Research On Current Situation And Financial Security Of Basic Public Health Services In Border Counties Of Yunnan Province

Objective To investigate the implementation status of basic public health services in border counties of Yunnan Province,and reveal the gap between basic public health services and residents’ health needs in border counties,as well as find problems,especially in the issue of financial security.The main propose is to improve financial security measures for public health services.Methods We employed a cross-sectional survey study.According to the level of economic development and regional distribution,eight border counties(cities)in Yunnan Province were selected as survey units.A total of 1974 permanent residents and 152 leaders and staff of health systems were surveyed.Using a combination of qualitative interviews and quantitative questionnaires.Qualitative research software Atlas.ti 5.0 was chosen to sort out and analyze the questionnaire data.The statistical methods included statistical description,chi-square test,rank sum test.Results1.Status of basic public health services1.1 Implementation of basic public health services:(1)Information platform has be used in these investigated counties,but the degree of informatization is low.(2)There were 0.633 village doctors per 1000 population in the survey,but this failing to meet the requirement of 1village doctor per 1000 population.The majority of the basic public health service personnel are technical secondary school(72.2%).The proportion of public health-related majors in the majors studied was 4.35%;the proportion of temporary employees was 49.70%;58.7%part-timers for basic public health services.(3)40.41% of rural doctors felt that the workload was increasing and it was difficult to bear.10.27% of rural doctors experienced an decreasing salary after engaging in basic public health services.1.2 Residents’ participation in basic public health services:(1)67.27% of the residents hope to receive services for the prevention and treatment of chronic diseases,but only 31.56% of the residents who receive the service.(2)Nearly 11.7% of residents had never heard of basic public health services.Factors affecting the awareness rate of residents include occupation,education,and average monthly income.(3)46.66% of the residents had a good grasp of health knowledge.(4)87.6% of respondents had received at least one basic public health service,Health education and vaccination were the services that residents received more frequently.(5)The equipment configuration of the village health office and the technical level of the village doctors were the two least satisfied by residents,with the satisfaction rate of 31.41%and 32.83% respectively.2 Financial security situation and problems2.1 Funding input: the central government invests 80%,the provincial level invests 10%,and the state and county level inputs 0%-10%.The county level burden was bigger for the Nujiang.Insufficient investment,especially in service promotion,basic equipment,salary and treatment of grassroots service personnel,human resources,training,etc.2.2 Performance appraisal and appropriation: in the border counties of Yunnan Province,the funds allocation method of “first budget,settlement after pre-allocation,and linked to performance appraisal” was basically established.However,during the implementation process,there were still problems: assessment frequency is too high,performance appraisal and incentive system need to be improved.The assessment criteria did not apply to the border situation.There are problems such as untimely disbursement,low advance appropriation ratio,and township advance funds.2.3 Funding allocation: the allocation of funds was mainly two types: the village clinic receives subsidies for those who do basic public health work,funds shared by the departments which are involved in township hospitals;Who does the work who gets the subsidy funds without sharing situation.However,there still exists the situation that the subsidy funds have not been paid to individuals and have not been distributed according to work.2.4Use of funds: there was a situation of “funds stranded” and the funding management plan was not enough detailed.The application is not clear.The scope of use of the fund management plan is narrow.Part of the work at the village level can not be carried out,these work by the hospital can not share the subsidy funds.Some of the services provided by township hospitals generate medical costs but the subsidies cannot be converted into business income.Professional institutions need financial support for training,supervision,and assessment of subordinates but they cannot use subsidy.Conclusion1.Status of basic public health services1.1 Status of provision of basic public health services: the counties have a systematic management system for the national standards.However,the following problems still exist:(1)The construction of basic public health service information platform remain to be improved.(2)The number of service personnel is insufficient,which is less than the national standard.The basic public health service personnel are overburdened.The staff structure is unreasonable.The degree of education is low;the public health related majors are relatively small in the majors studied;temporary employment is more common.1.2 Residents of border counties in Yunnan Province have high demand for basic public health services,but the demand is not satisfactory.The awareness of basic public health services needs to be improved and the equipment configuration of village clinics and the technical level of rural doctors are not satisfactory.2 Financial security2.1 Funding input: The border counties in Yunnan province are underfunded,especially in terms of service propaganda,basic equipment,salary and treatment of grassroots service personnel,manpower security,training,etc,the investment in these aspects should be increased.2.2 Performance appraisal and appropriation: The border counties in Yunnan Province have basically established the fund allocation method of “ first budget,settlement after pre-allocation,and linked to performance appraisal”.However,in the implementation process,there are still problems: the performance appraisal has too high assessment frequency,and the appraisal standard does not apply to the border situation;untimely disbursement,no disbursement to individuals,and low pre-allocated.The performance appraisal and fund disbursement system should be improved,and the supervision of fund disbursement should be strengthened.2.3 Funding allocation: the border counties in Yunnan Province have basically established a distribution method according to the distribution of labor,but there are still cases where the subsidy funds have not been paid to individuals and have not been distributed according to work.2.4 Use of funds: There is a situation of “funds stranded” and the funding management plan is not detailed enough.It is recommended to improve the budget management plan of Yunnan Province and expand the scope of use of funds in combination with the characteristics of border counties.