The Analysis About The Effect Of Health Care Reform Of Townships Hospital In The Economically Undeveloped Areas In Guangdong Province

Objective:Understand the changes of the township hospital in economic underdeveloped areas of Guangdong province after the implementation of the essential medicine institution and system of income and expenses, and analyze the related factors for putting forward some suggestions.Subjects and Methods:The survey adopts the combination of qualitative and quantitative research methods.Qualitative research methods include literature review and interviews. Quantitative research methods include collecting local health statistics yearbook data, financial annual reports,and the data collecting by the self-made questionnaire. The sample is collecting by the combination of stratified sampling and typical sampling.This investigation content mainly around the changes of normal work、fiscal funds、human resources and staff’s work enthusiasm of the township hospital in economic underdeveloped areas of Guangdong province after the implementation of the essential medicine institution and system of income and expenses, and analyze the related negative factors of development of the township hospital and the enthusiasm of the staff performance for putting forward some suggestions.Result:1. After the health care reform, the business income and portfolio of the townshipshospital have not show an obviously change, the average annual revenue of the townships hospital in 2014 is 6.81% less than 2010,the outpatient amount is 8.00% less than 2010,and the inpatient amount is 15.16% less than 2010. The fiscal keep a growing trend in five years, the average annual fiscal in 2014 is 132.80% more than 2010. After the year of the implementation of the essential medicine institution, the amount of Outpatient service and emergency treatment of townships hospital show a different degree of decline. The outpatient amount of all the townships hospital in 2011 is 21.97% less than 2010, but it shows a slowly rise in following year when the essential medicine institution is improved.2. Hospitalization expenses for medicine in Eighty percent of townships hospital get fall first year, such as the hospitalization expenses for medicine in 2011 is 28.21% less than2010. They begin to pick up in the subsequent years, the hospitalization expenses for medicine in 2014 is 2.32% more than 2010. The medicine expenses proportion keep a downward trend in 5 years, but only four townships hospitals’ outpatient expenses for medicine proportion get under 30% in 2014, and the number of hospitalization expenses proportion of townships hospital under 30% puts six.3. The result of human resources survey shows that the vacancy rate of all townships hospitals cannot reach a state of all expect two hospitals, and the highest vacancy rate of townships hospital is 61.86%. Staff education is given priority to with technical secondary school; age is given priority to with 30 to 39 years old. Personnel loss was occurred in recent years, most of which have doctors’ qualifications. The training of staff appears less and with short cycle.4. The medicine expense is cheaper in the initial time of the essential medicine institution, but is artificially high now. The kind of essential drugs increased year by year,and the kind of the essential drugs are reaching 798 now. The specifications of the models of some drugs lack of applicable to the townships hospital. The cheaper drugs often appear lack. It often takes a long time for drug delivery. Feedback mechanism of drug procurement platform is imperfect. The government failed to fully compensate for the essential medicine.5. The system of income and expenses can guarantee the base income of staffs, but theperformance salary distribution system cannot produce an effective stimulus. The pattern of the system of income and expenses are not following only one in townships hospital. The fiscal fund is keeping increased in most of townships hospital. The funding of basic public health services cannot be used to its own filed. The performance salary distribution system cannot produce an obvious gap and effective stimulus.6. The medical insurance shows a largely identical but with minor differences, and that is good for the distribution of the outpatient in grassroots medical institutions. But the limitation of the total amount of reimbursement may act as a hinder for the development of the townships hospital somehow. The individual cost standard is different in vary area,dividing into different class, with different proportion of medical insurance fund pays.Ordinary outpatient reimbursement ratio is floating around 50%. Inpatient insurance reimbursement ratio increased with the decreasing levels of medical institutions. All regions have the starting line in hospitalization insurance reimbursement, and most area give an amount limit of the insurance reimbursement.Conclusion:The portfolio of the townships hospitals cannot show an obviously change, the control of the medicine expenses cannot show obvious effect and many people loss in the process to adapt to the new policy. The implementation of the essential medicine institution show helps to reduce the burden of patients, but the management is needed to be improved. The system of income and expenses can increase the financial input, and also give big help for the remote and backward townships hospital who get poor conditions. The salary distribution system shows a restraint to motivate the staff. The medical insurance can attract the patients, played a certain role to support the townships hospital. The reimbursement cap line and total medical insurance fund limit has certain resistance of townships hospital.Medical insurance payment owed is reasonable. The loss of staff and lower enthusiasm is an important factor which restricts the development of the townships hospital. The performance salary distribution system cannot produce an obvious gap and effective stimulus, leading to the loss of staff.Suggestion:1. Improving the system of the essential medicine institution, and making a safeguard mechanism for drug procurement and distribution security mechanism.2. Adjusts the system of income and expense, transfer the special subsidy to the subsidized by the performance salary distribution.3. To improve the medical insurance and give play to the role of bypass patients.4. Strongly promote of talent team of the construction in basic health institutions.