| 1.Study Objects and Significances(1)To meet the need of disease prevention and control system reform and constructionsIn 2003,the occurrence of the epidemic of atypical pneumonia revealed that Disease Prevention and Control System in China have many deep-seated problems. The Party Central Committee and the State Council explicitly brought forward the goals and tasks of strengthening public health system,and strived to build disease prevention and control system which covers urban and rural and whose function is perfect in three years.To achieve this goal,the state has adopted a series of important measures and taken a comprehensive and systematic construction work.Construction of disease prevention and control system has been incorporated into national development planning,as one of the important tasks of building of a harmonious society.The system of disease prevention and control faces an unprecedented opportunity for development.In the guidance of bond-financed projects,levels of nation devoted 11.6 billion to construct disease prevention and control center,improving the infrastructure and working conditions.National finance has also significantly increased the support of the special bund for prevention of major diseases.In the base of conclusion of many years of work,it launched 37 kinds of Direct Network reported test of infectious diseases and public health emergencies in a nationwide in 2004.The Systems construction and application made China's disease surveillance and management model undergo tremendous changes,which have greatly increased timeliness and accuracy of disease surveillance reports,and improved the epidemic analytical capacity and the capacity of detection of the early outbreak of infectious diseases. Through training of personnel and the corresponding measures are implemented,the ability and level of the disease prevention and control institutions has a further improvement.The environment of the whole society gives a very favorable condition for construction and development of disease prevention and control system,and the concept of all sectors of society participating in disease prevention and control work has more and more acceptance. How to evaluate the progress of the three years construction of disease prevention and control system,the target's reach level of building the system,and analyze the problems and challenges in the process of building the system,is the need of scientific management and decision-making scientific,also the needs of consolidating the system building results and improving the construction of system.Laboratory equipment directly reflects the level of technology of disease prevention and control system.To evaluate the whole regional disease prevention and control system must evaluate its laboratory equipment of the building.This paper is the evaluation of allocation of laboratory equipment,which is part of the whole study.(2) Practical requirements of improvement of laboratory testing capacity of Disease prevention and control institutionsDetection and Evaluation of laboratory tests is the most important functions in Disease Control and Prevention institutions,including its specific tasks:to develop the biological,physical,chemical detection of risk factors related to diseases and health,isolate and identify pathogen of infectious diseases,laboratory diagnose of disease risk factors,analysis and identify of the incident poisoning Toxicology, evaluate of toxicology,provide of technical support to of treatment of public health emergencies,prevention and control of illness and health-related risk factors and health supervision and law enforcement.Appropriate configuration of laboratory equipment plays an important role for the disease prevention and control institutions to achieve laboratory inspection and evaluation functions.In July 2004,The Ministry of Health,National Development and Reform Commission issued (hereinafter referred to as "guidance"),clearly put forward the requirements of laboratory construction and requirements of equipment capacity and testing personnel,effectively promote the standardization of hardware and construction of laboratory building.In the "guidance", (hereinafter referred to as "equipment standard ") will clearly divide the equipment into three types:required for the completion of conventional(Category A),equipment in accordance with the basic functions(Category B) and equipment in accordance with local characteristics,the work demand(Category C).This meets the actual and future development needs. How does all levels of disease prevention and control institutions implement of "equipment standard",and how to evaluate becomes an important research background and content.Through the evaluation of the apparatus and equipment,it provides a scientific basis of decision-making and equipment planning for all levels of disease prevention and control institutions and health administrative departments.(3)The needs of fill the blank of evaluation laboratory equipment of disease prevention and control institutionsThe study of equipment configuration of disease control and prevention,even the large-scale,high precision equipment is little.Through keywords such as medical institutions,disease prevention and control institutions,sanitation and anti-epidemic stations,equipment,configuration,useness,comprehensive evaluation,I search the Chinese science and technology periodicals databases in 1999-2007,and found 3370 literatures related to the field of health,and 1715 literatures about the medical institutions,and only 45 literatures about disease prevention and related literature, only one document relevant to comprehensive evaluation.Literature relevant to medical institutions mainly concentrated on the evaluation of fairness and efficiency of configuration of the major medical equipment,and studies of management of the scientific equipment,but always more evaluation of single or a certain type of equipment configuration,rarely comprehensive evaluation of agency units.In the field of disease prevention and control,comprehensive evaluation for equipment of the agency units provides assessment methods for the future construction of disease prevention and control system.The study aimed at evaluating construction of the laboratory equipment of the disease prevention and control system,probing into factors of laboratory equipment configuration of disease prevention and control system,in order to provide evidence-based basis to further improve inspection capacity of the disease prevention and control system.2.Research methods and Data SourcesIn this study,"A macro model of health system" and the "scientific policy-making procedures" as a guiding research methods,and "multiple qualitative and quantitative verification" method used to improve and demonstrate of methods and contents of disease prevention and control institutions laboratory equipment configuration.I study changes and states of laboratory equipment configuration through Longitudinal historical comparison,the regional horizontal comparison,a comparison with the standard method;AHP,fuzzy comprehensive evaluation are used to evaluate of the overall configuration situation of the agencies' laboratory equipment;explore affected factors to organize laboratory equipment distribution through econometric methods.The main data collection methods include documents summarized methods,the basic institutions surveys.Provincial Census,municipal and county-level areas is systematic sampling.The actual questionnaire recovery of the sample region includes 771 disease prevention and control institutions,including 28 provincial institutions, municipal bodies 177,566 county agencies.3.Main study results(1) Equipment configuration number at all levels of disease prevention and control institutions has been greatly improved,and allocation tends to improve, but standard configuration rate of institutions equipment configuration is still lowTypes of equipments of different areas in all levels of disease prevention and control institutions have increased a few;in particular the county level grew the largest proportion.After three years of construction,the number of equipment in every provincial disease prevention and control institutions configurations 69-104 species,the municipal has an average of 29-48 species,the county level 17-27 species. But contrast to the "equipment standard":the provincial disease prevention and control institutions main laboratory equipment needs 191 kinds,municipal 130, county-level 75 species,owing to historical debts it is still facing a serious shortage of equipment and obsolete equipment situation,and all levels of disease prevention and control institutions are still great lack of laboratory equipment configuration. Situations with low allocation rate are still more.Only Category A as an example,the rate of provincial allocation,municipal and counties less than 30 per cent of the bodies is 7.1%,25.8%,33.9%.In order to improve disease prevention and control institutions laboratory testing capacity,and give full play to public functions,the need to strengthen the building of the equipment continues.On the Category A equipment(required for the completion of conventional),the western county level disease prevention and control institutions currently only equipped with 32.3%,there is a great gap between the requirements from the "equipment standard ",which is still no guarantee that their regular work launches. Tip that western county equipment is the next step of the key areas in the allocation. In 2005,12 species(categories) of necessary equipment(category A and B) configuration rate of the provincial disease prevention and control institutions is below 20%,such as dispersion analyzer;24 species(categories)of municipal bodies was lower than the 20%,such as biological anatomy mirror,refract meters;18 of county agencies have less than 20%such as the formaldehyde analyzer equipment, sample pulverizes,which suggested that these devices are considered targets in the next round of construction equipment.(2) After three years,equipment assets of all levels of the disease prevention and control institutions increased substantiallyEquipment assets can be a direct reflection of equipment configuration size of the disease prevention and control institutions.In the construction of the system,the whole national disease prevention and control institutions increased investment in the construction of conventional equipment and basic equipment configuration and updating.Provincial,municipal,and county levels for disease prevention and control institutions equipment assets increased.The direction of government's equipment assets into disease prevention and control institutions is more reasonable.In the 2002 county has the biggest gap and at the three years construction,the county has the largest compensation.In 2005,provincial,municipal and counties disease control and prevention equipment assets reached 35.174 million Yuan,6.566 million Yuan and 968,000 Yuan,respectively,compared to 2002 increased by 71.5%,77.1%and 61.9%. The increase in assets of equipment can implement disease prevention and control institutions laboratory equipment configuration requirements,and facilitate the laboratory tests and public functions of.the disease prevention and control institutions(3) Equipment of different regions increasingly balanced,but the balance of equipment assets still worthy of attentionThrough three years of construction,the equipment distribution of the provincial disease prevention and control institutions more balanced,and county-level lower,the balance of the municipal better than the county level,but their values were less than 0.3,which means that through three years construction of the system,equipment of the overall disease prevention and control institutions in different types tends to balance among different regions.Whether the asset allocation is fair or not directly related to fairness of equipment distribution of different geography.From asset regional allocation balance,the Gini coefficient of the provincial disease prevention and control institutions was 0.437,and 0.538 for the municipal and county to 0.596,but provincial agencies become more inequitable,while Gini coefficient of municipal and county agencies asset decreased by 0.1 and 0.02,but still exceeded the warning line of 0.4,it needs strengthening government control.It confirmed that it is still a matter of concern of the overall balance of the construction equipment.(4) Governments input to equipment in the course of disease prevention and control system construction increased,but self-financing accounts for a large proportionIn order to effectively carry out the inspection work,play public health functions, laboratory equipment and other infrastructure must be strengthened.In the building process of disease prevention and control system,the investment of government to equipment increased year by year,and in 2005,the proportions of provincial,city, county institutions got input from government respectively reach 45.7%,41.4%and 33.0%,which is greater than the 2002.Municipal institutions got the largest increases. It means that government investment has target,which support for the weak institution-building.With the increase in social demand and the change of disease prevention and control institutions functions,the Government investment can not meet the requirements of the construction equipment of the disease prevention and control institutions.In order to make disease prevention and control institutions work smoothly,agencies have had to be conducted through self-financing,which throughout in the course of construction equipment of the disease prevention and control institutions represents a significant proportion of shares from 40.3%to 73.4%, to a certain extent,it affected these institutions construction and development.(5) Through fuzzy comprehensive evaluation we found that half of the provincial disease prevention and control institutions laboratory equipment configuration is not in placeThrough method of fuzzy comprehensive evaluation and AHP,we get weight of laboratory equipment of the disease prevention and control institutions,and the allocation of various equipment configurations can be analyzed and compared.The increase in asset value can be configured to provide laboratory equipment funding guarantee.The direction of configuration needs comprehensive evaluation.With fuzzy comprehensive evaluation we get that comprehensive evaluation scores of Jiangsu,Guangdong,Shandong,Zhejiang,Guangxi,Hebei,Liaoning,Anhui,Fujian, Sichuan,Xinjiang 11 provinces(autonomous regions) than three,which is still 60.7% (17 provinces) less than three.Compared to 2002,except Tianjin,Shanxi,Liaoning, Zhejiang,Guizhou,five provinces(municipalities),82.1%(23 provinces) construction equipment developed.(6) many factors affect and restrict the types of laboratory equipment configurationExaminer,per capita area of the laboratory building,resident population,average workers annual wage,actual number of projects carried out affects laboratory equipment configuration.The tests need to carry out objectively require equipment in the laboratory,in turn,also restrict configuration types of the laboratory equipment. This factor of laboratory equipment configuration affects most notable.Regardless of the provincial,municipal or county agencies,we found a rule that examiner,and per capita area of the laboratory building,resident population,workers average annual wage,actual number of projects carried out showed with the same level to laboratory equipment configuration.(7) equipment investment increased greatly improve the disease prevention and control institutions inspection capacityDisease prevention and control institutions laboratory equipment investment increases testing capacity.Different natures of the equipment will develop different types of testing capability.The number of necessary equipment increased enhances the number of projects of disease prevention and control institutions must be work of; the increased number of expanded equipment also increases the project demand for geographical characteristics and the ability to carry out.The degree of influence of the former is greater than the latter.Increasing the number of biology types of equipment enhances pathogenic microorganism detection capability of disease prevention and control institutions,and if we increase the number of chemistry types of equipment,it can enhance health risk factors detection capabilities,radiological health,occupational health protection detection capacity.From their respective impact and relevance,we can see that if we rich variety of chemical categories of equipment,it can produce greater results.4.Innovation and applicationBy fuzzy comprehensive evaluation and AHP,we can get integrated score as a agency unit of the laboratory equipment,combining the evaluation of the configuration of the types of equipment,the number of various of equipment,the impact weight of equipment in the process of laboratory testing.It provides a level of comprehensive evaluation methods for the field of public health equipment and other resources configuration.By the use of econometrics I explore the impact factors of equipment construction, and the use of AHP and fuzzy comprehensive method to evaluate,the entire region is the unit of the disease prevention and control institutions,which includes CDC and the professional control stations.The aim is conducive to the implementation of the policy of regional health planning,and the principle of the rational allocation of resources.
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