The Research On Structural Reforms Of The Divided Management On Incomings And Expenses In Township Hospitals

ObjectiveThis research take the Nanfeng , Shangli and Jian county in the Jiangxi Province as the object of study, through the widespread investigation and the detailed reliable data quantitative analysis, understood the real situation of the divided management on incomings and expenses in township hospitals in Jiangxi province, comparatively analysis implementation's effect and the existence question, to provide the suggestion and the reference for carrying out"reforms of the divided management on incomings and expenses in township hospitals"around the country.MethodsCarry on the follow-up study to the experiment site counties, collect two year data of the divided management on incomings and expenses, carries on the longitudinal contrastive analysis to the related target, and carries on the crosswise contrast with the undeveloped revenue and expenditure two line's comparison counties, appraises reform result of the divided management on incomings and expenses. Use the symposium, visit, questionnaire survey as investigation methods. Use the Excel2003 to establish database and input data, use the SPSS12.0 software to carry on the statistical analysis to the data.Results1. Financial subsidy situation: After implementation of the divided management on incomings and expenses, three experiment site county's finance subsidy and the personnel subsidize increase obviously, but the proportion was quite still low, the financial subsidy accounted for only 20%-25% of total revenue every year, personnel subsidize account for only 55%-60% of staff salaries.2. Business income situation: After implementation of the divided management on incomings and expenses, three experiment site county's business income has the growth, but drugs income also still sustained growth, and the proportion of the drugs income accounted for the gross income is very still high, equally reached above 43%.3. Provision of health services situation: After implementation of the divided management on incomings and expenses, three experiment site county's Provision of health services increase generally, specially hospitalized people.4.Expense control situation: After implementation of the divided management on incomings and expenses, three experiment site county's per capita outpatient, hospital costs show a downward trend overall, but still did not fall but rise situation. 5. Debt situation: The debt of three pilot counties is quite serious, and from 2005 to 2008, an average of the amounts of three pilot counties sustained growth. ConclusionsThrough investigates and studies, we can see that the pilot work has obtained"three increases, one to reduce"the preliminary result: First, increased the investment of the township hospitals; second, increased the business income of the township hospitals; third, increased the provision of health services of the township hospitals; fourth, reduced the farmer populace's medical expense. But there are still some problems: The government invests limitedly, the medical care personnel receive get unhooked very difficultly with the business income, the effect of reduce the farmer burden is not remarkable, historical debt question and efficiency question. Suggested that the government increases the financial investment dynamics, carry out each hygienic compensation policy, reah the synchronized growth of the public health disbursement , GDP and the expenditure, simultaneously establishes the compensation mechanism by the government purchases the service, guides the hospital to achieve the public welfare goal independently, thus maximum limit displays the financial funds to promote the rural sanitation enterprise, studies the community hospital in Beijing and Nanjing, the basic medication implements zero price difference sale, contains the medical expense unreasonable growth, manifests truly yields profit the actual benefit in the people; solves the historical debt problem as soon as possible ; standard medical personnel incentive mechanism, establishes take the post and the official rank as the foundation, the total amount control, the assignment reasonable wage payment system, eradicate the mechanism of "drug-dependent doctors" and unreasonable income.