Research On The Effect Assessment Of Township And Village Health Services Integration Policy In Western China

ObjectiveGuided by the theory of public policy evaluation, this study defined the connotation of the Township and Village Health Services Integration Policy (TVI) by analyzing the background and development history of TVI and exploring the policy issues. Based on the status of rural health system construction of western China, the fundamental goal and target system of TVI had been established and policy evaluation framework of TVI had been structured. Guided by policy evaluation framework of TVI, index system of the effect assessment of TVI in Western China had been developed and the tool used for evaluating effect of TVI in the empirical study, which provided a scientific and systematic tool for TVI affection evaluation and a theoretical guidance for optimization of policy implementation and local direction.MethodsFirst, through analyzing the background and development history of TVI, the policy questions were explored and then the connotation of TVI had been defined. Second, directed by the methods of document research, normative analysis and combining with theory analysis, practice guidance and expert consultation, the fundamental goal and target system of TVI had been established. Third, based on the SPO model and value orientation analysis of TVI, policy evaluation framework of TVI had been established. Fourth, by using the Delphi method, analytic hierarchy process (AHP), combined with empirical research, index system and weight of each index of the effect assessment of TVI in Western China had been developed. By the empirical study in Western China, the effect and infect factors were analyzed. Data source is from expert consulting data, empirical research field survey data and national health statistics yearbook data.Results(1) TVI policy is to form and establish a regional health service consortium which should suit for local economy and health service system development and with value orientation of systematic, economic and commonweal.(2) The target system of TVI includes six directly sub goals (i.e. optimize the allocation of health resources, standardized collaboration, providing health services continuity, improve the ability of healthcare capacity and health service quality and improve health workers’ satisfaction), and three indirect sub goals (i.e. improve the services’efficiency, improve residents’ health status and their satisfaction).(3) On the basis of the conceptual model, the policy evaluation index system includes the organization system, resource allocation and satisfaction with27indexes.(4) In the western region, more of the TVI mode was the loose integration mode. The rate of implement payment, pension insurance and unified financial management were66.67%,16.67%and33.33%, respectively.(5) From2008to2010, the rate of personnel exchange rate increased from5.25%to24.57%, public health workers had a7.75%increase and public health personnel density index rose to1.0685from1.0206.(6) In township hospitals, the proportion of public health workers was increased from12.96%in2008to15.42%and the proportion of working hours in public health services was increased by5.61%. While the rate in village clinics was raised from22.25%to65%.(7) In the loose integration mode, task completion rate of basic public health services in village clinics was48.84%, as the same time the rate in close integration was95.42%.(8) The supervision frequency between township hospitals and village clinics was raised from once a quarter in2008to1.43times a month in2010. The rate of village doctors attended more than twice doctor training was increased from60.37%to90.21%.(9) The writing standard rate of village clinics’prescription was increased from26.45%in2008to85.13%in2010.(10) The two couplet prescription antibiotics usage in village clinics in loose integration is11.52%and6.38%in the intensive integration.(11) In loose integration, the ratio of business income growth rate of township hospitals was0.77, and the ratio in the intensive integration was1.785. The average per capita income growth rate of village clinics was51.40%.(12) In loose integration, income satisfaction of village clinics was8.9; in townships’ business training satisfaction was6. The income satisfaction relatively close integration is7.5, training satisfaction was8.2.(13) The influence factors of effect of TVI policy can be divided into two parts, one is the content of policy itself and the other is the other policies which had the same scoped objects with TVI and township hospitals’ management efficiency.Conclusion(1) With the combined action of strengthen the construction of basic public health services of New Health System Reform, TVI could promote personnel exchanges, resource allocation and improve public health services providing. Meanwhile, the intensive integration could promote the implementation of public health services.(2) TVI could strengthen links between institutions and have the certain role in promoting the mutual coordination. What’s more, by strengthening townships hospitals management, the quality of medical practice standard and service of village clinics could be improved.(3) In the management of intensive integration, health personnel exchanges rate was higher and could promote the village clinics to return to commonweal. But the enthusiasm of the village doctors still depends on their income and the efficiency of township hospitals’ management. (4) The strategies for promoting TVI policy in western China:1) Clear and definite goals and strengthen the management efficiency of township hospitals.2) Make sure the reasonable income stable for village doctors and keep their enthusiasm.3) To carry out the intensive integration management in western China.4) Strengthen the combination of policies and cohesion.Innovation and LimitationMajor innovations:1) this is the first time to apply the theoretical framework of public policy on TVI in domestic health policy research.2) From the multiple perspectives of theory analysis and practice guidance, the goal of TVI has been defined and divided into quantifiable and verifiable sub goal system.3) Based on the guidance of conceptual framework and systematic analysis on the target system, the policy evaluation index system of TVI has been established, which provide a systematic tool for TVI affection evaluation.Major limitations:1) Cause of the difference among regional health service system construction, the optimal value of interval index use the value interval instead of standard values.2) Sample region of empirical research field survey exist certain national particularity and the sample number of villages and towns is insufficient.3) Due to the complexity of policy effect, this study used the theoretical analysis on influence factors instead of statistics methods.