Study On The Evaluation Of Operation Stuation And Development Countermeasure Of Rural Clinics In Shandong Province

Objective The study was on the basis of the situation of rural clinics,using qualitative and quantitative methods and questionnaire designed by the research group,to analyze the construction of rural clinics,human resources development,operation management,service delivery and their income and expenditure,to understand the problems existing in the operation of rural clinics,to evaluate the operational efficiency of public health services as well as basic medical services and to identify the influencing factors.System dynamics method was used to clarify the operating mechanism of rural clinics and to forecast their future development trend,and then put forward countermeasures and suggestions of improving rural clinics’ construction and operating condition to promote the healthy development of rural clinics.Methods This study used the multi-stage stratified random sampling to determine the object.The method of personal in-depth interviews and literature review were used to collect the data and questionnaire designed by our research group,and qualitative data was collected by the interviews with relevant person.Chi-square test was used to analyze the construction of rural clinics,and different modes of rural clinics’ service delivery,income and expenditure was compared and analyzed by u test and t test and other methods;The method of two-stage DEA-Tobit was applied to analyze the efficiency and influencing factors for two types of the health service;System dynamics analysis was used to build mathematical model and to predict the future development trend of rural clinics’ operation in Shandong Province,and then relevant countermeasures and suggestions were provided combined with management,economics,sociology and other related knowledge to promote the healthy development and operation of rural clinics.Results The overall construction of rural clinics had been strengthened in Shandong Province.Although provincial planning rural clinics were better than those of non provincial planning ones in part of medical equipment and service construction,there is a certain gap between the whole rural clinics’ construction and their standard requirements;Human resources of rural clinics was in short supply,aging status was serious and rural doctors’ training needed to be further improved;Rural clinics’ fiscal subsidies investment continued to improve,but still cannot meet the needs of the grassroots,and integrated management of rural clinics’ rights and obligations was not equal;Rural clinics’ overall services showed an upward trend,medical health services existing hidden trouble,and rural clinics presented a decreasing trend in balance of payments.The proportion of DEA efficiency unit for medical health services and public health services were low.Factors that affect the efficiency of medical health services were: whether the village clinics were provincial planning,service radius,the population of villages;public health service efficiency factors as the elderly population;SD method,which was used to simulate the future development trend of rural clinics,showed that rural clinics’ future income will be slowly rising,but rising incomes will be mainly from financial subsidies rising,and if it continues to enforce the existing policy of essential medicine system,do not to make any adjustments,rural clinics will gradually focus on public health service because of the drug shortage and the reduction of diagnosis and treatment income.Even worse,the limited grants from public health service will be insufficient to make up for the reduction of the medical income of rural clinics,and total income will be reduced gradually,as a result,the increasing workload will promote the decreasing quality of public health service.If the training satisfaction of rural doctors improved,it will be conducive to increase the number of health services in rural clinics.Conclusion The construction of rural clinics has been strengthened,but the equipment still needs to be further improved;The rural doctors need to improve the self-quality,the training need to be further perfect;Rural clinics’ rights and obligations are not equal under the integrated management mode,and the pay is not proportional to the return;Although the drug policy has been loosened the mechanism of raising the medicine by the medicine,the shortage of drug hampers the function implementation of medicine health services in rural clinics;Rural clinics transfers their work focus to public health services,but the quality needs to be further improved;the rural clinics’ financial dependence will more and more serious,and whether the essential medicine system improved and satisfaction of training enhanced become the vital factor to keep the rural clinics sustainable development.Therefore,on the basis of systematic research,we clarify the relationship and operation mechanism,and develop effective countermeasures to improve the future healthy development of rural clinics.