The Study On Delivery Models Of Health Services For Occupational Population In Shanghai

The goal of this study is to describe the differences of health services utilization with different delivery models of health services for employees in Shanghai and explore how to provide health services to employees with suitable delivery model in Shanghai.Quantitative and qualitative methods were employed to collect data as follwoings in the survey:1. The overview of health services delivery models for employees in Shanghai;2. The health services need of occupational population including medical health services, health risk factors and occupational risk in working place;3. The health services utilization of employees including medical, disease prevention & health promotion and occupational health services;4. The difference of health services utilization among different delivery models;5. The factors influencing the utilization of health services for occupational population.1. Main study results:(1) There are 4 kinds of delivery models for employee’s health services including:● The healthcare separation model in which the PHC is provided by a community healthcare centre nearby employees’ residential areas, while the governmental occupational health institutes are in charge of their occupational healthcare. This is the traditional and most popular model demonstrating a very limited coverage of employees.Intra-services model in large enterprises are led by healthcare institutes within a few large enterprises with occupational and PHCThe private healthcare model entitles those with high income, good health consciousness and high requirement for healthcare to purchasing health services from private providersThe integrated model of primary healthcare (PHC) and basic occupational health services (BOHS) where the family practitioners’ team from the community healthcare centres close to workplace provides a full package of services to employees with the help of organizers from workplaces including occupational and PHC such as non-communicable diseases management, health promotion and so on. This model has gradually caught great attention by Chinese government because of its high coverage of small and middle enterprises and informal employees and sustainable continuation of healthcare(2) The health services need of employees is demonstrated as higherThe medical healthcare services need kept high for employees in Shanghai with 21.5% of two-week morbidity rate,46.8% of the average morbidity rate of chronic diseases and 39.1% of insomnia prevalence.The health risks were prevalent among employees in Shanghai with 73.2% respondents having at least 2 kinds of health risks. About 21.8% employees had to work for about 45 hours and above per week.47.7% respondents felt high pressure from work and 52.7% employees showed positive on job stress. And those with poor mental condition took about 36.8% respondents. The smoking rate was up to 30.3% with 47% in male employees, and the passive smoking rate reached 48.4% mainly in working and entertainment place. Only 28.6% respondents took physical exercises regularly and 15% employees had the awareness about healthy diet. 41.6% of the employees realized the occupational hazards in their working place mainly as poor air condition, limited working space, noisy, too much dust and etc especially in high pollutant factories and construction sites.(3) The health services utilization of employees shows lower in ShanghaiIn those who got sick in 2 weeks before survey,76.1% patients received treatment and 58.9% chose to visit a physician with two-week visit rate 9%.The survey showed that up to 68.2% respondents were provided with less than 3 kinds of interventions.70.8% employees had taken blood pressure before our survey and 64.5% patients with high blood pressure (HBP) received the instruction about how to prevent and manage HBP from their physicians. The annual health examination rate and the biennial gynecological examination rate were as high as 74.9% and 66.4%. Only 46.8% employees, however, owned their individual electronical health records. And only 26.3% respondents received health educational materials and 18.9% attended health education classes. The utilization of services for maternal health and family planning guide were 47.8% and 39.3%.About 40.0% respondents were provided with less than 2 kinds of interventions. The utilization of each item is as blow:(4) The relationship between the delivery model and utilization of health services for employees There was difference of the utilization of medical healthcare, disease prevention & health promotion and basic occupational health services among the delivery models of health services for employees. The employees’utilization performed best through Intra-services model in large enterprises, following by the integrated model of PHC and BOHS, and the lowest through the healthcare separation model and the private healthcare model.(5) Key factors influencing the health services utilization for employees among different delivery modelsMost of employees had to work in their daily life but the community health centers always open from 8 am to 17 pm. And the working place always is far from where employee lives. So the advantage is extremely outstanding at the aspects of health service accessibility for the Intra-services model in large enterprises and the integrated model of PHC and BOHS.Under both of these 2 models, the health services were provided in working place with the accessibility of good time, geographic accessibility, familiarity with employees, affordability, feedback mechanism, integrated outreach services and so on compared with the healthcare separation model and private healthcare model.(6) Other key factors associating with health services utilization for employeesBarriers:Employees lack of health awareness, less support and guidance from healthcare policy related, limited human resources and poor HR management mechanism, limited funds and poor management mechanism, lack of unified information system.Motications:good enterprises involvement and participation, the government role as a bridge or link between the healthcare provider and enterprises.(7) With SWOT analysis, we found it’s effective and feasible for employees in large size of enterprises getting health services utilization through intra-services model, while employees from other kinds of enterprises provided by the integrated model of PHC and BOHS2. Advices on how to improve the health services utilization for employees in Shanghai(1) Effective health services under governmental support should be provided to employees in Shanghai;(2) Different health services delivery model for different type of enterprises as below: ◇ Large size of enterprises (over 1000 employees)——Intra-services model in large enterprises ◇ Other enterprises——The integrated model of PHC and BOHS ◇ The private healthcare model as a supplementary for those employees with the high demand of health services quality(3) Essential elements for a good health services utilization through Intra-services model in large enterprises and the integrated model of PHC and BOHS listed as below: ◇ Supportive environment:healthy policy related, information system, refined funding and human resources and optimizing management; ◇ Enterprises:supportive culture, specified organizer or intra-health care institute, coordination and activites organization; ◇ Community healthcare center:success of access to enterprises and occupational population, providing intergrated health services with match of needs employees, refined funding and human resources and optimizing management; ◇ Employees:high health awareness and promptly feedback ◇ Efficent communication among each role above...