The Research In The Status Of Incentive Mechanism And Policy On The Mode Of "Hospital Organization And Operation" And "Unified Management" Of Community Health Services

Guangdong Province is very active economic provinces in China, and Dongguan and Zhongshan City are both belong to the Pearl River Delta cities. Both of them are management town in the administrative institutional framework, However, according to local conditions of economic and social development and characteristics, they developed the different models of "unified management" and "Admin Office Court tube" town in village health services integration. Through the Survey of incentives of the Community in Dongguan and Zhongshan City. With comparing and analyzing the similarities and differences in the incentive mechanism in the framework of the same administrative system of community level health services, Which can develop and improve the existing incentives policy basis to make certain.MethodsThe combination of theory and practice, the combination of summarizes and logic, the combination of qualitative and quantitative research,the combination of theory and practice are used in this study . Specifically including:1. Document analysis: Through access to a large number of relevant literature, It is clearly that community health services at home and abroad the status of Research is incentive. In order to explore the city of Dongguan and Zhongshan community health services , we provide theoretical support for incentives.2. Key interviews: including Group interviews and Personal interviews. Through literature review and expert consultation to determine the way the group interviews and individual interviews with specific targets and contents.3. Brainstorming and Panel discussion methods.4. Site investigation Community health service agency staff and community residents survey. Content of the survey including: community health service agency staff treatment, job satisfaction, training, performance appraisal and reward and punishment, community residents and payment of medical expenses, medical treatment intent, satisfaction with community health services and community health services suggestions for improvement, etc.Each investigator of an unified training purposes subject to a clear, familiar with the questionnaire, in the specific course of the investigation to avoid subjective questions and answers, so as not to induce respondents. In the process of data collection, strictly implement the "three examinations", that is, immediate inspection is completed the questionnaire, every day of the returned questionnaires by hand uniform inspection, quality control personnel checks. Arising in the course of investigating the controversial issue of timely feedback to ensure the quality of field survey.Results1. Individuals, government and medical institutions bear the medical expenses in the proportion of survey:In the city of Zhongshan, 49.6% of the population think the Government should bear the medical expenses of more than 50.0%, 52.5% of City residents think that the Government should bear the medical expenses of more than 50.0%; cities residents suffering from chronic diseases or conditions of general diseases , the main treatment agencies focused on community health services, but the selection of patients with chronic diseases, the proportion of the community was significantly lower than the general diagnosis and treatment of disease; Zhongshan City, 83.1% of residents to the community health service institutions for the service as a doctor, 75.4% of residents accept service prescription, Dongguan City, were 71.4% and 52.9% of the residents to community health services and prescription doctor, the two cities the proportion of residents to other services was significantly lower than medical treatment and prescribe medication, community health services "Six in-one "function perfect.2. Community health services need to strengthen and improve the main areas:The residents of Zhongshan think that the community health service institutions need to strengthen and improve the first three main aspects to increase the medical equipment (33.9%), lower health care costs (32.9%), increased the level of medical personnel (30.3%), that government departments should be strengthened and the first three areas to improve for the increase in medical equipment (19.0%), increased the level of medical personnel (16.2%) and lower medical costs, Dongguan City residents that the community health service institutions should be strengthened and improved to increase the medical device area (57.9%) to increase services (40.6%) and increase drug varieties (36.8%), the Government should strengthen and improve medical equipment for the increase (27.8%), government to increase investment (25.5%) and increased services (24.4%), two City need to further strengthen and improve the terms of basically the same, Zhongshan City residents pay more attention to reducing health care costs.3. Community health service agency staff to implement the situation Engagement:Zhongshan City Community Health Service staff into the main channel of the unit are the candidates of the way, but the proportion of 86.5%, Dongguan, Zhongshan City, was higher than that (57.5%), Zhongshan City, through the "recommended" way into the proportion of units (20.0 %) high, and significantly higher than that of Dongguan City (5.3%); 67.4% of Zhongshan, Dongguan City, 72.3% of community health service agency staff agreed that appointment and appointment of cadres or staff is an ideal way; Zhongshan City, 45.7% Dongguan City, 36.7% of community health services staff of the unit is not satisfied with the existing staff appointment, Zhongshan City, only 4.0% of staff believe that the implementation of the unit's appointment with openness, significantly lower than the 36.7% of Dongguan City ratio;4. Community health service agency staff, the focus needs positive incentives:In the city of Zhongshan, the top 5 in order were to increase revenue (65.7%), increase in benefits (55.9%), fair performance evaluation (42.2%), increase in social insurance (37.0%), reasonable working arrangements (29.8%) , Dongguan City, the indicators are the top 5 in order to increase revenue (57.4%), increase in benefits (56.4%), fair performance evaluation (46.7%), reasonable working arrangements (36.2%), and given training in communication opportunities (35.9%), indicating that the Zhongshan and Dongguan City, community health services staff about the need for higher levels of spiritual material needs, but also have shown the need for some spiritual level;5. Community health service agency staff job satisfaction:The score after the survey results show that community health services, Zhongshan City, the staff are most dissatisfied with the respective prize money of 10 (2.37), wages (2.48), inter-department cooperation (2.51), income (2.54), bonus distribution method ( 2.76), reward allocation (2.81), working conditions (3.03), promotion opportunities (3.09), management systems implementation effect (3.13), employment mechanism (3.19) and the evaluation process (3.25), Dongguan City, was a bonus (2.81) , wages (2.95), income (3.19), promotion opportunities (3.19), bonus distribution method (3.25), reward allocation (3.28), management systems implementation effect (3.34), scheduling arrangements (3.49), working conditions (3.51 ), employment mechanism (3.51) and the evaluation process (3.52). It can be found, Zhongshan and Dongguan City, community health service agency staff, consistent with the factors of job dissatisfaction, but the City as a whole is generally higher than satisfaction rating to the same target, Zhongshan City, two cities on the current community health service institutions and incentives measures, which still need to pay incentive-based material incentives, supplemented by some mental stimulation.The issues the healthcare providers were not satisfied with are almost the same in Zhongshan and Dongguan. Dongguan, however, scores higher than Zhongshan in all the parameters. Regarding the incentives and measures, material incentive, i.e. payment incentive, is the most popular one, while spiritual drive is of some value.Conclusion1. There's room for improvement in the incentive system for Zhongshan and Dongguan, especially the existing problems in community health service and the imbalance of current incentive system between the needs of community health service itself and community residents.2. The "Unified management" community health service model in Dongguan is more efficient than the "Hospital oganization and operation" model in Zhongshan. Though the incentive system in Dongguan is in need of improvement, it is better than Zhongshan in steering residents' health needs and staff motivation.3. Incentive system to encourage the development of community health service should be established gradually. The concepts of dynamic management and management by objectives should be involved. Various incentive theories and principles, innovative incentive system, and improvement in surveillance system are needed to secure and promote a sustained development.