Analysis Of The Quality Of Medical Services And Related Factors Of Medical Clinics For Migrants

With the continuous development in economics and society of our country,migrant workers have become a new labor group formed in the process of urbanization.They have made a huge contribution for the development of urban economy in construction,manufacturing and other basic industries.They become an irreplaceable power in urban labour market.However,the protect measures of migrant workers in urban life have not been followed up completely.Medical problem is an essential part of that.Access to health care is an important way to meet health demand.And great health status can guarantee labor supply in high quality,improve the labor production and increase family income As the complex influence of economy,policy,knowledge and so on,migrant workers always choose clinics as their first medical treatment place rather than regular hospitals.So their medical service quality are essential for the health of migrant workers.What is the quality of the medical services exactly in these clinics?The current research data is very lacking.This research is mean to provide objective evidence on the quality of medical services in clinics which migrant workers usually visit,and analysis the relevant factors of medical quality.We use the "standard patient" method,together with questionnaire survey and vignette survey.Based on the combination of different ways,we choose 53 migrant clinics in Shaan,xi Xi'an and investigate them three times of each,collect the information of basic condition,the medical service condition and the knowledge level of doctors.In the "Standard patient" survey,we use angina,tuberculosis and diarrhea as the cases which has no obvious physiological symptoms and do not involve invasive procedures or test in diagnose.We measure the medical service quality through doctor's behavior in diagnose and treatment of three cases presented by standard patients.There are three main indicators,the complement of diagnosis process,the correctness of diagnose result,and the correctness of treatment.By the descriptive analysis and multiple regression analysis,we can clarify the correlate relationship between doctor training,facility construction and management to the quality of medical service.By the analysis we found that migrant clinic's,medical service is in vary low quality,only 18%items of questions or tests are carried out by doctors,only 11%of the case are correctly diagnosed,and only 35%of the diseases are treated correctly.Compare with other facilities no matter in or out of China,the results are so poor.Through analysis we know that doctor's education level,Compare the results from"standard patient" survey and vignette survey,we find that if doctors are informed in measure,they can complete 19%of the question and test,can correctly diagnose 23%cases and 38%disease can be treated correctly.It shows that the knowledge of doctors are poor similarly with their actual behavior.And there is an "know-do gap" in their diagnose.Through the correlation analysis,we find that medical certificate and training time recently are correlated with the quality positively.The medical knowledge is positively correlated with the diagnose in process and results,but no correlated with the treatment.We also find that the treatment is influenced by other variables such as income and curative effect.So the proper management is also important.Based on these results,we give some advices.Government should pay more attention to the poor quality of medical services in the migrant clinics and improve the quality of medical services for migrant workers.It can be down from strictly control the admittance of doctors in the qualifications and qualifications,increase the training of clinic doctors,strengthen the doctor's professional ethics and sense of responsibility,carry out a proper way of supervision or incentive mechanism on doctor's clinic service.