Study On Community Health Management Service System With Traditional Chinese Medicine Characteristics

The rapid economic and social development in China has driven residents' rising demand for health.How to maximize the health benefits under the realistic conditions of relative shortage of health resources and to solve the conflict between the people' s ever-growing needs for a better life and the unbalanced and uneven development,has brought a new challenge to the medical and health care industry in China.The community health management service with the characteristics of traditional Chinese medicine is a useful attempt to carry forward the concept of "prevention treatment",to give full play to the"simple,convenient,cheap and proved"advantages of traditional Chinese medicine,and to innovate the supply of health services.It is a valuable exploration for the development of health in the new era.It is the basic mission of health management researchers to sort out and sum up the experiences of community health management services in TCM in time and to conduct in-depth theoretical research.OBJECTIVE:This study take Gongshu District of Hangzhou as a sample area of the National Medical Service Demonstration Community with a special feature of TCM,research and evaluation of its current resources configuration,operation status and service effectiveness of community health management service systems with TCM characteristics,summarize the body of the system and its flow path.Summarize the successful experiences of service practices,analyze existing problems,and provide policy recommendations for service promotion.METHODS:The study is based on the argument logic of "combination of point and surface,specific and abstraction,on-site investigation and system research":1.On-site investigation:Take the sample area of the Twelfth Five-Year Plan"technology supported project of the National "Twelve-Five" Science and Technology Support Plan Project as a research site,and discuss the Liwan District of Guangzhou,Yangpu District of Shanghai,Shijingshan District of Beijing and Gongshu District of Hangzhou,eight community health service centers in this four districts,conducted questionnaire surveys targeting community residents and medical workers.Descriptive analysis,Logistic regression analysis and other methods are used to study the current status,service needs,service utilization and other issues of community health management service with TCM characteristics.2.Case study:Focusing further on the four sample areas,select the Gongshu District of Hangzhou City as a typical case,Gongshu District is a National medical service demonstration community with a special feature of TCM,the then vice minister of the Ministry of Health,the director of the State Administration of Traditional Chinese Medicine Wang Guo-qiang has been visited Gongshu District for further investigation and guidance 5 times in a year,The School of Health Management of Hangzhou Normal University is one of the cooperators of the five-way cooperation model of"government-industry-university-research-user" in Gongshu District's"Preventive Treatment Diseases"project.Descriptive statistics and econometric model(Gini coefficient,Lorenz curve,data envelopment analysis)were used to analyze the relative efficiency and fairness of community health management service resource allocation.Consolidate the community health management service with TCM characteristics in Gongshu District,to sort out and summarize the origin,process,and maj or achievements of health management services for TCM in Gongshu District,and evaluate the target,process and result of the service effect.To take the key population of community health management services as the research object,conducted on the practice of community health management services for the elderly in Gongshu District.3.Systematic analysis:Based on the summary of the community health management service with TCM characteristics in Gongshu District,take the multi-center governance theory as the perspective,use the soft system method(SSM)to target the tasks of the community health service system.To refine and classify the relevant subjects and functional sub-systems of the community health management service with TCM characteristics that is included in it,to summarized the functions and relationships of the system and sub-systems,and the overall efficiency of the system is analyzed based on previous research results,to provide ideas for system improvement.4.Development strategy:To consolidate the service model in Gongshu District,and develop the strategy from the point of view of practical research and system analysis.RESULTS:1.Service demand and utilization survey results show that chronic disease is an important threat to the health of residents.The prevalence of hypertension in the sample area was 17.96%,the prevalence of dyslipidemia was 7.98%,the prevalence of type 2 diabetes was 7.67%,and the coexistence of multiple diseases was more serious.Residents have more health problems in the two dimensions of "pain and discomfort"and "anxiety and depression",suggesting that the residents have a strong demand for services.Residents' demand for service is 73.4%,which is relatively strong.Residents' service utilization rate was 39.9%,the demand did not translate into actual use.Residents' satisfaction with the service is close to the border between neutrality and approval,and there is room for improvement in service quality.20.87%of medical workers expressed "very familiar" with the service,and the difference between awareness rate and residents was statistically significant(P<0.05).The DEA analysis research show that the average comprehensive efficiency of community health management services is good,but had an efficiency loss of 18.5%,and there were problems of excess input and insufficient output in the five DMU.2.Case study results show that according to the fairness of the population allocation,the Gini coefficient of Gongshu District community health organizations and the number of health workers is 0.61,0.40,judging from the fairness of geographical distribution,the Gini coefficient of Gongshu District's number of community health institutions and the number of health workers is 0.44 and 0.93.The unfairness of the number of community health technicians need to pay attention.The survey results on the allocation of health management service resources for community health management service with TCM characteristics in Gongshu District show that the appropriate technical equipment and manpower input for TCM have been increasing year by year,and the outpatient visits for TCM preventive and health care services have increased.The residents' utilization rate for preventative treatment has increased,and the quality of TCM preventive health service technicians is not high,and the problem how to attract talented people is a bottleneck that restricts service development.The results of key populations research suggest that the health problems of the elderly population in Gongshu District are more serious.In addition,the elderly has a large number of populations and the demand for health management services for the elderly is strong.Gongshu District has established a solid foundation in TCM health services for many years.It has taken advantage of TCM's health services,combined with the brand building of "see TCM doctor to Gongshu" built over many years,explored and established TCM as a feature,regional cooperation,public-private partnerships,complementary advantages,and resource-sharing features of TCM health management service for the elderly.3.10 subjects associated with the operation of the community health management service with TCM characteristics system:governments,health administration agencies,financial institutions,personnel agencies,community health service agencies,general hospitals,health insurance agencies,maternal and child health/illness prevention and control agencies,civil affairs agencies,residents,were refined by the use of SSM process.This system is owned by the government and "health-centered" is the purpose of systemic action.The integration of resources in multiple departments provides the basic conditions for the operation of the system.The community health service machine serves as the specific implementer of the system function and provides the residents of the area with TCM.Community health management services are featured to promote and maintain the health of residents.According to different functions and roles to divide the system into five functional sub-systems:social-economic system,decision-making system,management execution system,related support system,and performance evaluation and feedback system.Functional sub-systems running in tandem path analysis,combined with the findings point out the problems of the real level of impact the overall efficiency of the system,provide ideas for system improvements.CONCLUSION:The study concluded that community health management services with TCM characteristics are the direction of community health service development.The promotion of services has practical significance in meet the health needs of residents,respond to an aging population,promote preventive treatment concepts and methods of practical significance to participate in community health service system construction."Gongshu Model" has been formed with some features like following:Government guidance-centered on the health of the residents of the area to achieve the integration of multi-source resources;Community mobilization-focused on the improvement of the ability of community health service providers to improve TCM;Residents participate-aimed to increase the awareness of residents' active participation and sense of acquisition.The study considers that the full integration of TCM health services and health management services at the grassroots level can respond to the requirements of "provide comprehensive and full-cycle health services for people"proposed by the Party's Nineteenth Congress report:adherence to "health centered"and take the concept of treatment disease as guiding ideology,to integrate TCM health services into the basic functions of community health services,innovation in the form of government-purchased services to guide the orderly entry of social capital into primary health care services;use the health related projects to promote the improvement of residents' health literacy,improve residents self-awareness of health management;,strengthening the construction of general practitioners,stabilizing and enriching the ranks of grass-roots Chinese medicine talents,and establishing a quality evaluation mechanism for community health management services based on continuous quality improvement.