Changes Of The Health Care Facilities In Rural China

1. BackgroundIn China, countryside is fundamental to economic development, social stability and prosperity of the whole country. Health services have a direct influence over economic development and social stability in rural areas. Due to the establishment and functioning of three-tier network of health care services, more health resources were available and the health status of rural residents improved, which enhanced the health services and maintained the economic development and social stability in rural areas. Problems existed while achievements gained. The key problem in terms of health services provision in rural areas is that preventive care is neglected and cannot maintain its normal function, attaching more importance to treatment than prevention, using income from treatment to compensate expenditure of preventive care provision, devoting much attention to salaried or profitable services but neglecting those gratuitous or lack of profitability, if more specifically.In recent years, series of public policies and official documents had been published, reflecting the reality that more and more attention was paying to rural health services by the government. Each level of health institutions, the quantity and quality of health facilities will inevitably affect the function of the three-tier network of health care services. This study tracks the changes of the same health institutions in terms of their equipment and provides evidence for relevant policy to improve the health facilities and health care services in rural China.2. Materials and MethodsThe Macro Model of Health System and Scientific Policy-making Procedures were introduced as general methods of the study. The data used cover published literature, existing databases and data collected through repeated survey.174 villages, 49 townships and 12 counties of 3 provinces in eastern China were sampled and the basic information of health institutions, the attitude of health professionals, and household health-related information were collected. Strict measures were taken in terms of quality control in survey techniques training and data management. Specific methods used include longitudinal comparison, crosswise comparison among different administration regions, the normative gap analysis, comprehensive index calculation, fishbone map analysis, etc.3. Results(1) The status quo of health facilities in rural areasThe number of policy documents which aims to guide health institutions' infrastructure construction is increasing and becoming more detailed. Meanwhile, the role and function of health institutions at different levels has been clarified gradually. There are few research conducted from the perspective of the functioning of the whole three-tier network. Data from Chinese health statistics yearbook published in recent years indicate that the health facilities has greatly improved in China as a whole, such as built-up area, sickbed number and equipment. (2) The changes of health facilities in rural areasThe facilities of county-level hospitals were improving generally and old equipment was replaced by advanced devices. However, the trend of changes was different in township hospitals, the number was decreasing for most types of equipment. As for the proportion of financial allocation from the government, it is lowest at county-level hospitals and highest in village clinics. Township hospitals did better than county-level hospitals in terms of equipment utilization. The built-up areas increased and ward conditions improved in the above institutions. From 2003 to 2007, the improvement of equipment of county-level center for disease control and prevention was greater than that of county-level center for health inspection. In rencent years, the latter maintained almost the same..(3) The normative gap analysis of health facilities in rural areasOverall, health facilities had improved a lot in recent years, but many deficiencies still needed to be solved. Surplus and scarcity existed at the same time in different aspects such as built-up area, sickbed number, equipment. For instance, the sickbed number per thousand people had already exceeded reference standard in most township hospitals, many necessary devices were in shortage while about 20 percent of township hospitals already had or planned to purchase CT. In country-level center for disease control and prevention, type B equipment was in most serious shortage. The equipment of county-level center for health inspection was in serious shortage generally.(4) Comprehensive index and functioning of three-tier network of health care servicesComparing the comprehensive index in 2003 and 2007, it can be concluded that the township hospitals'role remained almost the same to patients The conflict between economic interests of township hospitals and village clinics still existed and township hospitals were at inferior position in the three-tier network. The treatment and preventive care had improved slightly, but the negative effect of income stimulation from treatment services to preventive care still existed, which had been proved by the attitude of health professionals.(5) Problems and corresponding strategiesThe fishbone map analysis on factors resulting in the problem of preventive care neglect in rural health institutions indicate that the sickbed number was in excessive growth, the building for treatment and preventive care was imbalanced, medical equipment was in surplus, while preventive care equipment was in shortage. The role and function should be strictly defined; more resources ought to be put into preventive care to maintain necessary facilities; the feasibility and efficiency should be justified before purchasing equipment and routine management should be strengthened to enhance the efficiency of utilization.4. Conclusions(1) The national standards health institutions'facilities are improved gradually, but the capability of guidance and feasibility remained to be strengthened.(2)The health facilities of the three-tier network had improved a lot, but the fund mainly rely on the health institutions themselves and more resources should be put into health services in rural areas.(3) Surplus and shortage existed simultaneously in health institutions in rural areas. The allocation of equipment should be implemented according to the demand of local people and scientific management and utilization is necessary. (4) The out-of-order competition in the three-tier health care net-work still exist, though relieved to some extent. The tendency of attaching more importance to treatment than prevention and using income from treatment to compensate expenditure of preventive care provision should be paid attention to.