| Objective: To summarize the experiences and deficiency of the reform of public hospitals at the county level in gansu province, to fully understand the current situation and needs, to explore and improve the reform program; To enrich related conclusions and collect baseline data; Offer suggestion and theoretical foundation for further reform.Methods: This article mainly adopted literature research and questionnaire survey. Use Epidata3.1 to inputted data and use SPSS17.0 to analyzed data; Use the absolute increment, increase rate, development speed to described dynamic series; Second category variable rates were compared with using chi-square test; Orderly classification variables were compared with using rank sum test; Medical staff’s satisfaction were analyzed by using Likert 5 grades evaluation;The size of tests were 0.05(two-sided test).Results: 1. The basic status of pilot From 2012 to 2014, in terms of medical resources, the average fixed assets of the first pilot hospital, the number of employees at the end of service, the actual number of opening beds, designated bed capacity has increased respectively by 35.91%, 9.29%, 19.24%, 14.04%; The growth rates of second batch of pilot hospitals were 37.34%, 11.01%, 30.51%, 24.97%;The increase of authorized size was not obvious. In terms of service delivery of the first pilot, the number of out-hospital patients and discharged patients were increased respectively by 28.75%, 18.63%; the second batch of pilot were 4.91%, 31.46%; The patients’ average length of stay of the first batch of pilot has reduced from 9.49 to 9.09 days, higher than the second batch of pilot(reduced from 8.88 to 8.45 days). In terms of medical expenses, the medical expenditure per patient and the hospitalization expenditure per patient of the first pilot were increasesed respectively by 4.05%, 13.16%; the second batch of pilot was 17.22%, 3.97%. In terms of income and expenditure,the proportion of subsidies income in general income were 21.43%, 19.43%, 20.79% over three years, which were significantly higher than the second batch of pilot(11.83%, 12.72%, 13.61%). The proportion of income from drug in general income were 36.49%, 35.89%, 33.98% respectively, lower than the second batch of pilot(39.77%, 39.09%, 37.41%), both pilots continued a downward trend; The proportion of income from drug in total expenditure of the first batch of pilot was decreased from 37.50 to 34.66, while the second batch of pilot dropped from 36.16% to 34.86%. 2. The reform of system From 2012 to 2014, The proportion of building modern hospital management system in the first batch of pilot was significantly higher than that of the second batch of pilot; those ratios were 71.79%, 92.11%, 86.84%, 97.44, 97.44%, 76.32% for the proportion of hospital which have the rights of personnel management, the establishment of internal organization, deputy recommended, appointment of the middle-level cadres, internal allocated, performing the annual budget by 2014, which were 62.50%, 90.63, 78.13%, 100%, 96.88%, 87.50% for the second batch of pilot. The cancellation rate of drug addition in the first batch of pilotwas significantly was higher than that of the second batch of pilot, the difference between two batch of pilot in three years was statistically significant(P<0.05); The cancellation rate of drug addition in the first batch of pilot was 94.87% by 2014, which was 68.75% in the second batch of pilot. In terms of the reform of personnel distribution system, the difference between two batch of pilot in three years had statistical significance(P<0.05). In terms of the performance appraisal institution, the difference between two batch of pilot in three years was not statistically significant addition to 2012(P>0.05). In terms of classification and treatment, the rate of referral channel with basic medical institutions in the first batch of pilot were higher than that of second batch of pilot in three years, but differences were no statistically significant(P>0.05). The rate of referral channel with basic medical institutions in the two batch of pilot were 43.59% and 40.63% respectively, the difference was not statistically significant(P>0.05); The rate of using residents health card were 43.59% and 43.59% respectively, the difference was not statistically significant(P>0.05). 3.Medical workers’ satisfaction of hospital management and cognition of reform The differences of the medical workers’ daily working hours, subjective feeling of the change of work time, satisfaction score to the current job, monthly income and perception of changes in income between two batch of pilot were not statistically significant(P>0.05); Medical workers’ satisfaction was influenced mostly by income, working strength and working environment. In terms of the pressure of the hospital performance appraisal system, the difference was not statistically significant(P>0.05); The satisfaction scores of rewards and punishment system for hospital were 3.47 and 3.51 respectively, the difference was not statistically significant(P>0.05); The satisfaction scores of management status were 3.69 and 3.8 respectively, the difference was statistically significant(P<0.05). The difference of medical workers’ understanding of reform program between two batch of pilot was statistically significant(P<0.05); The differences in the medical workers’ cognition of reform and expectations of health reform at present stage between the two batch of pilot were both not statistically significant(P>0.05).Conclusion: 1.The number of outpatient ambulatory and discharged patients increased stably. The average length of stay has declined. The growth rate of medical expenditure per patient and the average charges of outpatient were slowed down. The proportion of the government subsidies income in total revenue has risen while the proportion of medicine cost fell. In addition, health workers’ satisfactions have increased slightly. The status of independent legal person and the rights of management autonomy have been confirmed. The reform of cancellingdrug price addition was effective. These results are consistent with the expectation goal. 2.The gross of health human resource and the authorized size were shortage, each part of the income were growed excessively. The level of information construction was lag behind, and that health workers’ understanding of reform program was poor. These are opposite to the expectation goal. 3.Health workers’ satisfactions exercises a great influence by income, working strength, job satisfaction and working. Their first appeal was to improve income. |
PDF Full Text Request