Study On Status Of Hierarchical Medical In Jiangsu Province

Objetctive This study is intended to put forward Suggestions on the implementation of further optimized hierarchical medical in Jiangsu province,which is one of the four national comprehensive reform pilot provinces,through analyzing the current situation of implementation of grading diagnosis and treatment,grasping the main problems and contradictions and connecting with the actual situation.Methods This study collected data on health resource allocation in Jiangsu province from 2012 to 2016,including the number of medical and health institutions,beds,practicing(assistant)physicians,registered nurses and so on.Using Lorenz curve and Gini coefficient to analyze the fairness of resource allocation from the two dimensions of population and geography respectively.Selecting input and output indicators to evaluate the efficiency of health resource allocation by using data envelopment analyze(DEA).In order to analyze their cognition,satisfaction and factors affecting the implementation of grading treatment,stakeholders were interviewed and questionnaire survey was carried out to patients and health workers from community and districts medical institutions from December 2016 to February 2017.The results of questionnaires were input computer by Epidata 3.1 with two computers and two people meanwhile and were analyzed through descriptive analysis,chi-square test,logistic regression analysis by SPSS 21.0.Results(1)In 2016,the number of health workers in all hospitals increased by 34.99% compared to 2012,while in all community medical institutions increased by 15.00%.The number of health workers in hospitals was higher than that in community medical institutions in the same period of last year from 2012 to 2016.The number of health workers per thousand people owned increased by 29.20% from 2012 to 2016.In 2016,the total number of medical and health institutions increased by 3.36% compared with 2012 and the growth rate of hospitals was higher than the community medical institutions.The total number of medical and health institutions' beds increased by 33.01%,and the total growth rate of hospital was higher than the community medical institutions and the same as year-to-year growth.The number of beds per thousand people owned increased by 31.59% from 2012 to 2016.The total income and total expenditure of medical and health institutions increased year by year from 2012 to 2016,but their year-on-year growth rates showed a downward trend.There was a continuous upward trend in hospital and community medical institutions outpatient service visits.The number of outpatients which community medical institutions doctors treat every day was about 2 times than of hospitals'.The number of inpatients in hospital and community medical institutions increased continuously.The year-on-year growth rate of the hospital was higher than community medical institutions,and the same as utilization rate of sick beds.The number of patients with standardized management of hypertension and type 2 diabetes increased year by year,with a total growth rate of about 41.96% and 45.63% respectively.(2)In terms of population equity,the Lorenz curve of the cumulative percentage of beds was the farthest from the absolute mean line,which was the most relatively unfair.In terms of geographical equity,the five curves was all far from the absolute mean line.The distance from geographical equity curve to the absolute mean line was farther than the population equity's.In 2016,the Gini coefficients according to population distribution were less than 0.2 except the beds',and the geographically distributed Gini coefficients were all between 0.2 and 0.3.The Gini coefficient of population distribution was less than the geographical distribution.(3)The efficiency of health resources as the DEA of general hospitals,community health service centers and community health service stations was relatively effective in 2016.(4)According to the results of Logistic regression,patients with spouses,chronic diseases,and higher level of satisfaction with community medical institutions treatment are more willing to have the first visit in community medical institutions.The health workers at district medical institutions are more willing to implement two-way referral than at community medical institutions.The higher satisfaction of hierarchical medical is,the higher the willingness of staffs to implement two-way referral,and the same as who think the hierarchical medical can improve their income.A clear referral guide is a contributing factor to the tow-way referral..Conclusion At present,the total amount of medical and health resources is expanding,but the overall trend is still more tilted to the hospital.The problems of difficulty in seeing a doctor and expensive medical treatment have not been alleviated yet.The overall health resources allocation is relatively fairer,but its efficiency varies.The rate of awareness and satisfaction of patients with graded diagnosis and treatment is low,whether is suffered from chronic diseases and their satisfaction with community medical institutions' diagnosis and treatment are important factors affecting their first visit choice.The cognition of hierarchical medical need to be further improved.The institutions they working,the satisfaction of hierarchical medical and the cognition of the influence of their income and whether there is a clear referral guard are important factors in the implementation of the two-way referral.What's more,our province's regional information sharing system and big data network have not been established yet.At last,health care policy does not sink patients currently.Therefore,persisting in the principles of government leading,upper and lower linkage,patient oriented,first diagnosis in charge,segmental service,safety and convenience,and resource sharing,optimizing the allocation of resources,and strengthening the first diagnosis of the community medical institutions and the construction of the grass-roots talent team are beneficial to carrying out hierarchical medical further and to promoting the establishment of a new pattern of medical treatment and a new order.