A Research On The Present State And Change Tendency In Development Of Private Medical Institutions In Gansu Province

Objectives: This article aims to find the advantages and disadvantages of private medical institutions in Gansu province by analyzing the present situation in health institutions,health manpower,health facilities and health financing in 2015,comparing with related aspects of public medical institutions.At the same time,this article analyzes the health service resources,utilization of health service,efficiency of health services and health services effect to study the change tendency of the development of private medical institutions in Gansu province,and has longitudinal evaluation to identify the development change tendency nearly nine years.Based on the research of the present situation and change tendency of private medical institutions in Gansu,to understand the present state and find the problems in the development process as well as the factors that affect its development;and to explore the ways and means to solve these problems,the purposes of this study are to provide the reality basis and some feasible policy suggestions for policy making of the relevant departments,so as to promote the sustainable development of private medical institutions in Gansu province,and to meet the diversified health needs of the people.Methods: Firstly,the article uses the method of descriptive statistics analysis to compare the differences in some health indicators,such as absolute number,composition ratio and proportion,among the private medical institutions and public health institutions of Gansu in2015.These health indicators include organization development,human resources,the number of bed,health financing and medical services,and so on.Secondly,dynamic sequence with the average speed of development and the average speed of growth are used to analysis variation tendency of medical health service resources,utilization of health service and health service efficiency and effect of health services of Gansu's private medical institutions in 2007-2015.Finally,using the expert consulting method to determine evaluation index system of the development of private medical institutions;and using Analytic Hierarchy Process(AHP)to determine the weight coefficient of each indicator;meanwhile,the method of Rank Sum Ratio(RSR)is also used to evaluate the development of private medical institutions for nine years in Gansu province.1.The present state of private medical institutions in Gansu province(1)Analysis results for the health agency show that: In 2015,grassroots medical institutions have the most proportion(97.72%)in Gansu's private medical institutions,and private medical institutions only account for 24.75% of the total number of medical institutions in Gansu.Meanwhile,private hospital account for 33.03% of the total number of hospital in Gansu,and private grassroots medical institutions account for 24.61% of the total number of grass-roots medical institutions in Gansu.Through analysis to private hospital and public hospital show that the number of hospital of traditional Chinese and Western medicine and specialized hospital of private medical institutions are all more than public hospitals;but the general hospital,hospital of traditional Chinese medicine and national hospital are less than the public hospital;the level of private hospital are low,and the rating of the hospital are only 34%,these numbers are far less than public hospitals,and that hospitals are small-scale.(2)Analysis results for the health personnel show that: In 2015,all kinds of health personnel of private medical institutions in Gansu are far less than the public medical institutions.Total number of health workers of private medical institutions in Gansu account for 14.58% of the health personnel in Gansu.Numbers of health care providers of Gansu's private medical institutions are lower than the public medical institutions,the proportion is only 0.79,and the proportion still has a long distance to the state configuration standard(1:2).The above results show that the health personnel of Gansu's private medical institutions are a relative shortage.The allocation of physicians and nurses is not reasonable,and there is a serious shortage of nurses.(3)Analysis results for the health facilities show that: In 2015,the numbers of bed of Gansu's private medical institutions account for 7.38% of the total beds of Gansu's medical institutions,meanwhile the numbers of bed has a long distance to the goal that the numbers of bed of private medical institutions account for 20% of the total beds of medical institutions by 2015.Overall,the numbers of bed of the hospital and grassroots medical institutions are far less than the public medical institutions.(4)Analysis results for the health financing show that: Gansu's private medical institutions haven't the subsidies from the next higher medical institutions,the grant from the state,the income from scientific research project and medical income are less than the public medical institutions,and the income relies mainly on the medical service,medical income accounts for 91.31% of total revenue.At the same time,hospital outpatient expense of private medical institutions is per capita8.89 RMB higher than public hospitals;inpatient hospitalization cost is per capita 1936.26 RMB lower than the public hospital.(5)Analysis results for the health service show that: In 2015,outpatient visits of Gansu's Results:private medical institutions account for 15.81% of total outpatient visits of Gansu;and hospital admissions account for 5.34% of total hospital admissions of Gansu.Times of bed turnover,beds workday,utilization,average patient length of stay are lower than the public hospital.(6)The proportion of profit medical institutions is most in Gansu's private medical institutions.Profit hospital has 108,and accounts for 73.97% of all private hospitals.2.change tendency of private medical institutions in Gansu province(1)Health service resources have an upward change tendency.In 2007-2015 in Gansu,the number of private medical institutions has decreased by 1773.The private hospitals from 42 in2007 increase to 146 in 2015,increase by 104;grassroots medical institutions in general has a decreasing change tendency,reduced by 1312.In nine years,the number of comprehensive hospital and specialized subject hospital has a obvious increase change tendency,and the proportion of comprehensive hospital has been more than other hospitals.The average annual growth rate of beds is 15.79%.In 2007-2015,all kinds of health personnel overall has a growth change tendency.The allocation of physicians and nurses increase from 0.51 in 2007 to 0.79 in2015,but the allocation is still not reasonable,and there is a serious shortage of nurses.(2)The indicators of utilization of health service have a steadily increasing change tendency.Outpatient visits has declined of Gansu's private medical institutions in 2007-2009,but from 2010,the outpatient visits has been an increasing change tendency,the annual average growth rate is5.13%.Hospital admissions of Gansu's private medical institutions in 2007-2015 has a growth change tendency,the average annual growth rate is 20.74%.(3)The efficiency of health services have greatly improved.The annual growth rate of times of bed turnover is 5.12%.Overall,utilization of bed also has a growth change tendency,increases from 61.96% in 2007 to 70.98% in 2015.Beds workday has relatively steady upward change tendency in general.Because the level of medical technology improves,average patient length of stay has a downward change tendency;it from 9.54 days in 2007 falls to 9.22 in 2015 days.Physicians daily for hospital bed days also have obvious increase.(4)The effect of health services is getting better,but stability is poor.In 2007-2015,the cure rate of hospitalized patients has fallen,but the range is less.The improvement rate of hospitalized patients has the obvious promotion,it from 25.40% in 2007 grows to 29.73% in 2015;at the same time,inpatient mortality from 0.38% in 2007 down to 0.02% in 2015.The mortality of emergency treatment is unstable for nine years,so the treatment level appears unstable situation.(5)The study has a expert consultation for 14 experts of relevant field,and sets up a index system of comprehensive evaluation for Gansu's private medical institutions that includes 4first-level indicators and 22 second level indicators.(6)In 2007-2015,the overall strength of private medical institutions in Gansu shows an enhanced change tendency.The study uses the method of Rank Sum Ratio(RSR)to comprehensive evaluation for health service resources,utilization of health service,efficiency of health services and health services effect.Analysis results for WRSR show that: the overall strength of Gansu's private medical institutions shows a growing change tendency in 2007-2015,and comprehensive strength has improved greatly in 2010 and beyond.Conclusions: 1.The overall strength of private medical institutions in Gansu shows an enhanced change tendency with increasing total health resources,health services utilization,efficiency of health services and health services effect.2.Gansu province has many private medical institutions,but they are all small-scale.3.Weak technological strength of Gansu's private medical institutions.4.The competitive power of Gansu's private medical institutions is weak.5.Government subsidies for Gansu's private medical institutions are less,and medical costs have the most share.6.The special characteristics of Gansu's private medical institutions is prominent,and the major medical institutions of private medical institutions in Gansu are profit medical institutions.