Research On Medical Service Provision In Different Regional Types Of Township Health Centers

~[Purpose]The sample towns were classified according to regional comprehensive factors such as natural geography and social economic conditions,the quantity,structure and influencing factors of medical services provided by different regional types of township health centers(THCs)were analyzed,the results provide a reference for the establishment of policies on the management,resource allocation and service functions of township hospitals according to the comprehensive development of towns.[Methods]Through literature analysis,the regional factors of township health centers were identified.Multi-stage stratified unequal probability sampling and cluster sampling were used to select 366 towns.The collected data mainly come from the self-made questionnaire,the statistical yearbook of the sample area,the local reported data and the government’s open data.SPSS20.0 was used to divide the sample towns into different types of comprehensive development by using the method of hierarchical cluster analysis.Through EXCEL2013 and SPSS20.0,anova and descriptive analysis were adopted to analyze the quantity and structure of medical services as well as the differences of medical resourcesprovided by THCs in different types of towns.Finally,through the SPSS macro compiled by Hayes(2012),the mediating effect model of the medical service quantity of township hospitals of different regional types was established based on the theoretical hypothesis,analysis of variance,multiple linear regression and other data analysis results,and the influencing factors of the medical service quantity of THCs of different regional types were analyzed.[Results]1.Geographical distribution and basic characteristics of different types of townsAccording to the physical geography,economy and population factors of the towns,the sample towns can be divided into three types of towns.The first type of towns with a high level of comprehensive development are mainly distributed in the eastern and central regions of China,and the terrain is mainly plain.There are more permanent residents and chronic disease patients,higher population density,and higher per capita GDP and industrialization level in the township area.The second type of towns with medium level of comprehensive development are mainly distributed in the eastern and western regions.The terrain of the towns is dominated by hills and mountains.The population density and the level of population urbanization is relatively high.The third types of towns with low level of comprehensive development are mainly distributed in the central and western regions.The terrain is mainly hills and mountains,and there are fewer resident population and chronic disease patients,lower population density and population urbanization level,lower per capita GDP and industrialization level.2.Differences and influencing factors in the provision of medical services in THCs of different regional typesThe higher the comprehensive development level of the towns,the more medical services available in the THCs,the more medical resources available,and the more extended medical services and featured medical services provided(P<0.05).But more than 50%of the THCs have the ability to provide expand medical services or characteristic medical service in the third types of towns with low level of comprehensive development.And in the second type of towns with medium level of comprehensive development,THCs provide basic medical service still accounts for about 40%,the ability of these THCs and the level of social development does not adapt.In the towns with the highest level of comprehensive development,32%of the THCs were able to provide characteristic medical service,and the service capacity of the township hospitals was unbalanced.For the first type of towns,the total income of THCs and the number of health technicians can positively predict visits in THCs.The total income of township hospitals can positively predict the number of health technicians.Through the mediating effect of the number of health technicians in township hospitals,the per capita GDP of township hospitals has a negative predictive effect on the visits in THCs.For the second type of towns,population density and total income of THCs have a positive prediction effect on the visits,while the mediating effect of population density of township hospitals on the visits is not significant(sobel value is 0.400).For the third types of towns,the per capita GDP and the number of health technicians in township hospitals have a positive prediction effect on the visits of the THCs,and the per capita GDP of towns has a positive prediction effect on the visits.The proportion of the elderly has a negative predictive effect on the visits,while the mediating effect of health technicians on the relationship of proportion of the elderly and visits in the THCs is not significant(P>0.05).[Conclusions]There are great differences in the physical geographical conditions and the conditions of social and economic development among the towns.In the towns with a high level of comprehensive development,the visits and resources of medical services provided by THCs are also large.However,the structure of medical services and the capacity of medical services are still not suitable for the level of socio-economic development of the towns.The government needs to classify the management,allocate the medical resources and determine the service function of the township health centers according to the comprehensive development conditions of the towns.