Study Of Public Policy On Urban Community Health Service

BackgroundIn order to solve the problem of rising medical expenditure, china has been implementing a reform in health system, community health serive(CHS) is among of the most important measures. A serial of policies in CHS were established by the central government in february in 2006. As one province of china, Zhejiang' s CHS has been greatly developed since 1999, but it is necessary to adjust the pulic policy on CHS for the big change of society and performing the nation policies. Thus, health bureau of Zhejiang proince carried out a study on public policy on urban community health service.ObjectiveTo suggest the strategies and some opinions of developing CHS in Zhejiang province with the view of policy network after evidence based policy analysis.Methods and MaterialLiterature review was used to explore experience-proved measures in CHS after describing the policy history of CHS in mainland of china and some developed countries.Clustering analysis and principal components analysis were used to classify 32 districts of Zhejiang province according to the CHS level. Logistic regression analysis on polytomous ranked response variable was used to explore the factors for classification. Moreover, poisson regression was used to evaluate the relationship between some variables and the total number of outpatients in CHS per capita.The material used in this paper was from below:1. Health Stat. Year 2005(Zhejiang provincial health bureau), Questionaire 1, 4 and 6.2. Specific investigation for CHS in Zhejiang province in Dee. 2005.3. Quick supplementary investigation for CHS in Zhejiang province in Dec. 2006.4. Vital Stat. Year 2004(Zhejiang provincial police bureau).5. Zhejiang statistical yearbook 2005 (Zhejiang provincial statistic bureau)6. Related reports and documents from others, such as NPC & CPPCC sessions 2007Results1. Urban CHS sytem has been set up on the whole. There were 369 CHS centers and 1940 CHS stations, which covered 15.17 million persons, accounting for 85.2% of the population. These CHS institutions employed 25801 staffs, whose health professionist accounted for 87.2%. The total outpatients in 369 CHS centers was 25.22 million, accounting for 27.63 of that in cities. Income of CHS institutions was 3.328 billion, while expenditure was 3.1 billion. Profit margin of drug was 30.3%, and personnel expenditure was 33.2 thou- sand RMB per year.2. Policy on CHS has been improved greatly. State -owned CHS centers and stations accounted for 93% and 79.6% respectively. Public finance for CHS was 0.27 billion RMB, thus 15.43 RMB per capita in the 32 counties, among of which 16 ones have established social - economical programming con(?)aining CHS. 317 CHS (?) and 472 siations have participa(?)ed bas(?)e medical insurance system, and building area of 85.6% CHS centers and 30.9% CHS stations were up to national bar.3. Classification of CHS level. 32 districts of Zhejiang province were classifted 4 kinds after clustering analysis and principal components analysis. 3 factors, health professionist per 10 thousand, percentage of CHS institutions participated basic medical insurance system and percentage of work force owned standards for personnel posts, were statistically significant for the logistic regression analysis on polytomous ranked response variable -CHS level(P=0.015, 0.027 and 0.058).4. Modeling for the factors to the total number of outpatients in CHS per capita. There were no statistical significance for the 9 independent variables tested with possion regression model with dependent variable, the total number of outpatients in CHS per capita. Principal component 1 among of 4 ones was statistically significant in the possion regression model, which standed for urbanization rate, coverage of CHS and percentage of basic medical insurance.Conclusions1. Urban CHS sytem has been set up since 1999, and environmental policies about that have been improved greatly. A model of "severe diseases treated in hospital, light ones treated in community" was formed on the whole.2. 20 RMB per capita for funds allocation to urban community public health service.3. CHS standard , goal and patronized measure, such as aid fund, should be taken according to the classified directions.4. For the standard for personnel posts, 13 health professionist per 10 thousand was proposed, and 10 health professionist per 10 thousand was also tolerable for those districts can't be up to that par. Moreove, percentage of work force owned standard for personnel posts was advised to reach 50%.5. For the percentage of CHS institutions participated basic medical insurance system, 50% was suggested at least.6. Considering the various variables influencing the outpatients of CHS, integrative measures should be adopted with a preference in policies on personnel resource and technique, urbanization rate, coverage of CHS and percentage of basic medical insurance.