Health Services Comparison Study Of The Community Health Service Facilities Held By Different Ownership

ObjectivesThrough systematical analysis and comparison of health services supplied by community health service (CHS) facilities held by different ownership, including capacity of services and main factors, quantity and quality of services, stakeholders' reaction, to find out the similarities and differences of the CHS facilities in services held by different ownership, explore the main reasons behind these, to give reference information for further development of the community health service system construction.MethodsLiterature review:Through collection of previous survey data or research results published or unpublished by others, understand the previous studies. By systematic literature review, choose suitable measurement indicators and construct an analysis framework for our study.Questionnaire survey:(1) Investigation of the community health service facilities. According to the ownership, we randomly choose 46 CHS facilities, let the informed staff fill out the questionnaire, including the basic settings, the health workforce, the financial input, the pharmaceutical policy, etc. (2) Investigation of the staff. In the sample facilities, we randomly sent out the questionnaire and let the staff fill it themselves, including employment type, practice scope, title of technical post, income level and satisfaction. (3) Investigation of the residents. The trained investigators randomly choose the community residents and ask them questions on the questionnaire, including basic information, utilization of the CHS facilities, health knowledge and satisfaction. (4) Prescription investigation. Including antibiotics use, hormone use, rate of intravenous injection, price and eligibility of the prescription. Interviews with relevant stakeholders:(1) interview with informant persons from relevant departments of the municipal government, mainly including the department of health, finance, development and reform, etc, to understand the similarities and differences in policies and input between the CHS facilities held by different ownership. (2) Interview with managers of the CHS facilities held by different ownership. Understand the operation conditions of the facilities, the strength and weakness of development. (3) Focus group interview with staff. Understand the staff's attitudes towards CHS, satisfaction and expectations for the institutional developments. (4) Focus group interview with residents. Understand the residents'attitudes towards CHS and experiences in the CHS facilities held by different ownership.Quantitative analysis:Epidata 3.0 was used for validated entry and documentation of data; Excel2007 and SPSS 13.0 were used to analysis the similarities and differences between CHS facilities held by different ownership in settings, input, services amount, satisfaction of staff and residents, etc.Qualitative analysis:Four steps were used to analysis the main ideas of the interview, to understand the attitudes of the stakeholders towards the CHS facilities, the thoughts about the status quo, constrains factors and policies of the facilities.Comparison analysis:Quantitative and qualitative analyses were combined. The logical framework model was used to compare input-process-output-results between CHS facilities held by different ownership. Understand the similarities and differences between CHS facilities, and explore the main reasons behind these.ResultsServices amount:from January to June in 2008, the number of out-patient and emergency per person from highest to lowest were CHS facilities held by hospitals, enterprises, private and governments, with 0.594,0.501,0.265 and 0.225 respectively. There is no significant difference. The rate of the hypertension patients who were managed care from highest to lowest were by private, hospitals, governments and enterprises, with 95.10%,86.10%,82.53%and 75.27%respectively. The difference is significant (χ2=70.522, P<0.05). The rate of the diabetes patients who were managed care from highest to lowest were by hospitals, private, governments and enterprises, with 97.95%,93.83%,79.18%and 70.21%respectively. The difference is significant (X2=89.152, P<0.05)Satisfaction of staff:The integrated satisfactions of the staff from highest to lowest were by private, hospitals, enterprises and governments, with 62.98%,44.01%,43.60% and 24.23%respectively. The difference in single indicator is significant.Satisfaction of residents:The integrated satisfactions of the residents from highest to lowest were by hospitals, governments, private and enterprises, with 84.13%, 84.11%,80.65%and 79.29%respectively. Except the indicator of the convenience, the difference in single indicator is significant.Prescription investigations:The rates of eligibility of the prescription from highest to lowest were by hospitals, enterprises, private and governments, with 89.67%, 57.48%,47.69%and 36.73%respectively. The difference is significant (χ2=148.8, p<0.05)ConclusionsAll the CHS facilities held by different ownership have fulfilled some function in provision the basic medical service(BMS) and public health service(PHS) and played important roles in construction of community health service network. The services were accepted by the residents in different degree.The CHS facilities held by governments can receive comprehensive input from the government, which guarantee the facilities can run smoothly without worrying about the profit. But with these support, we need to explore how to ensure the CHS facilities can run efficiently. The facilities held by hospitals can get support from the hospitals in management and technology, which ensure the quality of the services. But it should be noted about the stability of staff and the development direction. The facilities held by enterprises have relatively fixed targeted customers, which make the services supply convenient. Also it can get some support from the enterprises. But with the transition of the institutional functions, expansion of targeted population served and decrease of input from enterprises, how to keep sustainable development is an issue need to be considered. The facilities held by private have good autonomy and flexibility. But due to lack of inputs and support policies, it has heavy burden to run. Also it should consider the sustainable development while ensuring the quality of the services.