Study On Accessibility Of Basic Occupational Health Service For Workers Of Small And Medium-sized Enterprises In Urban Areas

Objective:At present, there exists many occupational health problems in SMEs (small and medium-sized enterprises) in Hubei Province, and workers’ occupational health service is in poor conditions. In order to promote prevention and cure of occupational diseases and to protect SME workers’ occupational health interests, it is of great practical significance to carry on further research on SME workers’ basic occupational health service in Hubei, promote the accessibility and expand the coverage of occupational health service.Methods:1Literature analysisRead and collect the main research results home and abroad on basic occupational health service, accessibility of health service, SME workers’ occupational disease prevention, to provide a basis for the building of a conceptual model on basic occupational health service and the exploration of accessibility methods of SME workers’ basic occupational health service in Hubei.2On-site investigationQuestionnaires, insider semi-structured interviews and secondary data collection etc. were employed to implement on-site investigation of basic occupational health service accessibility from four dimensions-workers, small and medium-sized enterprises, occupational health service institutions, government regulatory authorities in typical survey regions including Wuhan City, Huangshi City, Jingmen City and Suizhou City.3Data analysis methods3.1Statistical analysisChi-square test or non-parametric test, non-conditional logistic regression, multiple linear regression, Spearman rank correlation, Hierarchical cluster and other data analysis methods were employed by SPSS11.5software. P<0.05was considered statistically significant.3.2Synthetical evaluation analysis TOPSIS analysis of accessibility of SME workers’ occupational health surveillance in the different regions was conducted using DPS V7.05, to explore the influence of inter-regional accessibility differences on SME workers’ occupational health surveillance.3.3PEST analysis From the political, economic, social and technical aspects, this paper discusses both positive and negative impacts that external environmental factors have on the development of SME workers’ basic occupational health service in Hubei.3.4Macroscopical policy normative analysis From the perspective of accessibility, the key problems and their causes and mechanisms of SME workers’ basic occupational health service in Hubei were analyzed, and the recommendations for corresponding model and strategy about the development of SME workers’ basic occupational health service in Hubei were advanced systematically afterwards.Results and conclusions:1SME workers’basic occupational health services situation is not optimistic. Only29.8%workers are entitled all the five basic occupational health service currently. Logistic regression analysis shows that the factors affecting their basic occupational health services are as following:whether to participate in work-related injury insurance, whether to sign labor contracts with their enterprises, size of enterprises, whether to join labour unions, their monthly income, weekly working time, age group, job nature.2SME workers’labour contract-signing condition is satisfying; while work-related injury insurance and labour union-joining situation is poor. Knowledge of occupational health surveillance is poor; attention to occupational health surveillance is inadequate despite the strong desire of occupational health surveillance. Health beliefs should be further strengthened. Spearman rank correlation analysis shows that there is a positive correlation between score of desire and that of knowledge about occupational health surveillance (r=0.467,P<0.05)3People in charge of SMEs are lack of awareness of occupational health, thus fail to take on the main responsibility. Foundation work of occupational health management is in poor condition, with a small number of management employees lacking of related work capacity and experience and enough training. The occupational health management system is not standardized and occupational health archives establishment is unsatisfying. Investment in basic occupational health service is not enough thus occupational health examination fees can hardly be guaranteed. Based on a representative indicator selected via variables cluster (R type cluster), the analysis of cases clustering (Q type cluster) over80SMEs shows that foundation work of management and investment about occupational health in collective and private enterprises are in relatively poor condition.4Hubei Province has made great progresses in building occupational health service institutions in recent years. The occupational health examination supply in aggregate can basically meet the occupational health examinations needs of workers exposed to occupational hazards in most districts. However, the number of occupational health examination agencies are still less than normal and are not reasonably distributed, thus SME workers have difficulty in having timely and convenient access to health examinations and other service provided by the agency in relatively short distance. Occupational health examination institutions should focus on improving health service methods and its quality. The effectiveness of occupational health service education and counseling on SME workers provided by primary health care institutions through basic public health service programs has not yet been evident.5The plan for occupational disease prevention has not been set up in many areas of Hubei Province. Safety supervision departments, especially those in grassroots areas, have not been guaranteed specialized agencies, full-time staff, law enforcement equipment, and enough working expenses. Multi-sectoral supervision and coordination mechanism of occupational disease prevention has not yet been established. Supervision and management force still need strengthening. Supervision and inspection coverage of enterprises, especially SMEs, is not enough; while supervision, law enforcement and punishment have been improved and the supervision and management of occupational health examination agencies is in fair condition.6Synthetical evaluation analysis via TOPSIS method shows that in the four regions, the order of accessibility of workers’occupational health surveillance has a fine correlation with that of their occupational health surveillance state, meaning the dimensions and indicators of accessibility can better represent various main factors in helping or impeding object acquire basic occupational health service. 7Recommendations for mode and strategy A developing mode with policy support, market-oriented operation and multi-faceted regulation should be built regarding urban SME workers’ basic occupational health service in Hubei.The recommendations for strategy about the development of urban SME workers’ basic occupational health service in Hubei:(1) Strengthen guidance of organizations, and revise policies and laws to improve SME workers’ basic occupational health service.(2) Strengthen publicity and training to enhance knowledge of basic occupational health service.(3) Increase SMEs’responsibility for the protection of the legitimate rights of workers’ access to basic occupational health service.(4) Build up occupational health service network and enhance its capacity to meet the needs of SME workers’ basic occupational health service.(5) Explore various channels to raise money to fund SME workers’basic occupational health service.(6) Make clear the occupational health regulatory system and operational mechanism to form a joint force of the supervision and management of SMEs.(7) Increase the number of professional occupational health personnel to promote the upgrading of working ability.(8) Make use of labour unions and other supervisory power to urge SMEs to effectively protect workers’ occupational health interests.Innovations:1In the context of "Basic Health service for All", basic occupational health service will be, for a fairly long time in the future, an important thought to SME workers’occupational disease prevention and control. In Hubei, this research still being in a blank state, this study presents the recommendations for mode and strategy about the development of urban SME workers’ basic occupational health service.2Accessibility is one of the main factors influencing the utilization of health services and the key to the understanding and developing of health policy. In this study, innovatively, the concept of health service accessibility is put into practice to construct a conceptual model to conduct a systematic study on accessibility of SME workers’basic occupational health service.