| BackgroundTownship hospitals are the leading force in rural health services in China. As the reform of economic structures has gone deeply and polybasic rural economy has developed rapidly, the circumstances of township hospitals have been changed greatly, which have brought many difficulties to them. Thus, the reforms in township hospitals have become imperative. "Cooperative management system", "movable property auction and immovable property rental" and "overall property transference" were the typical reforms of the township hospitals in Zhejiang Province. In view of the solitary but one-sided studies in the past and the urgent need for expediting the reform of the rural health system, it was indispensable to make a systematic and horizontal contrast and evaluation among the different reforms, and find out the actual effects induced by these reforms.ObjectivesThe aim of the study was (1)to clarify and compare the three reform programmes, (2)to evaluate objectively the actual effects induced by these reforms and (3)to provide some suggestions on improving the reforms.MethodsThree typical reforms of the township hospitals in Zhejiang Province were selected. They were "cooperative management system" in Xian Ju county, "movable property auction and immovable property rental" in Chun An county and "overall property transference" in Xiao Shan district. AH the township hospitals, in which the durations of reform were over 12 months in the three sample counties or district, were generally surveyed. The combinedinvestigations were used, such as the survey of the on-the-spot, the file and the forum, in the procedures of property treatment, stock allot, benefit distribution and personnel management in the three reforms. By longitudinal contrast health resources and utilization effects were also surveyed which included basic construction, health manpower, health service ability, employee's enthusiasm, economic running and patients' satisfaction. All data after check was saved in Excel data base by professionals. SPSS 8.0 version for Windows was used for the data analysis.ResultsAll the township hospitals according to the conditions of sample selection were completely investigated. Of all samples, 16, 6 and 7 township hospitals were in Xian Ju, Chun An and Xiao Shan sample respectively. Over 95% of total items were filled in.The following are the main part of the three reform programmes. Xian Ju Programme with "cooperative management system" was characterized by taking out all movable property and setting up national stock, collective stock and employees' stock which comprised shares (20%), longevity (50%) and services (30%). Chun An Programme with "movable property auction and immovable property rental" meant that the township hospitals audited the movable property once only and rented the immovable property for 3 years. The employees' benefits were distributed according to their contributions to the hospitals. 40% of the total surplus was also allotted to the employees while 60% was given to the renters at the end of the year. Xiao Shan Programme with "overall property transference" was distinguished from transferring all movable and immovable property to the transferees. Thus, all national property was withdrawn completely. The employees' status was changed into "social persons" and the township hospitals implemented employment contract system. It was established that the employees' benefits would not be less than 60% of the total surplus, while the repay of transferees would not be higher than 16% of the total surplus.Distinct achievements have been gained in the three reforms. The investment on the health service recourse has increased in Xian Ju sample and decreased in Chun An sample, while the number of medical employees decreased and the fund for medical facility purchase added in Xiao Shan sample. Clinical load raised in all the three samples in which the Xian Ju sample was most remarkable. The public health tasks were completed excellently in the three samples. Economic condition...
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