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Objective:To understand the capability of the emergency service at township hospitals in Fushun county and take emergency treatment of pesticide poisoning in Fushun as an example to measure the spatial accessibil-ity of the emergency service center. Methods:Gathered the heads of 26 township hospitals,using self compiled ques-tionnaire to collect emergency services data;basic data including administrative districts,hydrographic net,road net-work, population distribution and the position of the first aid post were collected, Travel cost method was used to quantitatively measure the emergency service spatial accessibility based on GIS platform. Results: The proportion of hospitals that are able to carry out rescue projects is low;it takes 13.57minutes on average from a residential area to a first aid post of pesticide poisoning in Fushun. The regions with poor accessibility of the first aid post are mainly distributed in the southwest boundary. Conclusion:The hardware and software level of emergency resources of town-ship hospitals in Fushun were lower;Township emergency network need to be improved;That using GIS to assess the accessibility of the first aid post is intuitive and easy to operate.
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Objective Measure the variation trend and the problems of bed allocation and its equity at primary medical institutions and provide theoretical basis for optimizing the policy of health resources allocation for the government.Methods Analysis of the distribution and equity of the inpatient beds at primary medical institutions in terms of geographical area by means of the survey of regular overall statistics forms and the methods of Gini coefficient and Theil index.Results From 2009 to 2012,the number increase of beds at such institutions geographically was 7.72%,while that in eastern,central and western regions of China were respectively 5.35%, 3.97% and 27.88%.The number increase at community healthcare centers was 46.58%,while that in eastern,central and western regions of the country were respectively 18.09%,29.57%和 81.53%.The number increase at township hospitals was 2.33%,while that in eastern,central and western regions were respectively - 3.83%,- 0.43% and 22%.The Gini coefficient of bed allocation at such institutions was beyond 0.6,while that in eastern, central and western regions were respectively under 0.3,0.3-0.4 and 0.6 above.The Gini coefficient of bed allocation at community healthcare centers fell from above 0.4 to under 0.4.The Gini coefficient in the western regions increased from 0.3-0.4 to over 0.4.The variation trend of township hospitals was similar with the overall conditions at such institutions.The intra-regional Theil indexes and their contribution rates of bed allocation at such institutions were higher than those of inter-regional. Conclusions The overall variation trend of bed allocation at such institutions was on the rise,yet its variation trend of equity remains unchanged.The bed allocation and its equity at such institutions were higher than those at township hospitals.The growth rate in western regions was the highest,but the absolute number was the lowest.Moreover,the equity of bed allocation in such regions was not only the lowest,but also was found rising.The influence of bed allocation in intra-region terms was large,while its equity was not only lower but falling as well.
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An analysis of the readmission service in rural townships and counties.Based on the concept of health integration,the authors proposed the service integration among hierarchical institutions in alignment with hierarchical medical system,and the autonomous service integration among differentiated hierarchical institutions.The purpose is elevation of quality of care in rural areas and better capital usage efficiency in NRCMS.
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OBJECTIVE:To provide reference for the further implementation of national essential medicine system of township hospitals. METHODS:5% township hospitals in a province were collected as sample by using random cluster sampling method, and statistics,comparison and evaluation was made by issuing questionnaires to get health resources distribution status,health ser-vice status and income and expenditure status before(in 2009 and 2010)and after(from 2011 to 2013)the implementation of na-tional essential medicine system of township hospitals. RESULTS:Totally 46 township hospitals were surveyed and totally 46 ques-tionnaires of township hospitals were recycled. Average number of beds in township hospitals increased from 15.1 beds in 2009 to 19.4 beds in 2013. Average annual outpatients increased from 11 200 in 2009 to 16 100 in 2013,and average number of hospital discharge increased from 644 in 2009 to 924 in 2013. The proportion of government financing to total income increased from 25.9% in 2009 to 47.1% in 2013,proportion of drug income to the total income decreased from 54.9% to 29.7%,drug profit rate decreased from 25.5% to 3.7%,and proportion of township hospital under deficit decreased from 17.4% to 4.3%. Average time that residents see a doctor in township health center increased from 0.47 in 2009 to 0.74 in 2013,and cost of average hospitaliza-tion and outpatient drugs decreased from 805 to 718 and 28.1 to 24.1,respectively. CONCLUSIONS:The implementation of nation-al essential medicine system has no negative effect on outpatient service,but first inhibits then promotes the inpatient services. Na-tional essential medicine system has effectively cut down the financial burden of drugs,but it has no effect on total health burden. It is difficult to realize the excessive rapid rise of health ex-pense by the single implementation of essential medicine sys-tem,and it needs comprehensive reform,collaboration and in-teraction of medicine and health to effectively relieve the prob-lem of“expensive ill”.
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Introduced are the concept and connotation of the prospect theory in behavioral economics,and the theory is used to explore the psychological characteristics and irrational decision behaviors of both supply and demand sides of talents in human resource development of township hospitals.The study found that the limited rational decision of people influenced the policy effectiveness of human resource policy for such hospitals,and the certainty effect strengthened the demand for restoration of government accountability and the breaking of staffing quota limits.The change and difference of reference point resulted in the lack of incentives and turnover of posts in such hospitals.The presence and change of the mental account caused unscientific human resource development.Based on such findings,the prospect theory can provide good explanatory power and theoretical enlightenment for such development.
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Objective To learn the burnout and turnover intention of physicians from township hospitals in Xi County,Henan province,for reference of health administrators and healthcare institution managers.Methods Cluster sampling method and qualitative interviews were used and all physicians from such hospitals were sampled for questionnaire survey in 2014,with 1 70 scales distributed.The questionnaire was the Markov Burnout Inventory generic version revised by Li Chaoping,and turnover intention questionnaire was that revised by Liang Kaiguang.Results 140 physicians from such hospitals were found with zero or low burnout (94.6%);Collaborative care in the county poses great positive effect on promoting professionalism and interpersonal relations, yet has limited positive impact on reducing workload and performance appraisal stress and increasing their income.Conclusion It is imperative to enhance training of managers of such hospitals for them to learn the appraisal method with organizational scale,and build a humanistic concern mechanism for physicians,for purposes of improving the organizational environment and minimize the burnout and turnover intention of the physicians.
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OBJECTIVE:To provide basis for the further implementation of the national essential medicine system in township hospitals. METHODS:By issuing questionnaires,an investigation was made on the basic information of township hospitals imple-menting“Health Ⅺ project”in Heilongjiang Province before and after the implementation of the national essential medicine system. Prescriptions of 4 days in 2008 and 2012 were extracted,statistically compared and analyzed by using random system cluster sam-pling medication rationality was evaluated. RESULTS:40 questionnaires and 3 173 prescriptions were recycled during the investiga-tion in 2009,and 40 questionnaires and 4 197 prescriptions were recycled in 2013. Compared with the township hospitals in project areas in 2008,the proportion of practice(assistant)physicians per township hospitals and the average number of beds were respec-tively increased by 1.5%and 4.6 in 2012. The average kind of prescription drugs was decreased from 2.9 kinds to 1.7 kinds,the us-age rate of infusion was decreased from 46.5%to 30.6%,antibiotics was decreased from 61.5%to 40.0%,two or more kinds anti-biotics was decreased from 18.9% to 4.8%,hormone was decreased from 11.9% to 4.2% and the rate of combined use of antibiot-ic and hormone was decreased from 9.2% to 2.8%;the drug expenditure of each outpatient service and hospitalization was respec-tively decreased 19.1% and 16.4%. There were significant differences(P<0.05). CONCLUSIONS:After the implementation of na-tional essential medicine system,the medication rationality of township hospitals in project areas has made great improvement,es-pecially on the aspects of prescription drug number,the combined usage rate of antibiotic and hormone,the usage of hormone and the drug expense burden,which reaches the policy targets;although the infusion rate and the usage of antibiotic show great im-provements,there are still some gaps between the current situation and the policy targets;the obvious decrease of the average drug expenditure of each service doesn’t make a relative decrease of the average expenditure of each medical service,which has a little increase.
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Objective To investigate antimicrobial use in 33 township central hospitals,and improve the rational use of antimicrobial agents. Methods Thirty-three township central hospitals in 1 1 counties were randomly select-ed,7 920 outpatient prescriptions,medical records of 465 non-surgery patients and 213 surgery patients were inves-tigated and analyzed. Results Of 33 hospitals,antimicrobial usage rate in outpatients and inpatients was 56.60%and 89.68% respectively,combined antimicrobial usage rate was 24.16% and 43.58% respectively. Antimicrobial use density in inpatients was 147.25DDDs. Antimicrobial usage rate in surgery patients was 97.18% ,combined an-timicrobial usage rate was 59.90% ,the percentage of one drug,two-drug combination and three-drug combination was 40.10% ,47.82% ,and 12.08% respectively. The percentage of antimicrobial use in patients of type Ⅰ,Ⅱ, and Ⅲincision was 97.56% (40/41),96.93% (158/163)and 100.00% (9/9)respectively,combined antimicrobial us-age rate was 30.00% ,67.72% ,and 44.44% respectively.Conclusion The overuse of antimicrobial agents exists in 33 township central hospitals,antimicrobial usage rate,combined usage rate,antimicrobial use density and antimi-crobial prophylaxis in typeⅠincision operations are all high.
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Setting quantity and quality of services as the base, patient satisfaction as the core of the performance appraisal and salary distribution system are important content of the current comprehensive reform of township hospital. To guarantee the profits for public in township health cares, prevent profiteering behavior, mobilize the staff’s work enthusiasm and establish an effective performance appraisal and salary distribution system are the most focused and considered problems for a great number of township health cares. The example hospital introduced the “progressive scoring” and “incremental increase in return”, which had positive effect.
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This paper analyzed some policies of new health care reform from the perspective of doctor -patient trust.The implementation of the policy of income and expenses in two lines has changed the management mode of township hospitals , eliminated some factors harming the doctor -patient relationship .The policy of equalization of public healthand other policies have guided the hospitals to change the way of service , service and health man-agement into the village increased the degree of doctor -patient trust .But at the same time , to ensure the new health care reform run smoothly , township hospitals introduced various ways of prescribing restraints .In addition , the policy of zero profit for basic drugs also brought some restrictions and regulations , resulting in a decline of satis-faction of patients , who have a tendency to blame the hospitals and doctors for these inconveniences .This misun-derstanding has becomed the new difficulties for doctor -patient trust as policy running .
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After an analysis of the urgent need of systematic medical information service in village and township hospitals and doctors and the advantageous conditions for medical academic libraries to provide information service for them, its imple-mentation strategies were proposed and how to promote the construction of libraries and the development of medical cause in villages and townships by providing information service in countryside were pointed out.
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ObjectiveTo understand condition about cost and economic burden of outpatients in countries and townships medical institutions in Xinjiang.MethodsThirty-one medical institution were selected and the cost and income of one-day outpatients were investigated,then the cost of different diseases,age groups and payment methods and the later disease cost burden were analyzed.ResultsOut-patient expenses of top ten common diseases was pneumonia100.12 yuan,injury 85.18 yuan,hypertension and coronary heart disease(CHD) 69.13 yuan,examination and diseases related to pregnancy 49.60 yuan,disease of the genitourinary system 41.71 yuan,enterogastrtis 34.80 yuan,bronchitis 30.72yuan,osteoarthrosis 24.60 yuan,upper respiratory infection ( URI ) 23.63 yuan,scytitis 21.14yuan;The outpatient expenses of those taking part in Neotype Countryside Cooperative Medical Care Insurance,whose family-month-income was less than 250 yuan,was 18.07 yuan,which disease cost burden was 25.56％.ConclusionThe expenses of infectious diseases in country and township hospitals was in the top ten.The cost of chronic non-communicable diseases was rising significantly;For those participating Neotype Countryside Cooperative Medical Care Insurance,the outpatient expenses was low and the disease economic burden was higher.
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Objective To probe into the current services and outcomes of township hospitals following their transformation, and their future positioning of functionality. Methods Pinpointing townships A, B and C as samples from a district in Beijing, in which field surveys were made in the township hospitals to learn their services, service provision methods and outcomes. Results Among the current services provided by these three hospitals, those of public health and primary healthcare nature in hospital A account for 50% each; those in hospital B account for 70% and 30% respectively; those in hospital C account for 60% and 40% respectively. Recommendable services provided in these hospitals include universal coverage of medical files, management of infectious diseases, public health emergency management, and immunization. Conclusion Township hospitals as the center of the 3-tier rural health service network, deserve a repositioning of their functionality to fit the health needs of residents at large.
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OBJECTIVE:To probe into the perioperative prophylactic use of antibiotics in township hospitals. MENTHODS:A total of 100 perioperative medical records in 10 township hospitals were randomly sampled from Jan. to Jun. in 2008 for retrospective analysis of the perioperative prophylactic use of antibiotics in respect of the drug kinds,drug application frequency,medication duration and drug combinations,etc. RESULTS:All of the patients received prophylactic antibiotics and the use of antibiotics was characterized by high starting point,widespread drug combination,lacking of consciousness of preoperative use of antibiotic in the initial medication time and prolonged medication duration. CONCLUSION:In order to standardize perioperative use of antibiotics and decrease incidence of adverse drug reactions and drug resistance,it is important to strengthen the training and supervision on the rational use of antibiotics among clinicians and pharmacists in township hospitals.
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OBJECTIVE To understand operating room management conditions and put forward improvement methods at township hospitals.METHODS An observatory study was conducted in 9 township hospitals using the evaluation criteria based on the requirements of the Guidelines for Disinfection in Hospitals.Technical Guidelines for Prevention and Control of the Hospital Infection in Operation Departments and the Guidelines for Hand Hygiene of Medical staff in Medical Institutions.RESULTS Problems were found to a different extent in all of the 9 township hospitals:faults in rules and regulations,unreasonable layout technological process,unstandardized sterilization and disinfection and short knowledge about hospital infection.CONCLUSIONS Special attention to managment of operating room,improving consciousness,strengthening medical staff study and improving system are the key issues for improving the management level of operating room at township hospitals.
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OBJECTIVE:To provide reference for systematic reform in national state-owned hospital.METHODS:System reforms of township hospitals in Zhangjiagang were analyzed.Then three kinds of reform modes were summarized including privatization,town-owned-town-management and sino-foreign joint venture.Reform effects were also discussed.RESULTS & CONCLUSIONS:The achievement that the reformed township hospitals have made in Zhangjiagang in improving the medical insurance and pharmaceutical management system,reforming hospital management system and operation mechanism and creating a harmonious relationship between doctor and patient can provide a reference for domestic state-owned hospital reform.
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The running of township hospitals by the government is a key issue in the current reform of domestic township hospitals.In light of the theoretical basis for the running of township hospitals by the government,the paper discusses and defines the content and realization form of the running of township hospitals by the government.It also puts forward rational suggestions for improving the managerial system in the running of township hospitals by the government.