The Study Of Service Capacity And Management Mode Of Prenatal Diagnosis In China

BackgroundIt is a fundamental state policy to control population growth and improve the quality of the population in China.Birth defect is an important factor influencing the quality of the population seriously.It has caused great burden to families and the society.Prenatal diagnosis is to diagnose some congenital and hereditary diseases by examining fetus situation in the uterus with various kinds of methods before the fetus is born.The main purpose of prenatal diagnosis is to identify hereditary defect fetus and various kinds of congenital deformities.Since the implementation of the Regulation of Prenatal Diagnostic Techniques in 2002,prenatal diagnostic technique services have developed well as a whole,but the problems are unbalanced development and incomplete network, etc.It is essential to investigate present utilization of prenatal diagnosis service.Study goalThis study aims to investigate the existing circumstances of prenatal diagnostic technique service organizations in China,to have a good understanding of the present situation and existing problems of prenatal diagnostic technique services,and to provide evidence-based policy suggestions for policy makers to improve standardized administration.Study contents1.To have an understanding of service capacity,management system,resource allocation, capacity of research and training,functions,et al,in medical institutions with prenatal diagnosis services;2.To analyze the management modes in selective provinces which carry out services of prenatal diagnosis well,and to provide reference of standardized management for health administration;3.To understand the function,development status,and construction standard of related prenatal diagnostic technique services in some developed countries and regions,and to provide experiences and references for the development of prenatal diagosis in China; 4.To identify the existing problems,and to propose some policy recommendations.Study methodologies1.Mail Survey:The study designed the unified questionnaire.The investigation objects were 90 medical institutions which were accredited to conduct prenatal diagnostic technique services by the local health authority.We collected relevant data from 2003 to 2006 in these institutions.2.Typical Investigation:This study chosed five provinces(cities),including Beijing, Hunan,Zhejiang,Guangdong and Shanghai,as a typical field investigation.Quantitative descriptions combined with qualitative analysis were used in field investigation.We made audits in fields and had interviews with local experts so as to obtain the relevant informations,such as resource allocation and functional performance of prenatal diagnostic technique service organizations.3.Literature Retrieval:We used "prenatal diagnosis" and "management" as the keywords to search in the OVID databases and Internet from 1996 to now.The literature review was to collect the management mode,development situation and construction standard of prenatal diagnostic technique services in some developed countries and regions(the United States,Canada,Australia,Britain and Hong Kong).4.Data analysis:Datas were inputed by Excel and Epidata,and quantitative datas were analyzed by spssl3.0.Main resultsSince the implementation of the Regulation of Prenatal Diagnostic Techniques in 2003, the developmental trend of prenatal diagnostic technique services in China was good.90 medical institutions in 24 provinces(municipalities,autonomous regions) have carried out services of prenatal diagnosis,and the average amount of facility in each province was 3.75.But the trend of unbalenced distribution was obvious,seven provinces have not yet carried out services of prenatal diagnosis,and two-thirds of total provinces are still at an initial stage.All the prenatal diagnostic service organizations were approved and licensed by the provincial level health authority.67 organizations(79.8%) set up prenatal diagnostic centers.Due to lack of the government subsidy,these organizations need to invest an average of 4.9391 million yuan each;only 17.9%of organizations received the government subsidies,and the average amount of subsidy was only 42,800 yuan. The management system in prenatal diagnostic organizations.60%of the organizations had complete institutional arrangement,and various duties were fulfilled well.But only 48.8%of the organizations fulfilled the quality control.In addition,85%of the institutions established and carried out the rules and regulations related to prenatal diagnosis.86.9%of institutions had the ethical committee,and merely 40%of which held related meetings per year.The resource allocation in prenatal diagnostic organizations.The facilities and equipment of ultrasonography and cell genetics were fully equipped,and the immuno-biochemical and molecular genetics were far behind;the average age of 1252 service personnel of prenatal diagnostic techniques was 41.68 years old,and the staff were based mainly on senior professionals presently,and currently 59.2%were the senior title level;the personnel continuing education was insufficient,only 46.64%of the staff had received training in the recent 3 years,and the training time was one month.The professional ability in prenatal diagnostic organizations.It showed from the evaluation of the service capability in prenatal diagnostic techniques that the operational proportion and service ability of genetic counseling,imaging diagnosis,and cell genetics were relatively high,the operational proportion of molecular genetics diagnosis was merely 51.2%;the amounts of prenatal diagnostic services raised at the average rate of 20%to 30%;the service prices were devoid of uniform standard of pricing,and they maintained at the original level.Scientific research and training work were two weak links in the prenatal diagnosis.Only half institutions carried out the related research works and the levels were uneven.On the scientific research,the award due to prenatal diagnosis was almost zero and there were less than 10%relevant key disciplines.On the training work,courses were mainly based on theory,and teaching hours was not enough.The quality of teachers were good,but the quantities were short.Lacking of the national authority teaching materials and the effective form of the post-training assessment still existed.Research conclusions and policy suggestions1.Bottlenecks in the development of prenatal diagnostic services,including service network,technical specification,compensation system,scientific research level,talent construction and resource allocation.2.Strengthen the macro-management and rational distribution of prenatal diagnosis to ease the unbalanced development of prenatal diagnosis in China. 3.Gradually improve the compensation system of prenatal diagnostic services.(1) Financing from multiple channels and supporting the development of prenatal diagnostic technique services;(2) Adjusting the price of prenatal diagnostic service items rationally;(3) Bring into the social insurance system and lighten burdens of demanders.4.Steadily promote the technical management and quality control of prenatal diagnostic techniques.5.Strive to improve the scientific research level of prenatal diagosis.(1) Strengthen the discipline construction of prenatal diagnostic technique services;(2) Improve the fundamental research of prenatal diagosis.6.Cultivate the technical talents of prenatal diagosis actively.(1) Strengthen the licensure and assessment of staffs;(2) Expand the training work of prenatal diagnostic organizations;(3) Increase the quantity and quality of high level training bases.7.Establish and perfect the service network of prenatal diagosis.The system should be relied on the original maternal and child health service system,with a multi-level and the referral system from bottom to up.