| BackgroundCurrently, Comprehensive reform of county-level public hospitals is always the key of the medical and health system reform in China. The reform effect will relate directly to the improvement of the rural medical system in our country.To some extent, it also reflects the implementation effect of dealing with serious illness at county-level hospitals and the reduction in peasants’ self-pay expense percentage in medical care.The characteristics of Guangdong Province of large fixed and floating population, maldistribution and the uneven fiscal revenue in each county of the province have brought great pressure to the medical and health resources planning and configuration of the province. Therefore, the county-level public hospital reform has been the highlight of the medical system of Guangdong province. Since the beginning of the pilot reform in February,2010, centered on the central deployment, Guangdong Province has been actively exploring specific mode suitable for Guangdong Province, and keeping the pilot work steadily proceeding. Guided by the Implementation Opinions on Deepening the Medical Health System Reform Issued by the People’s Government of Guangdong Province of Guangdong Provincial Committee of CPC in 2009, Guangdong government has issued a series of policies on the reform of county-level public hospitals.In conclusion, either our country or Guangdong Province has paid great attention to the reform of county-level public hospitals, and has issued pieces of policy documents and supporting documents. So to speak, the measures are well coordinated, intensive and strongly enforced. It’s been 3 years since Guangdong Province started the pilot reform at the county-level public hospitals at the end of 2012. To summarize the experiences of pilot reform, study the sample hospitals, evaluate the implementation effect of relevant reform policies at county-level hospitals of Guangdong Province, and find out the existing problems so as to put forward countermeasures and suggestions to guide the following work, has become the aim of this project.PurposeComprehensive reform of county-level public hospitals is always the key of the medical and health system reform in China, and the reform effect of county-level public hospitals is of great significance to the development of medical and health services. Through basic data table of pilot reform evaluation of county-level public hospitals, field survey data and questionnaires, this paper explored the effectiveness of management and operation mechanism of county-level public hospitals, reasonability of medical care level, and patient satisfaction, based on which the paper evaluated the effect of comprehensive reform of county-level public hospitals and analyzed the existing problems in current reform of county-level public hospitals and put forward improvement measures.ObjectiveIn this paper, This study combined with typical cases at the county level public hospital compensation mechanism reform in Guangdong province. It analyzes the present situation of the drug after zero bonus at the county level public hospital compensation, and it research the satisfaction of hospital staff and the patients condition about the current situation of public hospital compensation mechanism at the county level. It provides a feasible suggestions in order to promote the reform of public hospitals.Methods1. Research objectThis paper took 9 county-level public hospitals of Guangdong that have conducted pilot reform as the research object and surveyed part of their patients from June to December of 2014.2. Research methods(1) Research toolsDesign basic data table of pilot reform evaluation of county-level public hospitals, patient satisfaction evaluation scale, and interview outline for hospital director and department head. Basic data table mainly include four parts:availability of medical services, operational performance of medical institutions, medical resources and basic health care. Availability of medical services covers number of diagnosed and treated patients of county-level hospitals, number of diagnosed and treated patients of basic medical and health institutions, number of hospitalized patients of county-level hospitals; operational performance of medical institutions covers average length of stay of discharged patients of county-level hospitals, rate of utilization of hospital beds, average medical expenses per time, average hospitalization cost of discharged patients, total income, business income, hospital financial assistance, assets and liabilities; medical resources cover number of hospital beds of county-level hospitals, number of certified (assistant) doctors in county-level hospitals, and number of certified doctors with senior title in county-level hospitals; basic health care covers data related to employee’s medical insurance, resident’s medical insurance, and New Rural Co-operative Medical System.(2) Quality controlThis research was funded by Medical Science Foundation of Guangdong Province. Survey and statistical analysis of data were conducted according to plan to ensure the entire study is scientific and reasonable. All quantitative and qualitative data were obtained from reasonably planned channel so that the data is true and reliable. At the same time, all data collected from field survey were reviewed and corrected if necessary.For satisfaction survey, during the questionnaire distribution, investigators voluntarily explained the fill-out method to respondents, who then finished the satisfaction questionnaire independently. During the fill-out, investigators shall not induce respondents in any way, so that the questionnaire result is the true reflection of respondents’opinion. After the questionnaires were collected, questionnaires with completeness lower than 80% or identical answer were rejected.(3) Data management and statistical processing Establishment and analysis of the database were conducted by SPSS20.0, missing item was made up by average value of the data series. P<0.05 indicates that the difference is statistically significant.Scale evaluation method:this study used descriptive statistics to analyze the distribution of respondents and the influence of demographic differences on patient satisfaction. Cronbach coefficient was used to evaluate the internal consistency of evaluation scale; factor analysis measurement scale was applied to evaluate the validity; Spearman correlation coefficient was used to calculate correlation coefficient(4) Specific methodsThrough field data collection, in-depth interviews and questionnaires, this paper surveyed the county-level public hospitals of Guangdong that have conducted pilot reform and evaluated the progress of reform measure of county-level public hospitals, including improvement of management and operation mechanism of county-level public hospitals, improvement of expensive and difficult medical treatment of the mass, satisfaction of medical staff at reform, government investment and its desired social and economic effect. Then the paper applied the survey data to summarize the experience and analyze the existing problems. Finally, through longitudinal comparison of pilot reform of seven county-level public hospitals, the paper put forward countermeasures and suggestions to solve the problem in reform of county-level public hospitals of Guangdong.Result1. The results achieved in the reform(1) Improvement of medical services in the study sample hospitalsThe monthly average number of visitors has increased compared to that before reform. Especially in county-level hospitals in Yunfu City and Huizhou City we have studied, the monthly average number of passengers have grew from 72,830 passengers to 85,000 and from 77,350 passengers to 10,350, respectively, the monthly increase number have turned out be to 12,170 and 10,350.(2) Growth trend of medical income in sample hospitalsAfter reform, the average total revenue of the pilot hospital medical monthly average was increased, which compared to the pre-reform (except a county-level hospital, in Jieyang City). Wherein, the average monthly growth of more than 10 million have five hospitals, namely:a county-level hospital in Yunfu City, Huizhou City, Meizhou City, Maoming City and in Qingyuan City. After the reform, the hospital service capabilities improved significantly.County hospital reform developed the potential medical resource needs:the growth of attendances, the outpatient and inpatient medical income also will increase. The monthly outpatient income compared to the previous is more substantial increased. Especially a county-level hospital in Jieyang City and Yunfu City. The average monthly income is increased greater than before. About the hospitalization income, the monthly average of sample hospitals have increased, which compared to the pre-reform (except a county-level hospital in Shantou City). Wherein, the average monthly growth of a county-level hospital in Jieyang City grew rapidly, reaching 17.407 million. In addition, there are 5 county-level hospitals that the average monthly income is more than 1 million.(3) Samples hospital average length of stay decreased as a whole after the reformSample hospitals actively implement disease management with clinical path and provide quality nursing service. The reform in hospital nursing mode has shortened waiting time for the process of testing, inspection, and other surgical procedures.After a year of practice, the average of stay of the sample hospitals was in a decreased trend than before. Except a slight increase of a county-level hospital in Shantou City and Maoming City, and a county-level hospital in Heyuan City remains unchanged, the other sample hospitals were decreased.2. Problems Found In Reform(1) The average cost of each time in many sample county hospitals did not fall but rised after the reformAccording to the survey data, since the county public hospital reform carried out, the average cost of each treatment after the sample hospital reform had no significant decline compared to the average cost of each treatment before. On the contrary, the average cost of each outpatient treatment increased in some areas’ county level public hospitals.Just in one county hospital of Shaoguan City, one county hospital of Shantou City, one county hospital of Qingyuan City and one county hospital of Heyuan City,the average cost of each treatment fell by 7.1 yuan. In addition to those hospitals, the remaining five county hospitals had different levels of growth in the average cost of each treatment.The average cost of hospitalization, the average cost of hospitalization after the sample hospital reform had no clear downward trend compared to the pre-reform. Only one county hospital of Huizhou, one county hospital of Shantou City, one county hospital of Heyuan City, and other public hospitals in those three counties had declined on the average cost of hospitalization. In addition to those hospitals, the average cost of hospitalization were reflected in different degrees of growth in the remaining six counties.(2) The situation of the government compensation mechanism to implement is not ideal3. Analysis on the satisfaction of patients in sample hospitals after the reformAccording to the requirements in 《The county public hospital in Guangdong Province comprehensive reform plan》:the reasonable income reduction by abolition of drug addition should be compensated by this principle that adjust the price of medical services of 80%, special financial assistance of 10% and hospital self-digestion of 10%. However, the actual implementation is not satisfactory:by adjusting the price of consultation fees, large inspection fees and other medical services, it failed to make up 80% for the reduction of hospital’s reasonable income. In addition, the implementation was ineffective about the 10% by levels of financial subsidies in the documents specified.4. Countermeasures and SuggestionsFor the problems exposed in the sample hospitals, the solutions are as follows: improve the government compensation mechanism, improve the long-term financial investment mechanism, rationally adjust the price of medical services; for sample hospitals of many counties whose cost per time does not decrease but increase instead, we should increase the services ability of the basic health agencies, strengthen the supervision of county-level medical institutions, and scientifically determinate the reasonable cost of hospitalization per time;we also need to continue to promote the county public hospital service capacity; to find the weakness of hospital medical services through satisfaction surveys and to deal with them; to optimize hospital services processes and to create efficient treatment experience.5. Conclusion:(1) Formulating reform effect evaluation system for the county public hospital of Guangdong Province according to literary documents, policy researches and other methods such as expert advice, and then start full investigation according to the index system.(2) Using a variety of methods such as descriptive statistics analysis, correlation analysis of sample hospitals of 9 county hospitals. Based on the research, I found that reform effects and problems of sample hospitals coexist. The effect includes that the health care capacity has improved, the monthly average attendances have increased compared to the attendances before the reform; the total revenues of sample hospitals each month have increased compared to the revenues before reform (except one county-level hospital in Jieyang City); the average length of stay in hospitals of sample hospitals after reform tended to decrease; Overall, patients’ degree of satisfaction is high in sample hospitals.However, some problems exist. On the one hand, the cost per time of sample hospitals of many counties does not decrease but increase instead. Even in parts of the county public hospitals also presented the rising costs of outpatient clinics; the average hospitalization costs of sample hospitals have not significantly reduced compared with the costs before reform; the government compensation mechanism implementation is not ideal. On the other hand, the patients’ degree of satisfaction for the environment facilities and logistics of sample hospitals are low.For problems exposed in the reform of sample hospitals, the countermeasures are as follows:improve the government’s compensation mechanism; improve the service capacity of health service agencies, scientifically determine the reasonable cost of hospitalization each time;continue to promote the service capacity of county hospital; find the hospital medical services short board through satisfaction surveys and continue to improve the weakness; optimize the hospital service processes and create efficient treatment experience. |
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