A Research On Willness For The "Gate Keeper System" In Urbal Primary Care Provider Level

BackgroundThe goal of China's Health Service Reform is to complement the Community Health Service (CHS) System. However the development of CHS System in which lacks of "Gate-Keeper System" has been limited. A number of problems such as failing to attract the patients, failing to launch the "Six in One" services and so on have affected severely the development of CHS.The government and scholars have realized that the lake of "Gate-Keeper System" in community health service has been an important factor that restricts the development. The documents are come on by the government begin to require establishing "Gate-Keeper System". The scholars also start to appeal the foundation of "Gate-Keeper System". The key point in establishing "Gate-Keeper System" is to come on the policies and measurements. Many places in local have explored much in theory or in practice, but researches on the policy in detail have not been reported in domestic.Now it is a very important time to explore and research the policies and measurements, and my research would have gotten the best opportunity. The researcher on willness for "Gate-Keeper System" in Urbal primary care provider levelcould get a road to ROME for CHS in China. ObjectivesThe analysis of the policy environment, science environment, humanities foundation of the "Gate-Keeper System", and the analysis of primary care provider's cognition and demand to the foundation of "Gate-Keeper System". On the view of provider it will get policies and implementation conditions of "Gate-Keeper System" that should be adapt to the development of our economic societyMethods1. Literature reviewSearch literature, especially from the country that successed in conducting "Gate-Keeper System".To know CHS developing instance of our country and the studies on "Gate-Keeper System".2. Questionnaire designQuestionnaire design based on experience from local health workers and CHS experts, guideline of conduct "Gate-Keeper System".3. Sampling methordsMulti-stage sampling has been used in this study. Sampled 2 out of 11 areas of Zhejiang province, then a city-country contact point draw from the two areas by random, investigated all CHS workers.4. Investigation on the spotTo know the main information of "Gate-Keeper System", consist of "Gate-Keeper System" concept and accepting situation, inspirit system for family doctor, information of health care, the development of CHS and so on.Results1. The respondents agree to establish "Gate-Keeper System" in China. Results 95.4% of respondents agree to set up "Gate-Keeper System", and results 56.0% of respondents agree to build fixed referral relationship between CHS and hospital.2. The respondent of three groups is uniform on the mostly cause that will affect the build of "Gate-Keeper System". The importance decreases in turn are "incomplete CHS system"(86.6%), "shortage of GP"(78.2%), "lack of nation investment on CHS"(77.4%), "lack of Health Insurance"(64.0%).3. More than results 60% of respondents insist that nation should come on "permission system of GP", "CHS allocation standard", "CHS criterion" and "referral system standard". The respondents of "GP performance measurement standard" "referral indication" and "guideline of diagnosis and treatment in CHS" are significant differences, but result 50% of respondent insist come on these criterion/standard.4. The doctor group (75.0%), the administrant group (83.9%) and the expert group (86.2%) point out the mainly problem of putting "Referral System" in practice is lack of system that can make sure when patient could see a specialized physician, secondly lack of referral criterion is another causation.5. Results 93.4% of respondent think it is reasonable to sign the responsibility and duty in the CHS service contract. Results 76.0% of respondent require signing the command of control index, referral standard and medicine in the contract. The different groups get significant differences on the view of assessment and motivation system, funds investment and usage, quantity and quality of service.Conclusions1. Most of the respondenst make sure it should establish the "Gate-Keeper System" in China.2. The respondent almost recognize that "incomplete CHS system", "shortage of GP", "lack of nation investment on CHS", "lack of Health Insurance", "lack of referral criterion" and "disability" should be the factors to block the foundation of "Gate-Keeper System".3. The providers believe it is necessary to import a contract model into the operation of "Gate-Keeper System". It needs external conditions which are "permission system of GP", "CHS allocation standard", "CHS criterion", "referral system standard", "GP performance measurement standard" and "referral indication" to guarantee the normal operation of system.The results will be usefull for reference to The Country which haven't established "Gate-Keeper System".