| [Purpose] The objective of this study is to explore the factors of the supply of surgery services in township hospitals on the basis of analyzing its present situation,figure out the policy target of incentive and constraints on the supply,and provide evidence for promoting the supply of suitable surgery services.[Methods] Based on the literature and policies collection,content analysis and second analysis methods were applied in analyzing the contents of surgery services of the rural areas including township hospitals from the international perspectives,and clearly identify the present situation of surgery services in township hospitals and its potential factors.According to the economic level,we applied the typical sampling method to select four counties,and collected data from all township hospitals and County Health Bureau including all surgery services in township hospitals,the NCMS reimbursement policy and areal health reform policy documents and health reimbursement data from 2011 to 2015.There were three steps to analyze these data in detail: first,factors of supply of appendicitis surgery services in township hospitals were analyzed with the panel logistic regression and negative binomial regression;second,we analyzed the factors in supplying the non-simple appendicitis surgery services in township hospitals through the panel logistic regression and panel Tobit regression;last,relevant health reimbursement data were extracted,and logistic regression was applied to analyze the health-seeking behavior of appendicitis patients.Epidata3.0,SPSS12.0 and Stata 11.5 were used in data collecting,management and analysis.In addition to the above quantitative analysis,we applied the semi-structured interviews to acquire the cognition and attitude of stakeholders towards the surgery services supply in township hospitals.The interviewees or stakeholders contained the deputy directors of three counties in charge of township hospitals,the NCMS office directors and vice presidents of township hospitals and some patients.[Results]1.The status of surgical services provided by township hospitals(1)In 2011-2015,both the proportion of the township hospitals' surgical services number in the overall surgical services and in the overall township' hospitalized cases decreased,and the number and sequence of the surgical disease in the top 10 hospitalizations in the township hospitals declined,too.In the past five years,the total amount of appendicitis surgery provided by the township hospitals in the sampling counties has decreased from 589 cases to 1309 cases,and the proportion accounted for the total amount in the county decreased from 41.84% in 2012 to 26.77% in 2015.(2)In the past five years,the township hospitals in the sampling counties which cannot provide appendicitis surgery increased,and the proportion accounting for the overall proportion increased from 8.33% to 11.67%.The township hospitals that were able to provide but not provide increased,the proportion accounting for the overall proportion increased from 1.67% to 15.00%.The township hospitals that had been providing declined,the proportion in the overall decreased from 90.00% to 73.33%.(3)In the past five years,the number of township hospitals in sampling counties with acute or chronic simple appendicitis,suppurative appendicitis,gangrene and perforated appendicitis surgery reduced,and the proportion of the overall township hospitals was reduced separately from 79.55%,45.45%,31.82% to 46.67%,28.33%,15.00%.2.The regression analysis of the influencing factors of surgical services provided by township hospitals(1)This study clearly shows that the annual per capita net income of farmers,the average costs of appendicitis surgery services,the number of anesthesia doctors and health insurance payment type have significant association with this surgery supply in township hospitals after the panel logistic regression(P<0.05).(2)After the negative binomial regression,we find that the annual per capita net income of farmers,whether performance salary included the surgery services supply,the gaps between average outof-pocket of appendicitis patients in township hospitals and those in county-level hospitals,health insurance payment types and medical institution combo types have significant predictive effect on the number of appendicitis surgery services in township hospitals(P<0.05).(3)It is discovered that the gaps between average out-of-pocket of appendicitis patients in township hospitals and those in county-level hospitals,township hospital types and medical institution combo types have great predictive effect on the choice of non-simple appendicitis surgery services supply in township hospitals after the panel logistic regression(P<0.05).(4)Number of outpatients in township hospitals,the gaps between average out-of-pocket of appendicitis patients in township hospitals and those in county-level hospitals,township hospital types and medical institution combo types are associated with the proportion of number of the non-simple appendicitis surgery services in the total appendicitis surgery services in the results of panel Tobit regression(P<0.05).(5)Patients age,whether appendicitis type was acute simple appendicitis,distance between patient home and medical institutions,distance between patient home and the county people's hospitals,and gaps of between distance between patient home and county people's hospitals and distance between patient home and township hospitals have significant effect on the medical institutions choices of appendicitis patients who need surgery services,after the logistic regression analysis(P<0.05)3.Analysis of expert rating of township hospitals' surgical services influencing factors(1)The most important five factors which affect the willingness of providing appendicitis operations of the township hospitals that have the ability but do not provide are the institutional capacity,medical risks,institutions' willingness to provide,the patient's reluctance,travel time of going to the county people's hospital.(2)The first five factors that affect the number of appendicitis operations in the township hospitals that have been providing are the institutional capacity,the patient's reluctance,service population,the willingness to provide and the reimbursement costs gap of the county and township medical institutions.(3)The first five factors influencing the number of appendicitis surgery in township hospitals that provide many appendicitis operations are the compensation types of appendicitis surgery,the institutional capacity,service population,the number of outpatient and emergency visits and the reimbursement costs gap of the medical institutions at the county and township levels.(4)The first five factors affecting the number of appendicitis surgery in township hospitals providing few appendicitis surgery are the institutional capacity,the medical risks,the reluctance of the patients,the gap between the county and township medical institutions and institutions' willingness to provide.[Conclusions] Over the past five years,functions of surgical services provision in township hospitals showed atrophy,simple structure trend,and the importance of it in medical services provision in the county and in medical services provision of township hospital declined.In the future health care reform,the government should strengthen the operation ability of township hospitals and encourage the township hospitals to provide basic surgical services.Based on strengthening the surgical capacity of town hospitals,the factors about health insurance and patients play a vital role in surgical services provision in township hospitals.Further widening the reimbursement costs gap and patient cost of the county and township medical institutions,and increasing the overall payment towards the surgical disease in township hospitals,the establishment of medical liability insurance,and guiding patients to visit medical institutes reasonably,all contribute to the improvement of the quantity and structure of operation provision in township hospitals. |
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