A Research On The Situation Of Gate-Keeper Development And Its Influencing Factors In Chinese Urban

Objective: By combining our community health service policy environment, academic environment, and the situation to Gate-Keeper in community health service, we will analyse the status and influencing factors of Gate-Keeper System in China, and propose the conditions to implementation and policy regulations adapt to our country's political, economic and social development of the Gate-Keeper System conditions and the new operating mechanism of community health services.Methods:1. Document study. By searching and looking up the literatures internal and external, we can comprehend the successful methods, experiences and effects of Gate-Keeper System abroad, and also the internal and external environment, status quo and problem of community health service in our country.2. CGE. Ask the experts, who know the community health service very well, for advice about the suggestion to the project planning and the modifying view of the investigating design.3. Sampling methods. Multi-stage sampling has been used in this study. We selected for 3 Community Health Service Centre(good, medium, bad) from each of 7 areas (Jiang'an District, Jianghan District, Qiaokou District, Hanyang District, Wuchang District, Hongshan District, Qingshan District). Furthermore, we selected randomly 5 districts( Jianghan District, Wuchang District, Qingshan District, Hanyang District, Jiang'an District) from the areas mentioned above as residents research points.4. Questionnaire design. Community residents are our research target. Community residents treatment questionnaire developed combined with the need for this study by a literature survey and advice and recommendations from expert in this area.5. Semi-structured interviews. Semi-structured interviews'targets are the leadership about community health services in Health Bureau and the leadership in community health service centers. Interview outline to relevant leadership in Health Bureau and interview outline to relevant leadership in community health service centers developed combined with the need for this study by a literature survey and advice and recommendations from expert in this area.6. Statistics method. Establishment database and compute the value of standardized indicators and performance index by Epidata3.0. Descriptive Statistics, Correlation analysis are applied by SPSS13.0.Results:1. The awareness ratio of community health service institution in Wuhan is 65.4%, and the ratio of first visit care in CHS center is 53.7%. We can get the information that Wuhan is still at the beginning of Gate-Keeper System through investigation. It has not yet formed a complete sense of Gate-Keeper System. From the document, we know that our country have gradually developed some cities with great development of community health service as Gate-keeper system pilots.2. The policy support for supply-side and demand-side are very important to Gate-Keeper System, such as medical insurance claims increased and the funding implementation, the coordination of two-way referral policies, a rational allocation of human resources system and incentive mechanisms.3. From the point of view of residents, the importance of factors affecting orders from small to big are as follows: distance, price, light condition, service attitude, medical insurance, trustful doctors, treatment environment. Therefore, there must be more targeted and focused to formulate relevant policies to establish the trust of a community health services in hearts of residents.4. From the supply-side perspective, the importance of factors affecting orders from small to big are: the economic compensation, Medicare reimbursement, and two-way referral system is imperfect, residents confidence is not high, medical personnel, technical level is not high , and its service functions in place, and not enough publicity, outdated facilities, service attitude, service environment. Therefore, from a supply-side perspective, the implementation of the policy is the root cause.5. Political, economic, cultural, social and other factors affecting China's medical and health policy development, therefore, the first community consultation system must be suitable for the establishment of China's current national conditions and the principle of sustainable development. Government, the supply-side and demand-side in division of labor, respectively, do their work and mutual coordination and promotion, and gradually establish a community for Gate-Keeper system.Conclusions:1. Gate-Keeper system is the direction for future development of medicine and health system in our country, and foreign form can be used as reference.2. There are many obstacles in development in our country's Gate-Keeper System: Government's supporting policies, community health service organizations'service capabilities, residents'health concept, which are constraints interrelated mutually.3. The ideal Gate-Keeper System model including: hospitals and community health services two-way referral system (a clear referral standards, processes, feedback), Regulation and guide of Government to Gate-Keeper System (increase Medicare reimbursement intensity, implementation of health management to the residents, implement the"zero gap"cost drugs supply, etc.), strengthen the capabilities of community health service agencies (human resources, financial, and material), improvement of the health awareness and the concept to medical treatment in residents.