A Comparison Of Community Health Services Between Urban And Rural Areas And Study On The Sustainable Development Strategy

【Background】From the 90's in the 20th century Community Health Services have been installedin the cities and now they hold quite a scale after over ten years of development. Theynot only improved the fairness and availability of public health services, but also playan important role in satisfying the health needs and medical treatment of urban andrural residents. With the continual development of community health services, deeplevel problems arise in the operation of such services, which limit the sustainabledevelopment of community health services and therefore need immediate solutions.【Objectives】By making comprehensive analysis and comparative study on the presentoperative situation of urban and rural community health service organizations, theauthor intends to explore the operational rules of community health serviceorganizations, find out the key factors limiting the development of community healthservice, analyze its cause and put forward strategies and suggestions for promotingsustainable development of community health service, and provide scientific basis forthe government in its policy making for promoting community health service 【Methods】Take as research object Zhejiang Province which practices synthesized progressin both urban and rural community health services, through two-phase clusterstratified random sampling of the community health centers in 4 urban districts and 3rural counties(county-level cities), respectively forming urban samples and ruralsamples. Then carry out spot investigation, including the basic situation of communityhealth services, the distribution of personnel resources, the financial balances and theprovision of services, its application and the response of its users (residents). Thequestionnaires on community health centers are filled in by their management-relatedfinancial and personnel staff, while the investigation on the community residentsreceiving health services is done on a chance meeting basis. After investigation isdone, the message is stored in the computer to establish a data bank, then carry outstatistical analysis using software SPSS 15.0 for Windows, adopting the combinationof descriptive study and analytic study, using methods of t test, Chi-square test,Nonparametric test, Logistic regression analysis; by adopting SWOT analysis methodto get a clear view of the inner strengths and weaknesses, outside opportunities andthreats of urban and rural community health services organizations.【Results】Investigation is done on 73 community health service centers, among which 27urban and 46 rural ones, and all the questionnaires are taken back. 1500 residentsreceiving medical treatment in the communities are investigated and 1410questionnaires are taken back, among which 647 are urban and 763 are rural, theeffectiveness ratio is 94.0%.Resource distribution:①The average coverage population and average hardwareinstallation of the community health service centers has reached or exceeded thenational standard, but there is a big difference between urban and rural areas, andfrom center to center, and there are still some service centers failing to reach theservice requirement. The average business housing use in rural community healthservices is distinctly higher than that in urban ones.②The number of community health service technicians is already sufficient, with young age but lower careerqualifications, and those of rural community health personnel and public healthdoctors and nurses are even lower.③The professional structure and distribution ofcommunity health service technicians is unreasonable, with higher rate of clinicdoctors and lower rate of public health doctors and nurses, and an inverted doctor-nurse rate, especially there is a serious lack of rural community nurses.④There arefew chances for community health service doctors and nurses to attend study andtraining and fewer chances for those in rural areas and public health doctors andnurses.⑤Low stability exists in the rank of community health service, with too high arate of temporary workers, and even higher rate of temporary workers in urbancommunity health service center personnel and nurses.Application of service and its response:①Residents receiving medical treatmenthave poor knowledge of community health services beside normal medical treatment,and a poorer knowledge among city residents.②The concept of "Dealing with minorillnesses at community level while major diseases in hospital" is gradually forming,especially in rural areas, community health service organization has become one ofimportant organs for the residents in choosing their medical treatment.③"Six-in-one"service function has not been fully displayed, and emphasis on treatment rather thanon prevention is still prevalent, with the urban area more seriously addicted to it.④The factors that residents consider most when choosing medical treatmentorganizations are convenience, technical performance, service attitude and medicalcost.⑤The overall satisfaction of residents receiving medical treatment is high, withthat in the cities higher than that in the countryside, in which the highest goes toservice attitude and lowest goes to medical cost.⑥The major factors influencing thesatisfaction rate of community health service are medical treatment safety, medicalcost, service range and attitude. Major factors influencing the satisfaction rate ofurban residents receiving medical treatment are medical treatment safety, medical cost,service range and clinic procedures; those affecting residents in rural communities aremedical treatment safety, medical cost, explanation and communication, and technicalproficiency. The most influential factors are medical treatment safety and cost. ⑦Residents receiving medical treatment mostly expect the rise in technicalproficiency, improvement in instruments and equipment, and lowering of medical cost.Urban residents believe technical proficiency should be improved in the first place,while rural residents hold that lowering medical cost is mostly needed.Financial operation:①The business scale of urban community health servicecenters is larger than that of the rural ones, either in overall income or in businessincome, on average they are over two times bigger than those of rural communityhealth service centers.②As a whole community health service centers are profitable,but there is a sharp difference between urban and rural, center against center. Theearnings yield of average total income in the urban area is higher than that in the ruralarea, and during a 5 year period on average there are 1/4 of centers on the lose, amongwhich there is only an average 8.2% central loss in urban community health servicecenters, while that in rural ones reaches 35.3%.③The development tendency offinancial balances in both urban and rural community health service centers is notoptimistic, the whole income rate being on the decline yearly, and the losing centerratio is on the rise over the years.④Medical technical service charge is too low,making the medical service on the serious lose all the time, especially the loss in ruralcommunity health service centers is more serious than that in urban areas.⑤Government investment is seriously lacking, which is on average less than 8% of thewhole revenue of community health service centers, with that in urban ones lowerthan that in rural ones. The intensity of investment, however, is increasing year byyear.⑥Medicine price difference is the major source of revenue for the communityhealth service centers to make up for the lack of public health service investment andthe loss in medical technical service, especially the rural community health servicecenters rely more on the income from medicine. It is still the law of survival for thecommunity health service centers to "rely on medicine to maintain medical service, torely on medical service to maintain preventive medicine".⑦Personnel cost is themost major cost expenditure beside medicine cost in community health service centers,and that in the rural areas is higher than that in urban areas.⑧The ratio of trainingcost is too low, with that in rural centers lower than that in urban ones. The SWOT analysis on the community health service organizations:①Strengths:fine availability; multiplicity of services; good relationships between doctors andpatients; relatively complete infrastructures.②Weakness: lower talent quality,unreasonable structure; insufficient budget compensation; "six-in-one" service has notbeen carried out completely; insufficient publicity.③Opportunities: governmentaland policy support; the increasing awareness of the health importance among thecommunity residents; the transformation of medical mode and the aging of population;the concept of "treating minor illnesses in the community" is gradually being formed;while medical cost in the large and middle scale medical institutions is always toohigh.④Threats: strong competition from other medical institutions; incompleteBidirectional referral system; insufficient medical insurance policy support; someresidents' over expectation of community health service; and unfavorable pressinclination.【Conclusions】The imperfection of community health service compensation system and the lowqualification of practitioners in the line are the bottleneck which limits thedevelopment of community health service, while the raise of technical proficiency,lowering of medical cost are the direction toward which both urban and ruralcommunity health service organizations should make their efforts.We should further perfect the compensational system of community healthservice, improve the service of community health, promote the further application ofcommunity health service, strengthen the effective operation of inner structure ofcommunity health service organs to ensure the sustainable development of communityhealth service.