Evidence Basded Research On Aossication Between Public-private Partnership Model And Public Health Performance In Rural China

[Purpose]This study aims to identify the migration pathway of EPHS institution,establish the conceptual framework,and therefore,the assessment model to compare the EPHS provision performance between the two PPP systems,which are respectively dominated by public and private hospitals at township level,to shed light on the internal pattern of how PPP systems influence the performance of EPHS provision,according to which,propose the corresponding management strategy to improve the system performance and provide the theoretical support for advancing the EPHS system.[Methods](1)Literature reviewCollected literature on EPHS,performance and PPP in the health care filed from databases,including Web of Science and CNKI,to define the migration pathway of the institutions related to the EPHS system and explore further knowledge of the System Dynamic Theory.Conduct the word frequency analysis to define the connotation of PPP in primary health system,and explore its hotspots based on Citespace visualization map.(2)Field investigation methodIn the first phase,this study randomly selected a total of 11 counties in Guangdong,Hubei,Henan,and Chongqing for questionnaire on the process of collaboration and the public health performance.In the second phase,data from a total of 4 counties,12 PPP systems at township level in Hubei,Henan,and Guizhou were systematically collected to update the information regarding the system performance.In the third phase,the EPHS performance of one township in Henan,including two PPP models respectively dominated by public hospital and private hospital,was monitored to provide the evidence in comparison of performance.(3)Delphi and Entropy methodExpert consultations were conducted to design the performance assessment index framework,the corresponding indicators and their weights.Entropy method was used to optimize the index weights.(4)Mathematical statisticsThe study has adopted TOPSIS to evaluate the EPHS performance whereas binary correlation analysis was used to explore its potential association with cooperation elements of PPP.Binary Logistic regression was employed to identify the impact factors of chronic patients’ proactivity and its impact on the performance.(5)Qualitative comparative analysisQualitative comparative analysis was used to verify the hypotheses of the impact of PPP mechanism such as training,cooperation,supervision and evaluation,incentive and constraint mechanism,and communication feedback on the performance.(6)Peter Senge’s archetype analysis technique and In-trees archetype generating set analysisThe study adopted Peter.Senge’s archetype analysis technique to diagnose the incremental upper limit of performance,employed the In-trees archetype generating set analysis to constructer system dynamics structure for the EPHS performance.[Results](1)Participated by private village physician and supervised by government departments,the main and special PPP models were respectively dominated by public township hospital and private hospital.To achieve multiparty win-win goals,the mechanism of training,cooperation,supervision and evaluation,incentive and constraint mechanism,and communication came into being between the township and village providers.(2)The structure,process and outcome of the conceptual framework of PPP based EPHS performance system,as well as the internal associations between these three elements.The general generating pathway of EPHS performance is to obtain residents’ satisfaction,the health status of target population,and effect of projects against the population through increasing the volume and level of standardization of EPHS,including expanding target population coverage,enriching personal service package,and increasing the number of population projects.The PPP mechanism directly influenced the process and outcome variables,due to the impact of f external variables on intermediary variables and the mutual effects among intermediary,process,and outcome variables.(3)After controlling the interference,the case study showed that despite the type of PPP cooperation,the system performance improved as time passed by,Between two different types of PPP cooperation,the overall performance of the mainstream PPP model dominated by public township hospitals surpassed the special PPP model dominated by private township hospitals.This was due to the absolutely superiority in structural performance.Regarding the outcome performance,although special PPP model was better than that of mainstream PPP model,although it had declined in these years.Simultaneously,there was no difference in structure performance between two models.(4)The degree of public and private cooperation is the fundamental factor of EPHS performance,and the level of performance was influenced by the supervision and evaluation mechanism.Lack of incentive and restraint mechanism lead to low performance under the condition of lack of coordination or weak supervision and assessment,while high performance results were not determined by incentive or constraint mechanism.The premise of the impact of service capability on performance is close cooperation.The high intensity strength skill training and inspection linked with financial incentives was an important way to improve service capability.[Conclusions]The high level of process and outcome performance is derived from effective public and private cooperation mechanisms,the cooperation tightness and supervision and assessment mechanism have great influence.The case study shows that the performance of mainstream PPP model is superior to that of special PPP model,but the special geographic location and enthusiasm of private hospitals should be ignored,and time is a risk facing the decision-maker when employing the special PPP model dominated by private township hospitals.While the uncertainty of the base number of the potential target population existed,the decision-maker is urged to pay close attention to that providers sacrifice the screening performance by rejecting the new key population from receiving the free project to maintain a high level of health management on key population.Simutaneously,to improve the performance,this study suggest to set realistic performance goals,strengthen relationship governance,improve the township-level cooperation management,pay equal attention to incentive and restraint mechanisms,enhance the connotation construction of special talents,accurately identify the reasonable demands of the target population.[Innovation and limitation]Innovation:(1)Based on quantitative comparison analysis,this study has revealed that the performance of mainstream PPP is better than that of special PPP model,and provided evidence to support that time is the key risk factor of social medical organization to provide public services.(2)Based on the qualitative comparative analysis,this study has demonstrated the evidence-based relationship between the mechanism of public-private cooperation and the EPHS performance,and therefore,put forward some pertinent strategic suggestions using the flow chart of system dynamics.Limitation:(1)The entropy method only optimized the weight of some objective indicators,while those of some subjective indicators are worth further refining.(2)The number of explanatory variables of PPP mechanism is limited due to the sample size.The effect of PPP mechanism on performance is difficult to avoid the subjective influence of the researchers.