Study On The Performance Evaluation Of Township Health Centers In Rural Area

ObjectivesWith the more and more health resources being put into the rural area from the government continuously,it is the problem needed to be solved that how to improve and increase the health service quality,efficiency and cost - effectiveness of THCs. As a scientific method, performance assessment has been widely and effectively used to supervise and administrate health service organizations.This study was aimed to use a serise of theoretic analysis and practical research to build up the performance evaluation theoretical framework and indicators system of THCs based on reviewing the literatures at home and abroad. Then provide some evidence for the government to implement the performance assessing, and also help the health administrators and researchers correctly evaluate the performance and quality of THCs so as to develop reasonable strategies suggestions in improving THCs performance.MethodsIn this study,lots of theories and methods were used from health economics,health statistics,social medical and health manangement,and based on objective and subjective assessment methods to explore the theory and methods of performance evaluation of THC in rural area. Main methods such as: 1.the research methods of performance evaluation theoretical framework and indictors were: (1) Literature searching ;(2)Experts discussion and Delphi method;(3) Variation coefficient method;(4) Hypothesis test;(5) The cross verification of objective and subjective assessment method.2. The method of computing the indicators weight including: (1) Subjective principle of the function's drive; (2)Objective principle of the difference's drive;(3)The comprehensive principle on the weight coefficient. 3.The methods of reliability and validity test of indictors system are Spearman rank correlation test method and Cronbach's alpha coefficient test way.ResultsBy systematical summing-up and comparing the performance evaluation methods and theories of domestic and overseas,focusing on rural health system reform trend and THC's functional orientation,and through experts discussion and empirical research,the results of this study are as follows: (1)Some relevant performance theory analyzed deeply and put forward the conceptation of THC performance.Firstly, performance is described in different levels by systems,organizations and individual,and THC performance belongs to organizations;Secondly,performance is multiple dimensions,bu not a single one,it's a comprehensive concept;Thirdly,it has Value Orientation,not only embodies the input-output efficiency, but the value of"Human-Oriented"and social responsibilities;Finally,THC performance should reflcet fully the function of"six-in- one"and service responsibility. On these theoretical analysis, the concepts of performance of THC is making full use of social resources to health service maximization and improves people's health status obviously, under the development idea of"Health for all"and "six-in-one ", center on patients, guarantee the quality of health service. This concept is prospective,and reflects the essence and historical mission of THCs in our country. (2) The of methods performance evaluation have developed to the innovation term of indicators system,and then absorbs and utilizes these mature methods, integrates the balanced scorecard(BSC)and Key performance indicators(KPI). In the end, we formed the theoretical system of THC performance evaluation in rural area.In the performance evaluation practice, the research and utilization of performance appraisal is still in its Starting period in primary health organizations,there is no scientific and systematic program of performance evaluation for THCs.(3)Having constructed the dimensions of performance assessment which contains six aspects,such as service efficiency, the quantity per person enjoys, the cost-effectiveness, the realization of function, the quality of service and the development potential in the THCs.(4)Building up THC performance evaluation indicators system,which composes of 6 first class indictors, 17 second class and 78 third class indictors.The weight coefficients of the three-level indicators were calculated by subjective principle of the function's drive,objective principle of the difference's drive and the comprehensive principle.The weight of 6 indicators of the first class are 0.20,0.15,0..10,0.25,0.20,0.10.(5) "The standard service unit"was chosen as the smallest unit to measure the quantity of health service provided by THCs.Then, all the service items were transformed to the standard quantity of "the standard service unit"based on technical content, labor intensity and risk degree. On the other hand,the input of THC includes: government input, self-investment, depreciation of fixed assets and capital and human resource.Then we explored the method of measure the economic efficiency of THCs.(6) Creating the new comprehensive indicators—"The comprehensive health index" reflects the entirety health state of population,the indicators of the incidence of legal infections, the infant mortality rate, stroke incidence of patients with hypertension,the incidengces of EPI related diseases,the control rate of patients with hypertension and maternal mortality were selected to measure the health status for residents.and other complex indicaors as"the quality of service " reflects the technical quality, non-technical quality and satisfaction of patients and so on. (7)The reliability and validity of indictors system: Spearman ranking correlation coefficient is 0.78(P<0.05),and Cronbach's alpha are 0.9012 and 0.8642 of the second class indictors and the third class indictors,it was showed that the reliability and validity of the indicators system is very good. (8)We made the questionnaires of THCs performance on the based of the indicators system.By the reliability and validity tested, had done the fields survey appraisal of THCs in 2006 an 2007 in Qinghai Province and Chongqing.The results showed there had obvious difference in service efficiency, cost-effectiveness,and service quality in THCs in different area, and low efficiency,low service quality and insufficient utilization of health services in rural areas are very common. Some THCs can not fulfill the function of"six-in-one", the service idea of"human-oriented"must be strengthened in work. ConclusionsBased on the results of the research,the conclusions and recommendations could be put forward.(1) The concepts of performance of THC is making full use of social resources to health service maximization and improves people's health status obviously, under the development idea of"Health for all"and "six-in-one ", center on patients, guarantee the quality of health service. This concept is prospective,and reflects the essence and historical mission of THCs in our country. (2)Based on the service functions and social functions of THCs,the theorical framewark of perforamce evaluation of THC has six dimensions: service efficiency, the quantity per person enjoys, the cost-effectiveness, the realization of function, the quality of service and the development potential.This theorical framewark enrichs and develops the perforamce evaluation theorical system.(3) The performance evaluation indicators system is set up surrounding firmly the performance evaluation theory and function positioning of THC.The whole indicators system is valid,feasible and realible.(4)The weight coefficient of the three-level indicators is based on subjective principle of the function's drive, objective principle of the difference's drive and the comprehensive principle on the weight coefficient.These methods were reasonable.(5) By composing "the standard service unit"and"The comprehensive health index",then forming the revelant measurement methods,it solved the technical problems about appraisal methods of efficiency and cost-effective.(6) Through compared evaluation, more times verified in fields and Cronbach's alpha coefficient tested,the result demonstrates that the performance indicator system is steady, practicable and has good reliability and validity.(7) From the perspective of the government, this performance evaluating indicators system could systematically disclose that in what level the Township Health Centers, could provide some good advice for the government to implement the performance assessing, and also help the health administrators and researchers correctly evaluate the performance and quality of the organizations so as to develop reasonable strategies suggestions in improving the THC's performance. Innovation1.Explored and improved the performance and performance evaluation theoriesFrom WHO promulgating the health system performance of 191 member countries in 2000, the scholars at home and abroad had done a series of studies in health system performance from different points of view and countries,but very lillle in the performance of THCs.Utilization the public health organizations performance evaluation theory, from the perspective of the government, integrated the duty and function orientation of the primary health institutions, pursued the values of human oreientation and harmonious society,the study developed the concepts of performance of THCs is making full use of social resources to health service maximization and improves people's health status obviously, under the development idea of"Health for all"and "six-in-one ", center on patients, guarantee the quality of health service. This concept is prospective,and reflects the essence and historical mission of THCs, and building up the performance evaluation theoretical framework form input, output,service quality,efficiency,cost-effectiveness and the development potential,et al.2.Established the method of measure health service—"The standard service unit"The service of THCs is very complicated and intercompared difficultly.Many researchers measure the quantity of health service based on time or cost,but not grasp the health service essence,such as technical content, labor intensity and risk degree. This study put forward:all the service items were transformed to the standard quantity of "The standard service unit"based on technical content, labor intensity and risk degree.So,we solved the technical and theory problem in measuring the quantity of health service by THCs.3. Constructed the new composited indicatorsOn the methods of appraisal six dimensions,we broke through the qualitative methods and constructed the new composited indicators. "The comprehensive health index" reflects the entirety health state of population,"the quality of service " reflects the technical quality, non-technical quality and satisfaction of patients and so on.At length, We build up the mathematical model to calculated the true performance scores of THCs.