, it' s economic and social benefits of utilization from 2000 to 2002 and so on. The medical staff completed the opinion questionnaires and the patients completed the satisfaction questionnaires. The reform methods, the socioeconomic condition of the town and the medical resources of the town were gotten from Sanitary Bureau of JiangGan Section, town government and township hospital.By analysis on the anastomosed degree between demand for CHS and CHS utilization or by longitudinal and transverse contrast in basic construction, health service ability, economic running and social benefit, the achievement of the reform was evaluated.In the data analysis, T-test, variance analysis and chi-square test were used in SPSS 11.0 for Windows.ResultsTotally 1134 residents, 6 village clinic, 2 CHS station, 1 CHS center, 40 staffs, 70 patient were interviewed.Reform content: (1) integration of CHS and Town-village integrative management, (2) integration of CHS and cooperative medical care system, (3) Adjustment of CHS functions.The residents Demands and utilization of CHS after the reform: 漏 Demands: Biweekly sicken ratio of the residents is slightly higher than the countrywide average level. 25. 4% of patients are willing to go to city-class hospitals, 63. 9% are willing to go to CHS organizations; 44.1% of the residents have their medical demands as diagnosis and treat; 93. 2% of the patients choose outpatient service; 21% need general practitioner (2) Utilization: Biweekly treat ratio is slightly lower than the countrywide average level; medical treatment account for 64. 24%, vaccination account for 15.98%, the aged health care account for 7.67%, health education account for 6. 93%; clinic service account for 84. 81%, visiting service account for 2.90%, no family sickhed exists; no formal general practitioner enrolled there, only 4 doctors attended the family medicine training.Improvement of the CHS organization after reform: 漏increase of the basic establishment building: the acreage of CHS station doubled, the medical equipment...