Policy Analysis On The Health Reform And Development In Tianjin

Objective:This study reviewed the course and major policy of the health reform and development in Tianjin since1997, indagated the background of policy making, the conditions and causes of policy implementation as well as the relationship between policy and health development, and evaluated objectively the effect of policy implementation by using the index system of performance evaluation. The ideas and concepts of health policy for health reform and development in Tianjin during the past dozen years were subsequently summarized. The study generalized about the concept, the strategy, the model and the thinking of health development with Tianjin’s characteristics, which could be used as reference for not only the further health development in Tianjin, but also the formulation and implementation of health policy in other regions.Methods:(1) Literature Search:The health policies, regulations, ordinances, decrees and comprehensive supplementary measures of both our nation and Tianjin, besides the relevant literature, were collected and searched.(2) Expert Consultation: According to the research themes, the expert consultation was performed focusing on the background and objectives of policy making, the conditions and effect of policy implementation, and the thinking and direction of future reform and development as well.(3) Structure-Process-Consequences Analysis:This study analyzed the structure of health system, such as the structure of health resources and health service system, and so on. Then the study got the consequences of health system by assessing the characteristic index changes of process.(4) Multi-dimensional Combination Evaluation:The health system performance was comprehensive analyzed and evaluated by indicators from multiple dimensions and hierarchy.Results:(1) Health status and health seeking behavior:During the past14years, the health status of residents in Tianjin has been improved significantly. The average life expectancy of the residents in2010was80.27,6.73years longer than that in1997, growing at an average annual rate of6.76%. The maternal mortality rate and the infant mortality rate were declining. The maternal mortality rate in2010dropped by12.7in100,000compared with that in1997. And the infant mortality rate in2010 was3.86%o lower than that in1997. According to the data from four National Health Service surveys, it suggested that the prevalence rate of chronic diseases and two-week prevalence rate of residents in Tianjin were on the rise, and that two-week visiting rate was gradually trending down, while the hospitalization rate, which was24.58%in2008in the surveyed areas, was slowly rising. It was also reported that hospital admission rate in urban areas was higher than in rural areas. The average percentage of those who should have been hospitalized was18.45%in2008in Tianjin, which was higher in rural areas compared with that in urban areas,20.09%and17.63%respectively.(2) Ability to prevent risks of diseases:From the perspective of health financing, the total health expenditure and per capita health cost tended to ascent obviously from1997to2010. The proportion of Health expenditure in GDP,3.86%in2010, fluctuated from1997to2010. The portions of government health expenditure stayed relatively stable. The portion of social health spending dropped from51.16%in1997to35.96%in2002, and then went steadily up to41.02%in2010. The portion of personal spending raised from28.40%to47%in2002, then down to35.74%in2010. Viewed from the development of health security, the coverage of medical insurance for urban worker and for urban residents, and the new rural cooperative medical insurance expanded and the per capita funding level increased.(3) Satisfaction and responsiveness:Residents’ satisfaction of health service in Tianjin improved continuously, and most patients are satisfied with the general services. Surveys in2008in Tianjin showed these inhabitants were most unsatisfied with outpatient services from following three parts:high medical costs(12.50%), waiting for too long time (12.50%) and lack of drugs (4.51%). And they were most unsatisfied with high medical costs(18.93%), cumbersome procedures (5.99%) and poor equipments and environments (5.43%).Surveys also reported the satisfactions towards health responsiveness. The most unsatisfactions parts are as follows. They are the absence of informing related health care knowledge in the treatment, the cost of relatively long or too long time in waiting room and in the way to hospitals, in the aspect of outpatient services. And relatively or very poor equipments and uncomfortable environment, little discussion with patients about the treatment, and the inconvenience of complaints were mentioned in the aspect of inpatient services.Conclusion:After more than a decade of development, the health status, the ability to prevent risks of diseases and the satisfactions of health services made a big progress. The health reform and development in Tianjin were based on the development concepts of healthy and harmony, the development ideas of leading moderately, the objectively right development strategy, and the scientific development mode, so that the health undertakings in Tianjin achieved great leaps and a unique development model was formed. However, it is still a prominent contradiction that The current level of health development and the health demand don’t coordinate to the growth of economy and society. What’s more,"hard and expensive to see a doctor" issue still exists. Therefore, it’s urgent to fundamentally resolve the systematic, mechanical and structural contradiction, thus health policy can be more scientific, practical and sustainable. Finally a health care system with Tianjin characteristics will be set up, and achieve the goal that all people in urban and rural areas will enjoy basic medical care and health services.