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Objective:To analyze the reform actions on raising the appropriateness of inpatient care use, as well as the current situation, so as to provide suggestions on improving the appropriateness.Methods:Policies and literatures on the appropriateness of inpatient care use released from 2009 to 2021 were collected from such official websites as the State Council and China National Health Commission as well as literature databases from home and abroad, for a text analysis. Based on the data of China Health Statistics Yearbook(2010-2021) and The Sixth National Health Service Survey Report (2018), descriptive methods were adopted to analyze the situation of inpatient care use in China. Results:Since the new healthcare reform, the Chinese government had standardized the hospitalization standards and procedures to minimize inappropriate use of inpatient care, increased financial subsidies for public hospitals to minimize their inappropriate patient attraction merely for economic interests, and reformed the medical insurance payment methods so as to regulate physicians′ behavior. Under the influence of the above policies, the average length of stay decreased from 10.5 days in 2009 to 9.1 days in 2019, with an average annual growth rate of -1.42%. The average waiting time in hospitals decreased from 3.6 days in 2008 to 1.5 days in 2018.From 2012 to 2019, the admission rate increased from 13.2% to 19.0%.Conclusions:Since the new healthcare reform, the average length of stay in China has decreased year by year, but the admission rate has increased year by year. Therefore, it is necessary to further reduce the inappropriate utilization of inpatient care use by speeding up the construction of the close-type medical alliances, improving the reform of payment methods, refining the performance appraisal standards for medical staff and strengthening supervision mechanism.
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Objective:To build the evaluation index system of traditiond Chinese medicine(TCM) service capacity in county-level TCM hospitals, for references to improve the TCM service capability in China.Methods:Based on the " structure-process-result" evaluation model, a preliminary screening index system for the evaluation of TCM service capacity in county-level TCM hospitals was established by analyzing relevant literature and policies; Two rounds of Delphi expert consultation were made to screen the evaluation indexes; The combination weighting method based on both expert scoring method and entropy weight method was used to determine the index weight.Results:The evaluation index system of TCM service capacity of county-level TCM hospitals was finally incorporated into 3 first-level indicators, 9 second-level indicators and 33 third-level indicators. The top five third-level indicators in terms of comprehensive weight were the person time of TCM preventive care in the year(12.02%), the person time of manual reduction diagnosis and treatment(9.03%), the person time of acupuncture and moxibustion(6.55%), the proportion of income from inpatient TCM services in medical income(5.87%) and the person time of massage(5.34%).Conclusions:From the perspective of the whole process of TCM service, the evaluation index system of TCM service capacity of county-level TCM hospitals reflectd the health service capacity of county-level TCM hospitals, highlighted the characteristics of TCM.
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To implement Healthy China 2030 Plan and Healthy China Actions (2019-2030) requires a high quality and efficient public health care system. Centers for disease prevention and control as one of the important components of the public health care system, should be critically transformed and reformed in their functions. Government needs to redefine and enforce the functions and improve assurance mechanisms for the centers to carry out the functions. The centers should strengthen their capacities for the transformed functions.
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Objective To provide a scientific basis for the formulation of effective incentive measures for rural health workers,by analyzing the factors influencing their work enthusiasm and constructing an incentive mechanism framework.Methods A field questionnaire survey and personal in-depth interview were conducted on 803 health technicians from 45 township health centers in Shandong,Anhui and Shanxi provinces.The study covered economic,management,education and career supports aspects,and the data were analyzed in descriptive,multi-level model and correlation analyses.Results The work enthusiasm scoring of rural health workers was 89.83 + 9.54.Workload,doctor-patient relationship,work competence and income index were the four influencing factors,with the differences showing statistical significance(P ＜0.05).The income index (income expectancy/real income affects work) influences the enthusiasm negatively,while the rest of the factors were positive.Work enthusiasm was positively correlated with three dimensions of job performance.The satisfaction of interpersonal relationship,workload and competence were positively correlated with work enthusiasm.The correlation indexes are respectively 0.35,0.33 and 0.21 (P ＜ 0.01).Conclusions To motivate primary health institutions and their health workers,the authorities should focus on the economic factors,and take into account non-economic ones,while improving the performance-based wage system and creating a fair workplace culture.
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Objective To understand the job satisfaction of health technicians at township health centers and explore the strategies of improvement.Methods Based on the theory of existence,relatedness and growth needs,both quantitative and qualitative methods were used in the study.The quantitative investigation was carried out with the multi-stage cluster sampling method.The questionnaire for township health center personnel was compiled by the research group as a measuring tool for a survey of 803 health technicians from 45 township health centers regarding their existence,relatedness and growth needs in terms of existence,relatedness and growth needs.The data acquired were subject to descriptive analysis and variance analysis.The qualitative investigation was made by means of convenient sampling in personal indepth interviews.The thematic framework method was used to analyze the contents of the interviews.Results The satisfaction of existence needs of health technicians at township health centers scored the lowest(2.59),followed by that of growth needs(2.91),and the highest scoring was relatedness needs(3.56).There exist significant differences in the scoring of existence,relatedness and growth needs,among different personnel category,gender,age,staffing quota,administrative posts,and academic titles.Conclusions The authorities should emphasize the existence,relatedness and growth needs of health technicians at township health centers,and improve their job satisfaction by perfecting the salary distribution system and perfecting the personnel training system.
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Encouraging and providing guidance to social forces to invest in health care industry is one of the key elements determined to deepen the health care reform.From four aspects of the unclear conception and undefinable functions of non-public hospitals, ambiguity of property rights of non-profit non-public hospitals, gradual reduction of traditional management measures, and deficiency of effective supervision on daily operations, this paper summarizes the major policy issues in non-public hospitals.To solve these problems, this paper conducts a systemic analysis of the historical experiences of the United States, Germany, Japan, and Taiwan.On this basis, this paper suggests that the government should clearly determine the connotation and extension of non-public hospitals, improve non-profit non-public hospital policy system, play a guiding role in planning and health insurance guidance, and strengthen the supervision of business operations.
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In this paper, 172 non-public hospitals have been investigated covering east, central and western regions with structured and semi-structured questionnaire and group interviews. We found that the health insurance policies were the most concerned policies by non-public hospitals, accounting for 26.5% of the total. We also found that non-public hospitals from different areas, levels profit nature have different policy expectations, for example Eastern regional institutions wanted to make a breakthrough of the planning policies, the central region wanted to change the health personnel policy, while the western region is considered to be limited by land policy. Tertiary hospitals were more concerned about research projects and land policy, and secondary hospitals were more concerned about access policy. There were 44.8% of the surveyed institutions considered that regulatory policywasmore stringent public hospitals and public hospitals, and there were no difference between profit and non-profit hospitals. According to the survey results, this paper puts forward suggestion that we should implement more targeted policies, purchasing more services from non-public hospitals and enhanced supervision. Considering the survey results research team puts forward sensitive advice as: provide preferential policies in according with different kinds of institutions reinforce purchasing service and enhance non-public hospitals supervision.
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Health policy and systems research in China has rapidly developed over the past two decades, which helps evidence-based policy making and health systems strengthening.This article aims at reviewing and analyzing, and to come up with a summary of the major progress and future development trend in health policy and systems research are reviewed and analyzed.This article discusses also the current challenges and opportunities of health policy and systems research prevailing in China.
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Objective:To analyze the correlated factors on the non-public hospitals efficiency performance and compare different types of them in order to provide reference for improving efficiency.Methods:Based on the result of 160 non-public hospitals total efficiency,questionnaire surveys were taken for collecting the information of region,quality,form of ownership,whether invested by the government,whether under the medical insurance,the total amount of employers,bed and service amount as the independent variables,while the total efficiency as the dependent variable to conduct the Tobit multi regression analysis.Results:Access policy,investment policy,nature of ownership,the number of beds,the proportion of physicians,the per capita services,assets and equipment had significant impact.Conclusion:The development of non-public hospital was related to the policy environment,operation mode and internal management.
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Outpatient care services are usually the patient's first contact between the patients and the most bas-ic health care. The provision of outpatient care contributes to immediate and large gains in health status. The pay-ment method is one of the most common incentive methods applied by purchasers to guide the performance of outpa-tient care providers. This systematic review applied cochrane review method, and searched, screened, assessed and synthesized the relevant original studies. 19 studies were finally included. It was found that existing payment methods combined with P4 P interventions could probably slightly improved the health professionals' use of some tests and treat-ments ( adjusted RR median = 1 . 095 , range 1 . 01 to 1 . 17 ) , but may have led to little or no difference in patients' utilisation of health services ( adjusted RR median = 1 . 01 , range 0 . 96 to 1 . 15 ) and may have led to little or no difference in the control of blood pressure or cholesterol ( adjusted RR = 1 . 01 , range 0 . 98 to 1 . 04 ) . Pay for per-formance involves a complex design, each detail design may contain different incentive effect, therefore policy makers intend to apply pay-for-performance to guide the behavior of health providers, the design on each components of pay for performance should be analyzed in order to find more potential intervention points.
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Objective:To evaluate the technical efficiency and scale efficiency of non-public hospitals in China to provide references for improving efficiency of non-public hospitals with the comparison with the differences among different non-public hospitals with different types.Methods:Input and output data of 160 non-public hospitals in 2014 were collected;C2R and BC2 models were adopted to evaluate the annual total efficiency,technique efficiency and scale efficiency.Results:There were 16 total efficient hospitals(10.00％),41 technical efficiency hospitals(25.63％) and 20 scale efficiency(12.50％),43 at IRS stage,99 at DRS stage.Conclusion:The overall efficiency of non-public hospitals was low relatively and most of them were lower than public hospitals at same level.Scale was an important factor affecting the efficiency of non-public hospitals.
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This paper aims at describing and comparing the changes of health resources allocation before and after new health system reform during 2006—2015 . Methods:Province-level data were used to analyze the inequities of licensed ( assistant) doctors and beds. 31 provinces were divided into 5 groups by GDP per capita and 3 groups by geographical regions. Absolute difference, relative ratio and concentration index were respectively used to compare and measure the absolute difference, relative difference and inequities in different groups before and after the new health system reform. Results:The findings of this study show the allocation of China's health resource before and after new health system reform to be as below:(1) the quantity of health resource is increasing, and the growth rate after the reform is higher than before. (2) the disparities of health resource in different economic development level areas are declining, and the decrease is faster after the reform. (3) the disparity of beds in different regions is decreasing, but the disparity of licensed (assistant) doctors in different regions is enlarging. (4) The inequities of health resource al-location in China are reduced, and the improvement is greater after the reform than before. However, the health re-source allocation is still highly inequitable to geographical areas. Discussion:(1) the policies of health resource allo-cation implementation after the reform needs improvement. ( 2 ) The amount of health resource still needs to be in-creased in certain areas, especially need to strengthen the training of high-qualified health personnel. (3) When al-locating health resources, government should focus on the impact of both population and geographical size factors.
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Objective:This study aims at exploring the impact of the health resources allocation on healthcare seeking behavior of inpatients with different income in China. Methods:Data at individual level were collected from China National Health Service Surveys conducted in 2008 and 2013 , interlinked with the data of health resources in county level. Multilevel zero-inflated negative binomial regression and multilevel multinomial logit model were respec-tively used to examine the impact of the health resources allocation on inpatient visits and the influence of the choice of healthcare providers by inpatients. Results: The results show that the increase of the number of beds in primary health centers ( PHCs) and physicians in county hospitals increased inpatient visits within counties. The investments in health resources in PHCs had greater impact on improving the likelihood of inpatient visits within counties for the low-income populations than that for the high-income populations. Conclusion: Investments in health resources in PHCs are vital to improve the healthcare seeking behaviors of the low-income populations in China.
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Objective To study the scale and structure of health professional education in China's colleges and universities and their changes from 1998 to 2012. Method Descriptive analyses of national data were conducted, mainly including calculation of absolute numbers, average rates of change per year, and percentages. Results The number of colleges and universities involved in health professional education increased from 189 in 1998 to 590 in 2012.The number of health professional students who were enrolled by, studied in and graduated from these colleges and universities respec-tively reached 587 thousand, 2 104 thousand, and 508 thousand in 2012, with annual growth rates of about 15 percent. The proportion of diploma graduates rose from 42.9 percent in 1998 to 54.0 percent in 2012, which was bigger than those of students at other education levels. In 2012, health professional educational institutions per 10 million popu-lation in western China was less than eastern and middle China by 1.1 and 0.9, respectively. Health profes-sional graduates per 10 thousand population in western China was less than eastern and middle China by 3.3 and 1.6, respectively. Public institutions and their students respectively accounted for 78.1 percent and 85.1 percent though private institutions and their students increased more quickly than public ones. Student-faculty ratio rose from 7.1∶1 in 1998 to 20.0∶1 in 2012. Conclusion The scale of health profes-sional education has been expanding at a decreasing growth rate in China. The disciplinary composition of health professional students has some-what improved and private schools increased at a quicker rate than public ones. However, the gap in scale of education between western China and middle/eastern China has been widening. Education re-sources per student cannot keep pace with the expansion of students, which has affected education of health professionals in many aspects.
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Massive open online courses (MOOCs) , which has caused a large scale of medical edu-cation in recent years, has led to an exploration boom in medical education. By the end of November 2014, on four large domestic and foreign MOOCs platform, a total of 178 medical related MOOCs were found, accounting for 12.2% of the total number of courses, among which public health MOOCs accounted for 44.9%. In terms of medical education, MOOCs are not only a powerful supplement of existing medical ed-ucation and can assist dissemination of medical knowledge, they can also promote pedagogy innovation and improve teaching quality to a certain extent. Moreover, the huge amounts of data collected by MOOCs can also be used to develop research of students' learning behavior. In addition, by recruiting study objects, the researchers have begun to use MOOCs supporting scientific research. As a novel educational development, MOOCs face many challenges while they bring opportuni-ties for medical education. However, active prac-tice and exploration will bring more powerful vitality for its development in the medical field.
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Recently , the country actively explores the pattern of an integrated healthcare which enables the as-sociation among hospitals of different levels , aimed to achieve maximum utilization of medical resources and lead a reasonable distribution of the patients .By reviewing the practices related to the integration of healthcare in Beijing , Shanghai , Zhenjiang and Wuhan city , this paper sums up in five typical mechanisms , i.e.organization and manage-ment mechanism , human resource management mechanism , interest distribution mechanism , service continuity and resources sharing mechanism .The effects of these practices were analyzed and the faced challenges were discussed . The following points were made clear during analysis and discussion:the sustainability of the collaboration mode and organization structure , human resource supports and incentive methods , health insurance guidance for hospitals and patients , two-way referral system and supporting measures , and building of information system .Then we put forward some suggestions , hoping to offer some references to the establishment of integrated healthcare in other regions .
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In order to meet the health needs of people, China’s health service system needs continuous reforms and adjustments. Health needs, equity and efficiency, quality of service, and the development history and current situation of the health service system are the four main dimensions to be considered during the building process of the system. This paper argues that building a people-centered health service system is the direction, and it describes its connotation from five different aspects, including human care, interrelated interests, primary health care-oriented, continuous integration, and conditions for support. This paper proposes the strategies and paths to build a people-cen-tered health service system, including to promoting the quality of primary health care, integrating health service sys-tems, and strengthening government’s responsibility.
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Objective:After examining the changes in medical expenses and flows of hospitalized patients with-in and outside the county under the New Rural Cooperative Medical Scheme ( NRCMS ) before and after the imple-mentation of health care alliance reform, this paper analyzes the impacts of health care alliance reform on the visiting rate of NRCMS patients within the county and explores their causes and channels. Methods:This paper uses the hos-pitalization data of NRCMS patients in 2013 and 2014 collected from Huangzhong county Qinghai province and inter-views with key informants and analyzes the hospitalization expenses, visiting flows and other indicators of patients. Results:After starting health care alliance reform, the total number of hospitalized patients to seek treatment outside the county decreased by 6 . 38%, the total hospitalization expenses to seek treatment outside the county decreased by 22 . 13%, and the hospitalization expenses per inpatient day to seek treatment within and outside the county increased by 14. 41% and 20. 69% respectively. Conclusions: By improving service capabilities of township health centers and increasing synergies between county-township-village health institutions, the county health care alliance reform has suc-cessfully enhanced the service capabilities of health care systems in the whole county and reasonably helped patients with common diseases to be hospitalized outside the county and frequently hospitalized people to return back to the county.
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The fragmentation of health care system within a county and serious capacity constraints of health-care services in township health centers are generally the most significant problems facing underdeveloped counties in western China. Under constraints of limited public financial resources, how to increase service capability of township health centers and improve service quality, continuity and convenience of health care system has become one of the most severe challenges in implementing China’s county health care system reform. This paper takes Huangzhong coun-ty, Qinghai province as a case study. It investigates how the locals use health care alliance to vertically integrate county health care resources during reform implementation, analyzes various aspects of reform measures and the corre-sponding structural characteristics such as the integration of administrative management, integration of human re-sources, dual diagnosis referral, interoperability of information systems, sharing of resources and test results, etc. , and provides similar China’s counties with a case study to be used for reference.
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Objective:To analyze reverse effects induced in the implementation process of“primary health care strengthening” policies, and the innovative initiatives and countermeasures raised in primary health care system’s comprehensive reform of Feixi county. Method:Based on the principles of Critical Discourse Analysis ( CDA) , this paper designs its analytical framework for policy analysis. Results:Many reverse effects appeared in the implementa-tion process of “primary health care strengthening” policies. However, through improvements in terms of manpower upgrading, network building, working conditions and management mechanisms, Feixi county has successfully strengthened the capacity building for primary health care institutions. Conclusions:The expected and unexpected re-sults should be evaluated systematically when the policies are being implemented, and local governments need to pro-ceed according to local conditions in order to prevent unintended reverse effects from happening.