Research On Responsibility Of Government Of Rural Three-tier Health Care Network In China

ObjectiveBasing on summarizing the government responsibility of rural health of the domestic and foreign researches,it carried on the description of present situation of government responsibility acting to the rural three-tier health network,analyzing the historical root, summarizing the core problems;In this foundation,it discussed and proposed the new system of government responsibility acting to the rural medical and preventive health care network,in order to provide some useful political suggestion for the new rural reconstruction and the health organizational reform currently.MethodsLiterature study ,case study ,experts consultation and theory analysis are applied together. Through the literature collection and analysis,it carried on the definition of the government responsibility on health domain,then described the situation of the rural three-tier health network of the whole country. Through the typical surveys of Shaoxing County in Zhejiang Province,Xi County in Henan Province and the Lintao County in Gansu Province,it showed present government responsibility expression situations in the network construction aspect ,including the financial investment,manpower support,supervising and system coordination,then analyzed;Through experts consultation,the expressing way,the problem and the development direction of government responsibility were clearer;In the foundation, it proposed"four suitable"definitions and other suggestion.Results1 The government invests are mainly from the county level,and the giant regional disparity existsFrom1978 to now,the central and local authority's financial assignment relations experienced four significant reforms. The reform caused that surpass 97% of the health business cost is provided by the local finance,especially by county level,,and the central and provincial level finance mainly implemented the limited shift payment. According to the current national condition,with the old system frame and imbalanced economy development level,the giant regional disparity existed normally.2 Current policy and the measurement have done good to the development of rural health manpower obtains,but still the persistent effective mechanism lacks In recent years,in order to support the development of the rural health manpower,the country appeared policies like"Opinions on How to Strengthen both Rural Health Personnel Training and Troop Construction"and implemented measurements like"project of ten thousand doctors go to the rural areas to support the health",which has done great effect and were approbated by most people. But because of the different development levels between urban and rural areas,the idea of"human always walks higher",as well as the lack of persistent effective mechanism and so on,the problem of rural health manpower is still the key point and difficulty which restricts the rural health development.3 The network and other rural systems have not been mixed each other well already,the function of government coordination displays insufficient The rural three-tier health care network is the carrier of NCMS,PHC,and MFA, but they have not been mixed each other well already,the problems of suitable reimbursing proportion and two-way referral still exist. The function of government coordination displays insufficient and the composition of forces of all systems above have not been able to unfold yet. Conclusions1 Definition of government responsibility to rural health Most generalized definition government responsibility:the government needs to make the positive response to the demand of the whole society,and takes the positive measures to meet the need and the benefit of the public equally and effectively. Only from this way can understand the connotation of government responsibility truly. Definition of government responsibility to rural health :the government takes"health"as the guidance and purpose,makes the positive response to the all health problems of the rural inhabitants,and takes the positive measures to meet the need and the benefit of health of the rural inhabitants equally and effectively.2"Four suitable"definitions related to government responsibility:Suitable system design,suitable investment,,suitable manpower,suitable supervising and managing Suitable system design:In the ideal network construction process,lots of problems and relations should be well analyzed and considered,such as relations of longitudinal and crosswise structure in the net,cooperation and competition between every organizations,various factors in or out of the net,and the environment and so on.Suitable investment:Investment of all levels of governments to the rural three-tier health care network should be suitable,and the most important thing is whether the quantity and the way of investment can meet demand of the rural inhabitants and the normal operation of network.Suitable manpower:Providing the primary health care as the most important work,the manpower which rural three-tier health care network needs should be suitable. On one hand,its special technique level and the title school record do not pursue those of large-scale hospital from the cities;On the other hand,numbers of unqualified health personnel should be dismissed and cared. Closer to the basic unit, the health personnel more tend to get the social function.Suitable supervising and managing:Anything to be benign developed cannot leave neither drive nor restraint. Suitable government supervising and managing creates one kind of good restraint environment for the network,which is the important guarantee that the network can develop continually. When the government is in choosing the way to supervise and manage,it is better constituting the systems and using the corresponding supervising and managing method according to the purpose of making the whole net develop quicker and better.Suggestion1 Enhance propaganda and guide the nation to transform the health conception Enhance propaganda,transform the health definition in people's mind,train the inhabitant to gain the new conception of continuous service,thus each level of coordinative service of network can be activated.2 Enhancement system construction of network and promote coordinated development Enhance the construction of systems and mechanisms in and out of the network. Lots of problems and relations should be well considered,such as relations of longitudinal and crosswise structure in the net,cooperation and competition between every organizations,various factors in or out of the net,and the environment and so on.3 Enlarge the invest amount from the government and improve the way Enlarge both the hardware and the software invest amount from the government,especially for the basic health organizations,and discuss and seek the right invest way which is suit to the rural health development,such as to purchase health service by contract and so on.4 Perfect the policies for the development of rural health manpower Advocate suitable manpower. Speed up to raise the suitable health manpower to meet the demand of the rural primary health care,and improve their work treatment and the social position,then to form a persistent effective mechanism. in addition, organizations of greater power should continuously do some help.