The Influencing Factors Of The County Medical Community On The Level Of Public Health Service

Since the “strengthen the basic health care” strategy of the new medical reform in 2009,primary public health services have become the focus of policy attention,and the government has invested a lot in public health.However,the issues of inadequate clinical diagnosis and treatment capacity of primary medical and health still exist.In 2019,the county-level medical communities started to be promoted nationwide with the core goals of improving the clinical diagnosis and treatment capabilities and establishing a hierarchical diagnosis and treatment pattern.But due to limited resources,this process may in turn lead to neglect and weaken of public health.Therefore,public health has gradually become the focus of medical community construction.The construction of the county medical community in Zhejiang province started early and is of typical significance across the country.Since the start of the medical community trial in 2017,Zhejiang has not only been committed to promoting close cooperation with county-level medical and health institutions,but has also begun to promote institutional reforms in the legal person system and the financial system.After the construction of the medical community,the outpatient service capacity of primary medical institutions in Zhejiang has improved,and the hierarchical diagnosis and treatment pattern has been gradually established;the coverage rate of family doctor contracted services has increased,and the "health gatekeeper" system has been promoted;the signing rate of emerging public health projects has effectively increased and the new service model of medical-prevention integration was promoted.But for the medical community itself,there are still a series of problems,such as difficulty in recruiting and retaining people in remote counties;it is difficult to further advance the signing of family doctors;and the performance evaluation system of the medical community is incomplete.During the construction of the county medical community,the level of public health services is mainly affected by three factors: ex ante factors,in-event factors and ex post factors.According to this,in order to strengthen the public health services of the medical community,first of all,the functional positioning of medical institutions should be clarified,and all-round coordination of all units should be promoted.Secondly,it is necessary to further promote the integration of medical and prevention,strengthen the integration of medical and health resources and services,and build a coordinated integrated medical and preventive service model.Finally,a health-oriented assessment system should be established,assessment indicators and proportions that truly reflect health goals should be set,and the use of assessment results also should be strengthened.