The Effectiveness Evaluation Of Contract Services Of Village Doctors In Partial Areas Of Three Provinces

Objective: To evaluate the effectiveness of contract services of village doctors that have been implemented in China for three years,and to provide reference and advice for further developing contract services of general practitioners and improving the contract services of village doctors.Methods: We learn about the current situation of contract services by reviewing the literatures and referring to relevant government documents.To learn more details about the implementations,achievements and existing problems of contract services of village doctors,we adopt various methods such as holding seminars,interviewing the experts on public health,hospital presidents and village doctors.Based on these information,we conduct a survey of contract services using self-designed questionnaire.Then,we utilize statistical methods to analyze the collected data including the general descriptive analysis,double entry,t-test method and non-parametric test.Finally,an integrated evaluation index system for contract services of village doctors is formed through the Delphi method.Results:(1)Village clinics: By analyzing the related data of the sample village clinics from 2012 to 2015,we find that the total annual prescription numbers increase significantly since 2013,when contract services of doctors was implemented.In comparison,the average fee for each prescription of non-pilot clinic is sustainably higher than pilot clinic during the year of 2012-2014(t2012=-2.576,p<0.05;t2013=-3.031,p<0.05;t2014=-1.989,p<0.05).(2)Village doctors: The more service population in sample village clinics,the higher income of village doctors(t = 2.974,p < 0.05);the income of village doctors increase with the number of annual prescription number(t = 2.222,p < 0.05);the income of village doctors increase with the number of the villagers who signed the contract(t = 2.100,p < 0.05);the income of village doctors increase with the amount of subsidies for basic public health services(t = 2.103,p < 0.05);In addition,the quantity of outpatient services of the village clinics,the service ability and quality of village doctors,enthusiasm of signing the contract,and the doctor-patient relationship have also significantly improved.(3)Villagers: The average health literacy score of respondents from three provinces is(69.41±11.63)points.Among them,the highest score is 94 points and the lowest is 10 points.Furthermore,the health literacy score of the villagers who signed up(70.27)is higher than those who did not sign up(68.43);total annual prescription number of signed villagers in less than unsigned villagers(t = 7.177,p < 0.05),total annual prescription expenditure of signed villagers is less than that of unsigned villagers(t = 8.297,p < 0.05).Discussions: The contract services of village doctors have made some progress after implementation.Specifically,the income and service ability of village doctors have improved and the grass-roots outpatient number has increased.As a result,the first-treatment system at the grass-roots level is gradually put into practice.However,there still exist several problems needed to be settled.For example,the workload of village doctors is heavy;the incentive mechanism need to be further improved and the retirement problem of village doctors need to be addressed;the ability of carrying out the contracts need to be enhanced;the promotion of health literacy between villagers is disequilibrium.The process of improving support system of contract services can provide reference and advice for further developing contract services of general practitioners.Suggestions: In order to increase the income and improve the retirement pension system of village doctors,the funding channels of contract service fee need to be broadened.As for the problem of insufficient service ability of village doctors,targeted training and examination as well as a specific assessment mechanism should be taken into consideration.Among them,the promotion of villagers' health literacy can be valued as the key assessment of village doctors,to prompt village doctors to pay more attention to health education and health management of the villagers and to ensure that the contract services of village doctors could obtain a striking and apparent effect.