| ObjectiveTo evaluate the service capacity and service efficiency of primary community health service institutions in main urban areas of Lanzhou City from 2016 to 2017,in order to provide scientific evidence by effectively and equitably allocating health resources of community health services.Methods(1)The data including the human resources,infrastructure,financial allocation of 230 community health service institutions in Lanzhou except the new district and all the three counties was selected to evaluate their service capabilities by using Excel database and SPSS 19.0 statistical software.(2)20 community health service institutions were randomly selected from 230 institutions to collect data such as service population,human resources,annual outpatient/emergency visits and the performance evaluation scores of public health service through questionnairesurvey.10 households were randomly selected from the covered population in each of 20 community health service providers through the Health Archives System,and a satisfaction survey was conducted through telephone visit using a self-designed questionnaire.Excel database was used to sort out the above data.SPSS 19.0 statistical software was used to conduct descriptive statistical analysis and chi-square test,evaluation indexes selection of service efficiency by extracting common factors through principal component analysis,and data envelopment analysis model in Max DEA 6.4 software was used to analyze service efficiency and main influencing factors.Results(1)Human resources: In 2016-2017,among the 230 community health service institutions in 5 urban districts of Lanzhou,there were 52 community health service centers and 178 community health service stations.On average,the service coverage population of each agency was 11,600 people.In 2016,the number of health technicians working in these institutions was 3,986,and the ratio of doctor and nurse was 0.70:1.In 2017,the number of health technicians was 4,018,and the ratio of doctor and nurse was 0.71:1.The average number of health technicians per 10,000 permanent residents was 13.6.(2)Infrastructure construction: From 2016 to 2017,the average construction area of community health service centers in 5 urban districts of Lanzhou was 1813.2 square meters,and the average construction area of community health service stations was 351.8 square meters.In 2016,the total number of equipments in various institutions was 1,537,of which 752 were more than 10,000 yuan.In 2017,the total number of equipment was 1,586,and 761 of them were more than 10,000 yuan.Compared with 2016,the total increase rate of equipment was 3.19% in 2017.(3)Financial allocation: 2016,the total financial allocation of community health service institutions in major urban areas of Lanzhou city was 121.88 million yuan,and in 2017 it was 131.54 million yuan.The total financial allocation in 2017 increased by 7.93% compared with that in 2016.Financial allocation is mainly used for public health projects.The average clinic fee of one outpatient visit was 47.80 yuan in 2016,and 47.93 yuan in 2017.The cost of outpatient visit was mainly paid by the basic medical insurance for urban residents.(4)Health service efficiency: In 2017,the average efficiency of 20 sample institutions was 0.93,and the proportion of effective institutions was 75.0%.The average technical efficiency was 0.98,and the proportion of effective institutions was 95.0%.The average efficiency of scale efficiency was 0.94,and the proportion of effective institutions was 95.0%.One institution with increasing returns to scale accounted for 5.0%.The main factors for the redundancy of non-effective institutions were the excessive population of the jurisdiction and the surplus of fixed assets.The main factors of insufficient output mainly were weak health education and vaccination work.(5)Resident satisfaction: The proportion of residents who satisfied with the convenience of medical treatment was high,and the total satisfaction rate was 67.74%.The satisfaction ratio of the service process was 64.52%.Gender had no significant effect on satisfaction of convenience,service attitude and service level.There was a significant difference in the satisfaction with other aspects among residents of different ages and different cultural degrees(P<0.05).Conclusions(1)The community health service system in the main urban areas of Lanzhou is perfect,and the infrastructure construction is basically up to standard,but the health human resource still needs to be improved,and the personnel structure needs to be optimized.(2)Community health service agencies in major urban areas of Lanzhou show high service efficiency,but further adjustments in input and output are needed to improve health service efficiency.(3)Residents have higher satisfaction with community health service institutions in major urban areas of Lanzhou,but the medical service level needs to be improved. |
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