| Objectives1.Health inspection and supervision-one of the basic requirements of society ruled by lawHealth inspection and supervision is the implementation of the health laws and regulations, to safeguard public health and medical services,and protect the people's health and related rights.Health inspection and supervision system plays a very important role in building the society ruled by law.2.Health inspection and supervision-one of the important parts of public health systemHealth inspection and supervision system is one of the important parts of public health system.In 2003 the SARS crisis told all the people the importance of public health system.And Premier Wen Jiabao said that,the goal of public health system was to establish and perfect the public health emergency system,disease prevention and control system and health inspection and supervision system.And the new medical system reform plan also mentioned it.3.The key issue of health inspection and supervision system-the incompletion of fulfillments of the public functions as the unclear definition and inadequate inputPreliminary studies found that there were many issues in the health inspection and supervision system.The key issue was the incompletion of fulfillments of the public functions. And the roots were the unclear definition and inadequate input.However,for the health inspection and supervision system,what is its public function? What about the status quo after the 3-year construction? What should the adequate input be? This series of issues must be resolved.And this paper just tries to answer these issues above.Materials and MethodsTo define the public function of health inspection and supervision system,applying literatures induction and analysis,brainstorming and intention survey.To know the status quo of the system,applying System Theory and "Structure-process-outcome" of "A Macro-Model of Health System" to develop the assessment index system and survey 630 institutions. To find out the influence factors of the functions fulfillment,applying factor analysis, correlation analysis,regression analysis and structure equation model.To nail down the input standard,applying criterion gap analysis and calculating the allocation standards of personnel and outlay.Results1.The public functions of health inspection and supervision system definedFollowing the rules of legal,social benefit priorities,consistent of functions and demands, practical and realistic,and dynamic,5 rounds and 41 person-times to revise and perfect,the public functions of health inspection and supervision system was defined,including 11 functions,31 categories,166 contents and 457 items.11 functions were:Health administrative licensing,health supervision and inspection,health monitoring and evaluation,case investigation,complaint and report disposal,public health emergencies dealing with,health inspection and supervision during important activities,health inspection,propaganda and education on health laws,information management of health inspection,team training and management.93.7%of 209 sample institutions agreed it.2.The assessment index system of health inspection and supervision system developedApplying System Theory and "Structure-process-outcome" of "A Macro-Model of Health System",3 rounds and 25 person-times to revise and perfect,the assessment index system of health inspection and supervision system was developed.The index system was made up of 100 indexes,included 4 parts-"resources allocation","capacity building","function fulfillment" and "external evaluation".3.The status quo of resources allocationHealth supervision team has basically been established,but the quantity is not enough and the distribution is not so good.At present the health inspection and supervision centers have been constructed in 31 provinces(autonomous regions and municipalities),as well as the Xinjiang Production and Construction Corps,341 cities(prefectures)(98.3%),2,731 counties (districts)(94.2%) of China.And the team is made up of nearly 100000 people.Among them, 77.4%are in the institutional units.The quality of personnel structure tends to become more favorable.At present,there is 67.2%personnel engage health administrative enforcement.The titles of the technical post mainly concentrated in the intermediate(33.4%),primary(28.5%) and senior(10.0%).The ratio of undergraduates is over 27.1%above.And 36.1%of the legal,administrational,and other non-medical professionals join the team.At the same time,education and training become more important,with 39.2%average growth.The overall input was increased from 1.238 million Yuan to 1.676 million Yuan per institution,an increase of 36.5 percent,but there was still a large funding gap.Employee expense,current expense and operating expense respectively increased 38.7%,24.3%and 32.5%.Financing channels tends to become more rational.Government plays an absolute important role,the proportion from the 2001's 62.1%rising to 2006's 74.4%,and there is a yearly increase in the trend.However,government investment remained inadequate.The average gap of employee expense was 111,000 Yuan among the year 2004 to 2006,which increased 18.9%.The equity of financing was gradually improved.The equilibrium index of the county institutions decreased from 0.62 to 0.46,and that of city from 0.50 to 0.36,province 0.48 to 0.33 during the year 2001 to 2006.The area of work space has been made remarkable progress.The work space areas per capita of the province,city and city respectively are 29.1 centiares,26.0 centiares,and 26.3 centiares.But there are big gaps between the usable area and the criterion,the same as the floorage area per capita and property right floorage area.And the proportion of self-financing is too high.The quantities of equipments have been much increased.The average equipment asset of the provincial institutions is 2.945 million Yuan,and 695,000 Yuan for municipal and 356,000 Yuan for prefectural ones.There are 42.1 kinds of equipments in the provincial institutions,and the municipal and prefectural ones are respectively 27.7 and 17.0 kinds.However,there is also a big gap between the equipments allocation and the criterion.4.The status quo of capacity building of the health inspection and supervision systemIn the recent years especially in the nearly 3 years,the capacity of health inspection and supervision system has been enhanced,including health administrative licensing,health supervision and inspection,health monitoring and evaluation,case investigation,complaint and report disposal,public health emergencies dealing with,health inspection and supervision during important activities,health inspection,propaganda and education on health laws, information management of health inspection,team training and management.The average level of punctual transaction maintained at the rate of 98-99%.The average rate of health supervision and inspection is 95.4%,3.8%advanced.The system accomplished much more jobs of health inspection and supervision during important activities.In 2006 each institution took part in 37 important activities with 230 person-times. The quality and quantity of case investigation and complaint and report disposal have been increased too.In 2006 there are 116 cases registered and 106 cases closed,and the rate is 89.9%, increased 36.8%.There are 78 complaints and reports disposed and the rate of disposal within time is 99.1%,increased 33.5%.The capacity of public health emergencies dealing with has been enhanced too.The team of emergencies dealing with has been formed,the number increased 87.2%.And the achievements of capacity building of information management and propaganda and education on health laws have been obviously reached.In 2006 there are 9.3,4.3,and 2.3 pieces of equipments in the provincial,municipal and prefectural institutions.There are 14.5 affiches promulgated,65.9%increased.There are 88.6,48.1,and 9.3 papers in the newspapers or magazines from the provincial, municipal and prefectural institutions.The lectures and trainings also have been increased 41.9%.5.The status quo of functions fulfillments of the health inspection and supervision systemThe implement proportion is much higher in 2006 than in 2003.And the implement proportion of the clear functions is higher than those unclear,which respectively 62.8%and 37.9%.The implement proportion of case investigation is the highest(82.3%),followed by complaint and report disposal(74.4%) and health inspection(72.6%),health monitoring and evaluation last(35.0%).With the continuous deepening of the construction of the health inspection and supervision system,the implement degree achieved an average level of 70.6%in 2006,11.5%higher than the initiative year.The fulfillment degree is 39.1%in 2006,a large gap from the full implementation.6.External evaluation of health inspection and supervision system90%of the samples think that after 3-year construction,the capacity of health inspection and supervision system enhanced,and the public understand more and benefit more.7.Input-output analysis of health inspection and supervision systemThe allocation of resources directly affects the capacity building and functions fulfillment. The correlation coefficient between allocation of resources and capacity building is 0.615; which between allocation of resources and functions fulfillment is 0.396.The results of structural equation model also suggest that the allocation of resources plays a positive role in capacity building and functions fulfillments.The path coefficients respectively are 1.03 and 0.74. 8.The resources allocation standard of the health inspection and supervision systemThrough calculations,the personnel allocation standards of province,city and county are respectively 122 persons,77 persons,and 45 persons.And the total number of the nation is 164,249 persons,54.45%increased.And 9.082 billion Yuan of recurrent expenses is adequate, an additional requirement of 5.661 billion Yuan(165.48%);5.705 billion Yuan for purchasing the equipments;and 4.323 billion Yuan for housing construction.ExplorationsApplying literatures induction and analysis,brainstorming and intention survey,the public functions of health inspection and supervision system was defined for the first time,including 11 functions,31 categories,166 contents and 457 items.And 93.7%of 209 sample institutions agreed it.The definition of public functions provides the precondition of enhancing the health inspection and supervision system.Applying System Theory and "Structure-process-outcome" of "A Macro-Model of Health System",3 rounds and 25 person-times to revise and perfect,the assessment index system of health inspection and supervision system was developed.The index system was made up of 100 indexes,included 4 parts,"resources allocation","capacity building","function fulfillment" and "external evaluation",which provides the theory base of the integrated assessment.Applying criterion gap analysis,a calculate method of the input standard is developed.And by using the method,the allocation standards of personnel and outlay are calculated,which provides a ration point of how much should the government pay for the health inspection and supervision system.It is the first time that the applying of structure equation model(SEM) in the field of health inspection and supervision,which find out the influence factors of the functions fulfillment. |
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