Research On The Performance Evaluation Index System For Grass-roots Health Institutions

ObjectiveThe Party Central Committee has projected the requirement of the establishment of basic medical and health care system for urban and rural residents in the access to basic medical and health services, which points the way for our health system reform. As the main body for service delivery of public health and basic medical services, the grass-roots health institutions (township hospitals and community health service centers) are the foundation for the construction of public health service system and the improvement of the health care system and also one of the core content of medical and health reform. The Government has continuously improved its functions, increased financial input and implemented innovation of management system, operation mechanism in grass-roots health institutions. Meanwhile, it is urgent for the Government to have a scientific and comprehensive evaluation on all aspects of grass-roots health institution reform to get an objective understanding about the performance consistent with its properties and functions. In this study, the connotation of grass-roots health institution performance was profoundly explored from the properties and functions of grass-roots health institutions and through literature review and Delphi method in order to build a reality-based performance evaluation index system appropriated to the property and function of grass-roots health institutions which is scientific, comprehensive and objective to evaluate the performance of grass-roots health institutions and provides theoretical support and data-based for government's decision-making, with reasonable opinions on the main body of the assessment and evaluation cycle. The index system, public welfare and the "gatekeeper" function for its value-oriented, carries out proper guidance and incentives to promote the healthy, rapid and sustainable development of grass-roots health institutions through the "baton" and performance management.Methods1.Performance evaluation index system for grass-roots health institutions was initially formed based on the literature review and expert discussions.2. Two rounds of the Delphi consultation were carried out with 12 experts selected from the fields of health management, health economics and clinical medicine. Experts were required to grade each indicator on the consultation list according to the importance, the basis and familiarity and put forward comments and proposal for relevant indicators. 3. The results of the consultation was statistically analyzed with SPSS13.0 on the basis of the database by Excel, the positive degree, concentration, authority level and coordination coefficient of experts were calculated so as to screen the targets. The final target system and weight were determined after the final composition of each index weighs by the subjective grading method and the combination weight product method.Results1. Performance evaluation index system for grass-roots health institutions oriented in public welfare and the "gatekeeper" function was established. The indicator system is divided into three levels, with the support, functional implementation, effect and development potential indicators as the first level indicators (four indicators altogether), 14 second level indicators and 52 three level indicators. The support indicators includes four secondary indicators such as capital investment, policy support, staff and facilities input; functional implementation includes six secondary indicators such as information management, health education, preventive care, chronic disease, rehabilitation and basic medical care; effect indicator including three secondary indicators such as health, responsiveness and satisfaction; the development potential indicator is mainly human resources.2. The weights of the three levels of indicators were determined through expert scoring and combined weights, of which the weights of the first level indicators are: the support indicator is 0.2895, functional implementation is 0.2634, the effect indicator is 0.2277, and the development potential is 0.2196.The positive indicator in the two rounds of expert consultation was 100%; authority extents were 0.744 and 0.770 respectively; the coordinate coefficients were 0.384 and 0.684.Conclusions1. The theoretical framework of performance evaluation for grass-roots health institutions was determined: with the philosophy of "people orientated" and "access to basic health care" ,the effective management on the grass-roots health institutions reflected the six functions; based on the quality of public health and basic medical services, the effective use of resources maximized the output of health services contributing to the improvement of residents'health.2. The performance evaluation index system for grass-roots health institutions was established: in the theoretical framework of performance evaluation, the index was screened through literature review and Delphi method; indicators screened out of were scientific and representative covering wide area, which can objectively, comprehensively, systematically reflect the performance of the grass-roots health institutions.3. The index system was based on the property of public welfare and the "gatekeeper" function for its value-oriented focusing on their six functions; in particular, the evaluation on the performance of public health can fully reflect their public welfare.4. The weight of each indicator was determined by expert scoring and through combined product method, which was scientific and reasonable and the results were relatively accurate.