| Objective: Based on a study of the development trend,current situation and influencing factors of the medical service capacity of township hospitals,this paper analyzed the key factors affecting the service capacity of township hospitals in minority areas in Guangxi,discussed the development strategies to improve the service capacity of township hospitals,and put forward relevant suggestions.Methods: The data of this study came from panel data and field survey of township health centers in Guilin City.This paper uses comparative analysis to understand the development trend of medical service ability in Guangxi Zhuang Autonomous region.The stratified and random multi-stage sampling method was used to investigate all township health centers in sample counties(districts).The basic data of township health centers in selected counties(districts)in 2021 were collected by means of cross-sectional survey,questionnaire,inquiry information system and in-depth interview.Based on grounded theory,statistical description,single factor analysis and multiple linear regression,the service capacity of township hospitals and its influencing factors were studied.EPIDATA3.1 was used to establish the database,and the two-person input was validated.SPSS26.0 was used for statistical analysis,and P < 0.05 was considered to be statistically significant.All data obtained from interviews were statistically analyzed by NVivo11.0 software.Results:(1)From 2011 to 2020,the number of township hospitals in Guangxi decreased year by year,and the overall number change trend was consistent with that of township hospitals in China.The number of beds in township hospitals,beds in rural medical institutions per 10 000 people,and rural health workers per 10 000 people in Guangxi and the whole country increased year by year,but lower than the national average.(2)From 2011 to 2020,the visits of township hospitals in Guangxi Zhuang Autonomous Region increased first and then decreased,while the visits of the whole country increased year by year,with a decline only in 2020.The number of inpatients fluctuated and the bed utilization rate fluctuated,but the overall bed utilization rate was higher than the national average level.The average length of stay of patients discharged from township hospitals in Guangxi and the whole country increased year by year,and the average length of stay of patients discharged from township hospitals in Guangxi was lower than the national level.(3)The annual total number of patients was statistically significant(P <0.05).The annual number of two-way referrals was very small,and there was no significant difference.(4)Social and economic factors such as the number of people served and the distance to the county people’s hospital had no significant effect on township health centers.(5)Such resource allocation indicators as the number of authorized personnel,building floor area,number of authorized beds,number of actual beds,and number of equipment over 10 000 yuan at township hospitals were statistically significant(all P < 0.05).(6)The results of diagnosis and treatment capacity of common diseases showed that most of the outpatients and inpatients of township hospitals were in internal medicine and general practice.Specialized medical services such as surgery,obstetrics and gynecology,and oral(ENT)are shrinking.(7)The research results of appropriate health technology showed that the number of appropriate health technologies that township health hospitals in Guangxi could carry out was less than half of the national standard,and the types of existing health technologies were few and the difficulty was low.(8)The multivariate analysis of the medical service capacity of township hospitals found that the number of health technicians,the number of beds,and the salary and performance payment model of county-level township hospitals were important influencing factors for such hospitals(P < 0.1).(9)The qualitative results showed that Managers and staff of township health centers are unclear about the reimbursement rules of medical insurance,with less relevant training,and difficulty in implementing medical insurance policies.(10)Lack of compact countywide medical alliances,which weakly improve the medical service capacity of township hospitals.The family doctor contract policy does not truly achieve the integration of medical treatment and prevention,and cannot meet the heterogeneous health needs of patients.Conclusion: Guangxi lags behind the national level not only in terms of economic development,but also in terms of medical services and health resources allocation at township hospitals.This is reflected in the gradual contraction of medical services at such hospitals,and a downward trend in bed utilization rate.The allocation of human,financial and material health resources at township hospitals in Guangxi has been significantly improved,but the quality of resource allocation still needs to be improved.The content of medical services and appropriate health technologies promoted by township hospitals are still in the initial stage,which can only meet the basic health needs of patients;The construction of local countywide medical alliances is lack of closeness,and the upper and lower medical institutions do not have a two-way referral pathway;Differences in the financial compensation mechanism at the grassroots level are important influencing factors for the initiative of medical workers at township hospitals in providing medical services.It is recommended to optimize the allocation of human resources,rationally formulate performance appraisal and allocation plans,and strengthen the training of medical staff in medical insurance policy related business knowledge;Establish and improve the mechanism of inter-departmental cooperation,the mechanism of authority and responsibility and the mechanism of supervision;According to the structure of service groups,geographical environment and other factors,township health centers were divided into different functional positioning,and classified management was implemented.On the basis of ensuring basic medical and basic public health services,clinical services such as traditional Chinese medicine physiotherapy,combination of medical treatment and elderly care,and special specialties were rationally developed. |
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