Exploring the System Roots of Service Capacity Weakening in Chinese Primary Medical Institutions / 中国卫生经济

The difficulty and expense of seeing a doctor was attributed to the out-of-level diagnosis and treatment, and the out-of-level treatment was due to the weakening of the basic medical service capacity. Since the new medical reform,the state has invested a lot, which led to the weakening of the primary medical service capacity. Exploring the institutional root of the weakening of grass-roots medical service ability could help to find the realistic path to enhance the service capacity of grass-roots medical institutions. Enhancing the service capacity of primary medical institutions was the only way to implement graded medical treatment. The administration of medical institutions restricted the improvement of service capacity of primary medical institutions, and the root of administration was the existing medical and health system. Only by starting from the reform of the system and realizing the administration of primary medical institutions, the service capacity of primary medical institutions could be enhanced.

Theoretical discussion on the mode of government purchase of basic medical services / 中华医院管理杂志

Constructed in the paper is a theoretical model of the strategic procurement services by the government from macro, meso and micro level based on the concept of strategic procurement.The design comprised of a responsibility system, purchase mechanism and evaluation mechanism for the core operating mechanism of the government purchase of basic medical service.It aims to accelerate the reform of public hospitals in an effort to provide theoretical support and reference of the reform nationwide.

Strategy of Basic Medical System Reform Under the Perspective of Institutional Supply / 中国医院管理

Financial funding model of basic medical service reform should shift from single paying attention to supply of medical services to coordination concern about medical service output.No fault medical damage compensation system should be included in the budget arrangement of national financial investment.In the face of high incidence of medical damage,the center of medical tort liability system should be changed from relief patients to prevention of medical injury.Negligence litigation system has a profound negative impact on health care system.Most attention to this negative influence should be paid when efforts are made to promote managed care.It is necessary to change basic medical service system linking with current medical tort liability system so as to design from a more macro perspective of system supply.

Development of basic medical service items in Shanghai community health service system / 中华全科医师杂志

Objective To define basic medical service items in Shanghai community health centers.Methods Two rounds of Delphi expert consultation were carried out with 36 experts specialized in general practice,general practitioner training,internal practice,public health and health management,then the scope of medical service system was set up based on experts' opinions.Results The newly-defined system consisted of three first-grade items:outpatient medical service,hospital medical service and medical service for home beds and temporary home visits.The first-grade items contained 22 second-grade items and the second-grade items consisted of 26 detailed items,including 17 baseline items,8 optional items and 1 restrained item.In two rounds of Delphi consultation the activity coefficient of experts was all 100％,authority coefficients of experts was 0.825,and harmonious coefficient of the importance of the evaluation was 0.361 and 0.488 (all P ＜ 0.01),respectively.Conclusion The preliminarily developed system of basic medical service items in Shanghai community health service can provide a reference frame for government policy-making.

Research on Shanghai resident satisfaction of primary healthcare after new health reform / 中华医院管理杂志

Objective The research was to achieve Shanghai resident satisfaction of primary health service after new health reform.Methods During self-compiled questionnaire survey,the research adapted stratified random sampling to select 9 community health centers in Shanghai urban,rural and suburb areas.Results Shanghai resident satisfaction rate of new health reform was 85.2％.Satisfaction rate of basic medical security system was 85.0％.Satisfaction rate of basic medical service was 96.5％.Satisfaction rate of basic public health service was 95.1％.Age,region,job,education and income were main factors to satisfaction of primary health service.Conclusion From an overall point of view,Shanghai resident satisfaction of primary health service after new health reform was high.However,the level of basic medical security and convenience of reimbursement were not high.Medical expenses of primary health care institution had not been effectively controlled.Basic medicine could not fully meet the medication needs of primary health care institutions.