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Objective:To establish a set of scientific and reasonable indicator system of common prosperity in the field of health, so as to promote the construction and evaluation of the demonstration area of common prosperity with high quality of health.Methods:According to the requirements of promoting common prosperity demonstration area with high quality of health in Zhejiang province, the initial indicator pool was established through literature research and theoretical analysis in July 2021, and experts were convened to carry out expert brainstorming to determine indicator system in the form of meetings. Delphi method was used to conduct two rounds of expert consultation on the indicator system.Finally, the analytic hierarchy process and percentage weight method were used to calculate the indicator weight value.Results:The final indicator system included 4 first-level indicators and 30 second-level indicators. Among the first-level indicators, the weight values of the development, equilibrium, inclusiveness, and sustainability were 0.326 4, 0.242 8, 0.245 8, and 0.185 0. There were 8 second-level indicators in developmental indicator dimension, of which the indicator with the highest weight was the per capita health expectancy. The balance indicator dimension included 6 second-level indicators, of which the indicator with the highest weight was the per capita financing difference of basic medical insurance between the urban workers with the urban-rural residents. The inclusive indicator dimension included 6 second-level indicators, and the proportion of personal health expenditure to total health expenditure had the highest weight. The sustainability indicator dimension included 10 second-level indicators, and the proportion of government health expenditure in fiscal expenditure had the highest weight.Conclusions:The indicator system constructed in this research could provide certain guidance and reference for promoting the construction of common prosperity in health, and provide some reference for follow-up research in this field.
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Objective:To establish a set of evaluation indicator system of policy coordination of integrated county healthcare consortium based on the construction practice of integrated county healthcare consortium in Zhejiang province.Methods:Based on the guiding opinions and relevant supporting policy documents issued by Zhejiang province, the initial indicator pool was established through literature research and theoretical analysis, and the indicator system was modified and perfected in two rounds by Delphi method. The weight value of the indicators was calculated by the priority chart method.Results:The indicator system included 4 first-level indicators, 10 second-level indicators and 35 third-level indicators. Among the first-level indicators, the weight values of health insurance payment, personnel salary, price reform, fiscal and finance were 0.406, 0.281, 0.141 and 0.172, respectively.Conclusions:The indicator system established in this study has certain rationality and feasibility, which can provide reference for promoting the construction of integrated county healthcare consortium in China from the perspective of policy coordination, and provide reference for relevant scholars to carry out follow-up research.
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The past ten years have witnessed China′s primary public health services making remarkable progress in the number of projects and funding subsidy standards, but such problems as the single nature of the main supplying entities, poor supply mechanism and low supply efficiency are still prominent. The authors comprehensively expounded the present situation of the supply of primary public health services in China from the aspects of implementation subject, service content, fund guarantee, human resources, supply mode and performance evaluation, studied and summarized the evolution process and characteristics of public health service supply model. On such basis, they recommended on improving the supply model from the perspective of tripartite subjects of government, market and social organization, so as to speed up the formation of the government-led public service supply model, in which the market, the society and other pluralistic subjects participate equally, construct the competitive supply pattern of medical and health services at county and township levels, strengthen the purchase from social organizations and improve the performance evaluation system and supervision mechanism.
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Objective To analyze the medical service capacity of primary healthcare in Zhejiang province since the ongoing healthcare reform and put forward suggestions. Methods Key indicators of healthcare resources and medical service utilization from 2009 to 2015 reflecting the primary healthcare were identified,for a quantitative analysis in terms of the structure-process-outcome dimensions. Results In terms of structural service capacity,the average headcount growth rate of primary healthcare′s technical personnel was 5. 7% per year; the personnel competence structure kept improving; the hospital beds at primary institutions and their ratio among all were slightly decreased,with better devices and informatization. In terms of procedural service capacity,the proportion of primary institutions with contract-based services amounted to 89. 9%,with the standard contract signing rate up to 18. 8%. In terms of consequential service capacity,the average growth rate of the number of outpatient visits at primary institutions was 6. 3%. The amount and proportion of inpatients were slightly decreased,while the hospital bed utilization ratio was increased slightly. Conclusions It is necessary to further strengthen the training and introduction of primary healthcare professionals. The functional orientation of hospitals at various levels should be clarified, encouraging contract-signing of general practitioners, promote the medical insurance payment reform featuring the capitation payment at primary level,and improve the income distribution and incentive mechanism.
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Objective To examine the occupational stability,training needs and capacity building requirements of the general practitioners purposely trained to work in rural communities,for improvement of policies regarding their training and issues related. Methods There counties were selected by stratified random sampling, where general practitioners graduated from such training completed an anonymous questionnaire. Focus group interviews were made to officials of the local Health and Family Planning Commission,those of primary healthcare institutions,and general practitioners themselves. Results The of the 190 valid questionnaires recovered, male accounted for 34. 2% and female 65. 8%. These general practitioners were mostly satisfied with their working environment, social status, work stress and job achievement,yet with lower satisfaction with their salary and availability of medical devices. Consideration of resignation was reported by only 5. 3% of them,with more males than females. As high as 63. 2% of them prefer to work in hospitals of county level. 91. 1% of them held it as necessary to participate in standard resident training,and 98. 4% held it as necessary to have on-job training. 94. 7% of them have participated in further education to gain a bachelor degree in medicine. Conclusions These doctors were found with high stability to work in rural communities and low turnover intention. Further studies are required to encourage these general practitioners to serve rural communities in a long term, and to improve the standard resident training mechanism,and their career development.
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Objective To explore the economic performance after the performance‐based reform at primary medical institutions in Zhejiang Province and put forward measures for improving primary medical services .Methods Questionnaire investigation was conducted among 84 primary medical institutions with staff over 20 .The financial statements of these institutions during 2009‐2014 were collected and studied as well .Results The average outpatients and emergency patients in 2014 increased 113.3% than that in 2009 .The total usage times of laboratory tests and other auxiliary examinations also increased(55.7% and 103.1% ,respectively ) ,yet with a decrease of inpatients.Moreover ,the proportion of income from traditional Chinese medicine (TCM )in gross income increased from 9.39% in 2009 to 17.14% in 2014 .The cost‐profit ratio of TCM drugs at half of such institutions exceeded 120% . Conclusions The performance‐based reform has motivated medical staffs of primary medical institutions and effectively vitalized such institutions.Rules and regulations of these institutions require further improvement .
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Objective To investigate health equity status of urban dwellers with different social stratification and provide evidence for health promotion.Methods 1,007 urban dwellers were surveyed in Zhejiang province in a stratified sampling based on their income,occupation and education,with their health equity analyzed.Results The proportion of urban dwellers to participate in social health insurance reached 97.5％,a proportion of statistical significance (P＜0.05).The two-week prevalence rate and two-week attendance rate of urban dwellers of different social stratification has no significant difference,but the rate of sickness without attending was significantly negatively correlated to social stratification.The proportion of no visiting because of poverty was 23.1％ in the lower social class,3.2％ in middle and lower class,and 0％ in the middle and upper class,a difference being statistically significant (P＜0.001).The outpatient clinic of first choice and ranking of the hospital was positively correlated to social stratification.Conclusion There is health inequity for urban dwellers with different social stratification,for which the government should pay more attention to lower social class.
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Objective To assess the equity of health resources configuration in Zhejiang,and provide references for regional health planning.Methods The Lorenz curve,Gini coefficient and Theil index were used to calculate and analyze.Results The Gini coefficient in 2009-2011 calculated by population density was between 0.330～0.343,which meant comparatively rational.The main reason of inequity configuration for hospital beds and nurses was inter-regional difference.Conclusion The Theil index could remedy the disadvantage that Gini coefficient could not reflex the total inequity was brought up by inter-regional or intra-regional difference.The health resource configuration should based on population health need and health service demand.
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Objective To evaluate the research input-output efficiency of 15 medical universities,and provide references for improving synthetic research efficiency.Methods Selected research input-output key indicators,and used CCR model and SE-DEA model to statistic and analyze.Results The average value of comprehensive efficiency of 15 medical universities was 0.811,pure technical efficiency value was 0.978,scale efficiency value was 0.827.There were 5 DEA efficient universities,7 pure technical efficient universities among 10 Non-DEA efficient universities.Conclusion The total research efficiency of medical universities in our country remained to improve,and should emphasize adjusting scientific research scale.
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Scientificly forecasting the health resources is the premise and foundation for making health resource planning.This paper summarized the application scope and characteristics of commonly used statistical models for health resources forecasting,introduced many S type curve prediction models commonly used in natural and social economic fields,hackled and concluded the weight calculation methods of combination forecasting models,and on this basis put forward that multivariable time series model or combination forecasting model based on single time series model and multi-linear regression equation of the predictive value should be set up for forecasting health resources,so as to provide methodological references for related forecasting research.
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Objective To explore the functional orientation of township hospitals in developed areas to achieve goals of the ongoing health reform.Methods Two rounds of Delphi consultation was made among 18 experts from around the country to learn the degree of importance of every function.Results The experts' average seniority of service in their fields was 23.28±10.41 years.The positivity coefficients of the two-round consultation were 100％.Kendall' S coefficients of the two-round consultation were 0.226 and 0.265 (p＜0.01).These data are of statistical importance,suggesting consensus among these experts and the consultation meeting the needs of forecast.In these consultation,seven class-1 functions and and 27 class-2 functions were determined.Medical services and public health services account for similar proportion of work of township hospitals.Conclusion The functional orientation was feasible and forward looking,for reference of township hospitals in developed areas.
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Objective To study the relationship between ATP level changes detected by hepatic 31P MRS with the pathologic changes of liver in rabbits and to investigate the diagnostic value of ATP level changes in acute hepatic radiation injury. Methods A total of 30 rabbits received different radiation doses ( ranging from 5,10,20 Gy) to establish acute hepatic injury models. Blood hepatic function tests, 31P MRS and pathological examinations were carried out 24 h after irradiation The degree of injury was evaluated according to hepatocyte pathology. Ten healthy rabbits served as controls. The MR examination was performed on a 1.5 T imager using a 1H-31P surface coil with 2D chemical shift imaging technique. The relative quantities of phosphomonoesters (PME), phosphodiesters (PDE), inorganic phosphate (Pi) and adenosine triphosphate (ATP) were measured. Analysis of variance was used to compare the results of 31P MRS and histopathology under various acute hepatic radiation injuries, and SNK was used further to conduct comparison between each other if there was significant difference. Results The ATP relative quantification in control( n= 10), mild ( n = 12), moderate ( n = 11 ), and severe ( n = 7 ) injury groups according to pathological grading were 1.83 ± 0. 33, 1.58 ± 0. 25, 1.32 ± 0. 07 and 1.02 ± 0. 18, with significant differences among them (F =22. 878 ,P ＜0. 01 ), and it decreased progressively with the increased degree of injury. The PDE index showed no significant trend for the evaluation of hepatic radiation injury. The area under the peak of β-ATP decreased with the increased severity of radiation injury. Conclusions The relative quantification of hepatic ATP levels can reflect the pathological severity of acute hepatic radiation injury. The decreasing hepatic ATP levels may be used as biomarker of acute liver injury following radiation.