The Feasibility Of Purchasing Community Health Service By Government On The View Of The Cost Component And The Structure

BackgroundAlong with the development of economy and the conversion of healthy idea, the concept that people belong to a certain unit has already day by day desalinate, but gradually returned to the society, the community. The community health service take meeting the need of primary health service as the goal and integrate with the prevention, the medical service, the health care, the healing, the health education and the family planning. The most difficult is lack of effective investment by government, especially the public health goods. The community health service display multiplicative function with difficulty and turn to an awkward predicament.The community health service is not only the key point of the current hygienic service, but the essential way of realizing the primary medical care for everybody. However, it is lack of effective investment by government for short of research on cost and structure for community health service at present. Research on the feasibility of purchasing the community health service by government through the cost and structure conform to the sociological and economic rule, also is the management goal for the government.That purchasing the community health service is on the premise of analysis of cost and structure. So that it lets the government know the direction and degree of investment in community health service and reduces blindness for government investment. The research not only conforms to the international convention, also has the support of economic and sociological theory, at the same time obtains the government and the domestic scholar's the approval. It will help to go out of the predicament for community health service and improve the equality of health resources attribution. Certainly, it is one of most important contents to construct our harmonious society.ObjectivesTo identify the direction and degree of investment in community health service though analysis the feasibility of purchasing the community health service by government on the view of running cost and structure. To provide scientific evidence for the government to promote sustainable development of community health service.Methods1. Literature researchA series of consults were done to obtain the information of cost and structure on community health service, especially abroad.2. Questionnaire designThe questionnaire was designed according to local health worker's practical experience and the finance report form.3. Sampling methodCluster stratified sampling was conducted in 8 community health service centers in Jianggan borough, 19 community health service centers in Shaoxing country and 8 community health service centers in Fenghua country according to the uniform questionnaire.4. Survey on SpotTo grip the running cost and structure of community health service centers, such as basic situation, revenue and expenditure situation, human resources, equipment construction, service development situation and so on.Results1. The setting of community health service centers conforms to the national standard.2. There are differences among the three samples in the fields of age, educational level and technical post (PO.01). The average age of collectivity is 34.51±10.60. The proportions of graduate are 49.9% in city, 41.1% in town and 28.5% in rural. However, it presents problems that the number of doctors is 2.4 times higher than national standard. The proportions of non-medical professionals are 18.2% in city, 17.5% in town and 11.8% in rural.3. The expend cost is mainly consist of labor cost, depreciation cost and affair cost, which are above 80%. The labor cost plays an important role. The main compensable income comes from drug, which is about 59.15%. Government financing is obviously fund shortage, which is about 11.42%.Conclusions1. Taking one thing with another, the city sample is better than the countryside sample.2. It has settled favorable foundation of purchasing community health service by government for its young oriented age structure, higher educational level and fine family medicine training background.3. The structure of compensation is unreasonable for overfull of drug income and short of government financing;The expend cost is mainly consist of labor cost, depreciation cost and affair cost (training cost), which are the directions of purchasing community health service.4. It is possible to purchase community health service by government in ZhejiangProvince according to analysis of the cost and structure, the correlative theory research, the economic base of Zhejiang Province and government's management goal. Community health service centers can attempt to conduct the new mechanism that public health and primary care are purchased by government, or primary care is partly purchased by basic medical insurance and extent health service is purchased by society and individual.