Sichuan Rural Basic Public Health Services Research On Linkage Mechanism Of Township And Village With The Background Of New Medical Reform

Objective This study by exploring the township (town) Governments and village committees in the management of public health functions in order to enrich public health service management theory through research and construction of village-level medical institutions under different environmental conditions of basic public health service linkage mechanism to promote the development of our province’s equalization of basic public health services provide a useful reference.Method This study uses the following 5 ways:(1) literature, collecting relevant domestic research, including basic government functions, basic public health services in rural areas, rural integrated management research literature, national, provincial policy documents, provide references for research programming and follow-up studies. (2) interview method, on 7 a sample County (district) Health Council related head, and 9 by township hospitals is in charge of returning to of Dean, and 27 a village Secretary and 27 a village for half structure interview, understanding full Township basic public health service run situation; (3) questionnaire survey method, on sample institutions, and village and focus crowd for questionnaire survey, understanding basic public health service of implementation situation and the management effect. (4) the Delphi method, refer to basic public health services in rural areas of expert opinion in the field to identify four key people management indicators and indicator system of the external environment. (5) analytical hierarchy process, using this method to determine the basic public health services management the 4 level indicators and 14 secondary indicators weight external linkage, rural pattern of environmental indicators 4 and 12 secondary level index target weight.Results (1) through a literature review and field surveys, summed up the grass-roots level in rural basic public health services, the Government’s basic functions, including:organizational management, system functions, funding, regulatory services functions. (2) to village-level institutions in the rural basic public health service management Division, assessment and allocation of funds, summed up rural basic public health services, rural linkage of the three operation modes: village team service mode, the principal-agent model, the integrated target management model. (3) through the Delphi technique and analytic hierarchy process to establish a basic public health services in the four categories focused on crowd control effect evaluation index system of indicators and external environment. (4) the composite index method in evaluating the pros and cons of different management models to external environment. Village team service mode rendering of external environment can features is Township economic good, and population density big, and hospitals public conditions good, and grass-roots Government attention; commissioned agent mode of external environment features for hospitals business volume big, and village doctor business quality good, and grass-roots Government tie; integrated target management mode external environment features is terrain for mountain or population density smaller, and hospitals business volume larger, and village doctor quality better. (5) must depend on the external environment of country linkage mechanism, internal and external interaction affect the implementation of basic public health services. Evaluation results showed that rural health management team mode rate, full rate, neonatal health checkup visit rate standardization management quality rate, blood sugar control, diabetes rates are up to 90%, rural basic public health effect is good; the principal-agent model tallest in the control of blood pressure, blood sugar, followed by the overall effectiveness of health management, integrated quality management model of health management, such as the elderly Checkup complete standardized management of poor quality rate, high blood pressure and diabetes, the overall effectiveness of health management in the previous two models. Discussion In population intensive of area, basic public health service workload big, village doctor cannot independent completed village level 40% of work, if local grass-roots Government compared attention basic public health service work, can integrated coordination and participation which, and township hospitals public health team power strong, public health team backbone can effective of led hospitals other medical personnel and village doctor common carried out work, in this conditions, township hospitals public health personnel, and village doctor, and Village health officer on can team of form to implementation task, that gave birth to village team service mode of formed; and some township hospitals medical business volume big,^and public health personnel relative insufficient, village level public health work main falls in village doctor of body, but village doctor capacity limited situation, can according to himself of business situation and work capacity, control national provides of service project, will himself capacity range cannot completed of part work commissioned to township hospitals, and township hospitals signed corresponding of agreement, This conditions formed of village cooperation way belongs to commissioned agent mode; Township geography for mountain terrain, and population live dispersed, township hospitals medical business volume more heavy, hospitals public health personnel carried out basic public health service cost larger (as chronic visit depending on), at, if village doctor business quality better, hospitals through on its strengthened training, regularly assessment, will village level of 40% work decentralization to they, signed target management responsibility, An integrated model of management by objectives to implement essential public health services.Recommended Different external stimulus or internal linkage mechanism’s construction of the village, thus forming the different characteristics of the model, in this study team service mode of rural basic public health services in promoting and implementing better, followed by the principal-agent model. Recommends in population density larger, and grass-roots Government compared attention, and township hospitals public team better of situation can take village team service mode, by township hospitals of staff and village composition group common completed public health service work, hospitals assessment team, team long assessment team members, according to assessment results issued funding; in township hospitals business volume big, and village doctor service consciousness and business quality better, and grass-roots Government compared tie of situation, Village doctor will cannot completed of part commissioned to township hospitals and of signed agreement, funding according to village two level institutions actual bear of work for expensed; Township environment for mountain or population rare, township hospitals public personnel insufficient, if village doctor business quality also good, can considered on village health room of work for refinement, developed detailed of assessment programme and rules, clear village doctor of work, and will public Wei subsidies directly and work number, and quality hook.