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ObjectiveTo evaluate the implementation effect of the basic public health service project in Jiangbei District of Chongqing， so as to provide a basis for further improving the service content and social/economic benefits of the project. MethodsThe evaluation was conducted according to the “National Basic Public Health Service Regulations”， “National Basic Public Health Service Project Performance Evaluation Guidance Plan” and the assessment indicators， indicator requirements and weights of each project. The items were evaluated one by one， and each item was calculated and compared to obtain the trends in the three years from 2018 to 2020. ResultsThe evaluation results showed that the twelve contents of the basic public health service projects in Jiangbei District either met or exceeded the national requirements. The overall effect increased year by year， from 71.73 to 78.74 points. Eight of the twelve service contents have improved year by year， among which the report and processing of information related to infectious diseases and public health emergencies reached 100%， and the vaccination rate of “eight vaccines” reached 97%. Maternal and children （0-6 years old） health care increased significantly， rising by 39.89% and 36.62% respectively. Chronic disease health management was unsatisfactory. ConclusionThe effects of implementation of the basic public health service project is significant， and the service quality has improved year by year. The service content and assessment indicators are still imperfect and is worth of further research.
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Objective@#To establish a hypertension risk assessment model among the middle-aged and elderly populations based on residents' electronic healthcare records of the basic public health service program, so as to provide insights into prevention of hypertension.@*Methods@#Demographic features and physical examinations were collected among residents at ages of 40 years and older from residents' electronic healthcare records of the basic public health service program in a county of Zhejiang Province from 2019 to 2020. The risk factors of hypertension were identified using a multivariable logistic regression model, and the odds ratio (OR) for each risk factor was transformed into approximate relative risk (RR), which was included in the formula for calculation of the disease risk proposed by Harvard School of Public Health to create a hypertension risk assessment model. The predictive value of the model was evaluated using a receiver operator characteristic (ROC) curve.@*Results@#Totally 7 275 subjects were enrolled, with a mean age of (66.15±7.91) years, and the participants included 3 189 males and 4 086 females, with a male-to-female ratio of 0.78∶1. There were 190 cases with new-onset hypertension (2.61%). Multivariable logistic regression analysis revealed that overweight, obesity, central obesity, borderline high triacylglycerol (TG), elevated TG, abnormal fasting plasma glucose (FPG), prehypertension and family history of hypertension were included in the hypertension risk assessment model, with approximate RR values of 1.66, 1.96, 1.54, 1.17, 1.64, 1.45, 1.69 and 1.11. The area under the ROC curve (AUC) of the model was 0.678 (95%CI: 0.641-0.715, P<0.001), and the optimal positive cut-off was 0.899. The model predicted 139 subjects with RR>0.899 for hypertension, with a sensitivity of 73.16% and specificity of 55.79%.@*Conclusions@#The hypertension risk assessment model created in this study is feasible to predict the RR for developing hypertension among the middle-aged and elderly populations, which has a predictive value in healthcare management.
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Objective To explore the effect of the utilization of National Basic Public Health Service (NBPHS) on the regular medication behavior and glycemic control of patients aged 35 and over with type 2 diabetes, and to provide support for the health management practice of type 2 diabetes patients in China. Methods Based on the multi-stage stratified sampling method, a questionnaire survey was conducted in 10 community health service centers or township health centers in Zhejiang Province, Shanxi Province and Chongqing City in China from November to December 2019. The data of socio-demographic characteristics, utilization of NBPHS in the last year, regular medication in the last six months and glycemic control were collected. The effect of NBPHS utilization on the regular medication rate and glycemic control rate of type 2 diabetes patients was analyzed by logistic regression. Sensitivity analysis was carried out using the multilevel logistic method and the total score calculation method for basic public health services in different countries. Results A total of 1 527 patients with type 2 diabetes aged 35 and over were recruited, 41.00% were male, 66.08% were aged 65 years old and above, and 39.64% were ill for 10 years and over. The survey showed that the regular medication rate was 89.26%, the glycemic control rate was 65.23%, and the score on utilization of NBPHS was 11.83±2.246 (range 0-15). With the more utilization of NBPHS, regular medication rate in patients with type 2 diabetes increased (χ2trend=4.816, P2trend=0.080, P>0.05). The multivariate regression analysis showed that secondary school and above (OR=2.20), longer duration of disease (OR5-9 years=1.62, OR10 year and above=3.92) and higher utilization score of NBPHS (ORQ3=2.01) were protective factors for the regular medication. Compared with the local household registration population, the local resident population (OR=0.54) was a risk factor for regular medication. Unmarried or divorced or widowed (OR=0.61) and longer course of disease (OR10 year and above=0.60) were risk factors for satisfactory glycemic control, while increased monthly income per household (OR2000-5000 yuan=1.52, ORMore than 5000 yuan=1.76) was a protective factor for satisfactory glycemic control. Conclusion The utilization of NBPHS has promoted the regular medication rate of patients with type 2 diabetes, and the higher utilization takes better effect. Emphasis should be paid on patients with low education level, non-local household registration, short course of disease, and no partner. At the same time, it is necessary to strengthen the utilization of NBPHS to promote the change of their health awareness and health behavior..
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OBJECTIVES@#The Fourth Plenary Session of the 19th Central Committee of the Communist Party of China put forward the idea of "promoting the equalization of basic public services". The utilization of basic public health services by the floating population is an important indicator to measure the equalization of basic public health services. This study aims to understand the intergenerational differences in the utilization of basic public health services between the older generation and the new generation of floating population, and to analyze the influential factors.@*METHODS@#We employed the personal questionnaire (A) of the national health and family planning dynamic monitoring survey on floating population in 2017. Pearson Chi-square test, bi-grouping logistic regression, and Poisson regression were applied to analyze the basic situation of the floating population and the intergenerational differences in the use of basic public health services between the new and old generations.@*RESULTS@#The proportions of the new generation and the old generation who had established the residents' health records in the inflow area were 36.42% and 34.96%, respectively, with the significant difference (@*CONCLUSIONS@#Although the coverage of basic public health services for the two generations of floating population is obviously different, the utilization of basic public health services of the floating population is still at a low level both in the new generation and in the old generation. There is an urgent need to improve the utilization of public health services for the whole floating population according to the characteristics of generations.
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Humanos , China/epidemiología , Escolaridad , Servicios de Salud , Población Rural , Población UrbanaRESUMEN
Objective:To comprehensively evaluate the provincial basic public health service projects and put forward feasible policy recommendations for further improving the basic public health service projects and propose a more scientific and reasonable evaluation method of the implementation status of the projects. Methods:stratified ran-dom sampling method was used to obtain the data on basic public health service information system through institu-tional survey,and relevant policy documents were obtained from governmental institutions' websites. Through Delphi method ( -expert consultations),combined with analytic hierarchy process, evaluation indicators and weights were determined;and cost effect analysis and weighted TOPSIS method were applied to comparatively evaluate the perform-ance of basic public health service projects vertically and horizontally, respectively. Results: The actual per capita project subsidy standard was found to be low;the cost effectiveness of some projects has improved,especially the standard-ized health management of patients with chronic diseases;and there is still a relatively large disparity of the performance of basic public health service in different counties with the highest Ci value is 0.7811 while the lowest is only 0.2694. Con-clusions and Suggestions:Based on the evaluation analysis of this study,it was found that it is very meaningful to integrate the floating population into the budget scope and establish a dynamic growth mechanism;optimize the performance apprais-al program and comprehensively applying cost effect analysis and TOPSIS method to overcome the defects of a single meth-od;and increase fiscal investment to promote the construction of primary medical institutions.
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Objective:To analyze the satisfaction degree and influencing factors of basic public health services in urban and rural areas in Hubei province,and to provide the evidence for further improvement of the quality of basic public health services. Methods:A total of 12 primary health institutions (6 urban community health service centers and 6 rural township hospitals) were selected from Wuhan,Huanggang,Jingzhou of Hubei Province. A questionnaire survey was conducted on the satisfaction,accessibility,comfort,safety and effectiveness of basic public health services among 719 residents. Results:The overall urban and rural residents'satisfaction score of basic public health service was 71.62 points,and the total satisfaction rate was 73.44%. The urban residents overall satisfaction score was 74.67 points,and the overall satisfaction rate was 75. 34%. The rural residents overall satisfaction score was 67.64 points,and the overall satisfaction rate was 71.52%. Among the specific indicators,the most satisfactory items were the convenience of visits (83.03%),privacy protection (80.25%),and indicators least satisfactory were medical technology(61.61%)and equipment facilities(64.53%). Logistics regression analy-sis showed that accessibility,comfort and safety of basic public health services had a greater impact on community residents' satisfaction;and gender and annual medical expenditure had a certain impact on residents'satisfaction. Conclusions:The over-all satisfaction of basic public health services in urban and rural residents of Hubei province is at a general level and still to be promoted. Urban residents'satisfaction is higher than that of the rural area. The basic public health services should further strengthen the quality improvement to further promote the equalization of basic public health services in rural as in urban areas.
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Objective:The aim of this study is to explore the utilization of basic public health services by elder-ly migrants and its influencing factors, and to provide data support for the equalization of public health services. Methods:The framework of the Behavioral Model of Health Services Utilization elaborated by Anderson was used as the theoretical basis. Basing on the data of 2015 National Dynamic Monitoring of Mobile Population,the multivariate logistic regression model was used to analyze the materials coming from in-depth interviews. Results: The utilization rate of basic public health services by the elderly migrant was low and there are differences as compared to other groups. The type of household registration,living duration and the scope of mobility were the main factors influencing the utilization of health services by the elderly migrants. The allocation of funds to primary health care services is in-consistent with the workload,and other difficulties for the community service agencies. Conclusions:The accessibility of basic public health services for the elderly migrants is poor,the health consciousness is weak,and health education should be strengthened. The elderly migrants coming from rural areas,having long-term residence and migrating long distance should be paid more attention too. The administrative departments should strengthen the statistics on elderly migrants,ensure a fair allocation of funds for the basic public health service,and optimize the top-level design of in-formation technology to improve the use of the basic public health services for elderly migrants.
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Objective: It analyzed the current situation and influencing factors of provincial essential public health service level index(PHI) in 2016. The ordinary least square(OLS) and the geographically weighted regression model(GWR) were constructed respectively. The advan-tages of GWR in the field of health economics were compared. Methods: Moran’s I was used to analyze spatial auto-correlation and hetero-geneity of PHI. OLS and GWR models were constructed to estimate the main influencing factors and their directions. Results: There were a positive spatial auto-correlation in provincial PHI and a weak agglomeration pattern in geographical distribution; the level of economic devel-opment and government funding, population size, population structure and population urbanization level were the main influencing factors of the PHI. There was spatial heterogeneity in provincial regression indexes estimated by GWR. Conclusion: When dealing with geographically related issues in the health economics, the GWR model was better than the OLS with a higher degree of goodness of fit.
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Objective To scientifically measure the workload of basic public health services project on village level .Methods 257 village doctors and 24 public health administrators that work in rural health clinics in Qianjiang city ,Hubei province and Qianjiang distrcit ,Chongqing city were sampled ,with questionnaire survey and key informant in-depth interview methods used to screen basic public health service projects affordable on village level ,for workload measurement .Results 35 basic public health service projects were chosen as the measurement projects regarding their relative workload. Hypertension follow-up workload 100 was set as the benchmark ,finding the rest relative workload of other projects range from11～936 .Conclusions It is reasonable to use the relative value measurement based on RBRVS theory on village level basic public health service projects. Results of this study can offer support for the pricing and further dynamic modification of the basic public health service projects .
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Objective:To summarize the cost of basic community public health service in Chinese community for the period 2009 to 2016 and to provide suggestions for the formulation of the compensatory policy and work in-struction in each region.Methods: The literature search conducted on Chinese literature database(including CNKI, VIP, Wan Fang) from the period of 2009 to 2016.The literature was analyzed with the help of NoteExpress managing Literatures,and the relevant papers and their references were comparatively analyzed by using Microsoft excel 2007. Results:There were a total of 817 relevant articles,of which,48 were included in this study and 19 with detailed re-search results.For the 48 articles,41.7% adopted full costing method and 20.8% used activity-based costing meth-od,54.2% using six-item screener. More research of cost estimation applied to current evaluation of public health service in community,the results of cost estimation showed that the cost of basic community public health service per capita was significantly different among the studies in the period of 2009to2011 (20.9 RMB to 95 RMB).The man-power cost was the main cost of basic community public health service(between 56.59% and 74.9%).Conclusions:Further exploration and research on the cost estimation of national basic community public health service in China re-quires to be performed,and the cost estimation methods are supposed to improve in practice.
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Objective To investigate the cost of public health service in Qingpu District and provide evidence for the government in funds investment.Methods On the basis of the basic public health service items of Shanghai City in 2014,the items in this research were determined by experts consultation,and then economics methods were used for the cost estimates.Results In this research,it was proved that 664 public health personnel were needed to fulfill the task of public health service stipulated by the government of Shanghai City while the actual number was 579,lacking 85 personnel.In 2013,the investment input on public health service in Qingpu District amounted to ￥8 987.75×104 while the actual need was ￥13 438.10×104 according to this research,so there was a lack of ￥4 450.36×104.Conclusion On the basis of the population and service area in Qingpu District,the number of personnel working on public health service and the investment input by the government were not adequate to accomplish the stipulated task,so the government should increase health personnel and investment input on public health service.And a compensation mechanism should be set to motivate the related work in secondary or tertiary hospitals.
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Objective To explore the impact of health management programs on hypertension related to their cost of the hypertensive,so as to provide evidence for related policy-making.Methods Data was from the 2011 China Non-communicable and Chronic Disease Survey Project which was developed in 161 counties (districts) and Xinjiang production and Construction Corps.Information regarding hypertensive patients were collected through a questionnaire.Two-part model was used to analyze the influence from health management scheme.Results This study included 1 1 294 participants who were 35 years old or beyond,with 4 904 (43.42％) males and 6 390 (56.58％) females.The median cost from the outpatient was 100 (30-200) Yuan,and the cost of patients under management program were significantly lower than those without (P＜0.05).Median pharmacy cost appeared as 30 (15-100) Yuan but there was no significant difference noticed between the cost from the managed or unmanaged patients (P＞0.05).Regarding the calculation on the outpatient cost,results showed that the patients under the management program were more likely to practice ‘outpatient-medical-behavior’ (OR=2.50,95％CI:2.26-2.76) with nearly three quarters of the cost from the unmanaged patients.Hypertensive patients from the urban areas were more likely to adopt ‘medical behavior’ (OR=1.31,95％CI:1.18-1.45) which was 1.69 times of the costs from the rural patients.Results of the pharmacy cost showed that the urban hypertension patients were more likely to purchase medicine (OR=1.10,95％CI:1.01-1.20) and was 1.19 times the costs of the rural patients.Conclusion Health management program on hypertension showed preliminary but promising results in reducing the out-patient cost in the treatment of hypertension,thus should be promoted and implemented.
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Objective To explore the impact of health management programs on hypertension related to their cost of the hypertensive,so as to provide evidence for related policy-making.Methods Data was from the 2011 China Non-communicable and Chronic Disease Survey Project which was developed in 161 counties (districts) and Xinjiang production and Construction Corps.Information regarding hypertensive patients were collected through a questionnaire.Two-part model was used to analyze the influence from health management scheme.Results This study included 1 1 294 participants who were 35 years old or beyond,with 4 904 (43.42％) males and 6 390 (56.58％) females.The median cost from the outpatient was 100 (30-200) Yuan,and the cost of patients under management program were significantly lower than those without (P＜0.05).Median pharmacy cost appeared as 30 (15-100) Yuan but there was no significant difference noticed between the cost from the managed or unmanaged patients (P＞0.05).Regarding the calculation on the outpatient cost,results showed that the patients under the management program were more likely to practice ‘outpatient-medical-behavior’ (OR=2.50,95％CI:2.26-2.76) with nearly three quarters of the cost from the unmanaged patients.Hypertensive patients from the urban areas were more likely to adopt ‘medical behavior’ (OR=1.31,95％CI:1.18-1.45) which was 1.69 times of the costs from the rural patients.Results of the pharmacy cost showed that the urban hypertension patients were more likely to purchase medicine (OR=1.10,95％CI:1.01-1.20) and was 1.19 times the costs of the rural patients.Conclusion Health management program on hypertension showed preliminary but promising results in reducing the out-patient cost in the treatment of hypertension,thus should be promoted and implemented.
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Objective To explore regional variations of basic public health services implementation in Zhejiang Province at prefectural,county and township level,respectively.To find key problems which obstacle the equalization of basic public health services in Zhejiang Province.Methods Descriptive analysis was made on surveillance data of basic public health services in Zhejiang Province,2014.Gini coefficient of key indicators was calculated at prefectural,county and township level,respectively.To the key indicator with higher Gini coefficient,Lorenz curve was plotted and Gini coefficient of each prefectural-level city was calculated.Results An increasing tendency from prefectural to township level was showed in Gini coefficient of all twenty-five analyzed indicators.The Gini coefficient at township level was 0.497 for the average financial fund per migrant person,and the highest prefectural -level cities were Taizhou (0.709 ),Lishui (0.838 ), Quzhou(0.918).The Gini coefficient at township level of other indicators were 0.314 and 0.235 for the children and elderly health management of traditional Chinese medicine,and lower than 0.05 for maternal &children health care, immunization,and coverage rate of electronic health record,and between 0.066 to 0.179 for health management of chronic disease and severe mental illness patients.Conclusion Average financial fund per migrant person and health management of traditional Chinese medicine are current major problems which obstacle the equalization of basic public health services in Zhejiang Province.
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Objective To investigate and analyze the residents′knowledge and satisfaction on basic public health services in five districts of Gansu ,to judge the implementation effect of the current policy ,in order to provide the suggestion to improve the effect of the implementation of the policy of basic public health services .Methods Based on typical sampling method ,1 688 rural and urban residents had been investigated coming from five counties in Gansu by using questionnaires to survey .Results The de‐gree of residents′knowledge about the policy was low (57 .23% );the residents could know about the policy through a variety of ways ,and mainly for medical staff to promote by approaching their homes ;91 .94% of surveyed residents thought that policy service was more convenient when they were accepting ;90 .99% of surveyed residents thought that they satisfied with the service attitude of staff ;82 .35% of surveyed residents believed that the policy service effects was obvious ;90 .11% of surveyed residents overall satisfied with the service of policy .The above results were different in proportion in various counties(P<0 .05) .Conclusion The degree of residents′knowledge and satisfaction on basic public health services in five districts of Gansu still needs to be improved .
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Objective Estimate type I and type II error probability (α,β)of sampling deduction,using sample size set in national basic public health services supervision.Methods Assuming a series of population indicator value of supervised area,αand βwas calculated based on binomial & hypergeometric distribution theory according to the sample size and indicator requirements set in supervision plan.Results When the population indicator value of supervised area was just equal to indicator requirements,probability of type I error was as follows,health record utilization rate(0.41 ),health record qualification rate(0.26),children systematic management rate(0.32),postpartum visit rate(0.32),the elderly health examination form completion rate (0.35 ),standard administration rate of patients with hypertension or diabetes (0.37),control rate of blood pressure of hypertension patients(0.34),control rate of blood glucose of diabetes patients (0.43),standard administration rate of severe mental illness patients(0.50).When the population indicator value of supervised area was 0.05 lower than indicator requirements,probability of type II error of those indicator was as follows, 0.41,0.54,0.53,0.53,0.51,0.50,0.57,0.47,0.38.Conclusion Current sample sizes of all indicators result in weak sensitivity of unqualified area detection.In order to avoid mistake,the sample size should be improved.
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Objective To understand the correlation between TCM service utilization and health behavior of community residents.MethodsAself-designed questionnaire about TCM service utilization and health behavior status was used to investigate 200 people from 4 communities on random sampling. The items in the questionnaire were evaluated and analyzed to test the correlation of TCM service utilization and health behavior of community residents.Results The two indexes significantly correlated in 0.01 level (bilateral),r=0.674, bilateralP=0.000.Conclusion The correlation between TCM community service utilization and health behavior status is positive. The higher the level of TCM community services utilization is, the higher the index value of health behavior status will be.
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Objective To develop appropriate evaluation methods of local basic public health services which are suitable to county level and above.Methods Data on basic public health services of 1 1 cities in Zhejiang province in 201 2 was evaluated by different evaluation methods including weighted synthetic scored method,weighted synthetic index method, Weighted Technique for Order Preference by Similarity to Ideal Solution (Topsis ) and Weighted Rank -Sum Ratio (RSR).The consistency of evaluation results were tested by Kendall's coefficient of concordance W test.Combination evaluation was conducted to evaluate four single synthetic evaluation results through average method,weighted average combination evaluation method and hierarchical clustering analysis.Results Different synthetic evaluation methods had different evaluation results.However,in the order,the top two were all Hangzhou and Ningbo.Kendall's W test showed good consistence of four evaluation results.Rank of 1 1 cities were Hangzhou,Ningbo,Shaoxing,Jiaxing,Huzhou, Taizhou,Jinhua,Zhoushan,Lishui,Wenzhou and Quzhou based on combination evaluation value by average method, which was the same to the rank based on weighted average combination evaluation result.Eleven cities could be classified into four categories by hierarchical clustering analysis with statistical significance (P <0.01 ):Excellent (Hangzhou, Ningbo),Good (Huzhou,Jiaxing,Shaoxing),Middle (Zhoushan,Jinhua,Taizhou)and Poor (Wenzhou,Quzhou, Lishui).Conclusion These four synthetic evaluation methods used in this study are all suitable to county level and above in basic public health services evaluation.Various synthetic evaluation methods could be used in practice with combination evaluation of various evaluation results.Average method which is convenient and accurate is preferred when consistency of various synthetic evaluation results was testified.Hierarchical clustering analysis could be used for combination evaluation when no precise rank is needed.
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Objective: To describe the status of the basic public health service in township health centers, analyze the resource allocation which influences the supply of basic public health service. Methods: The data is based on monitoring project surveys collected by the health statistical information center, Spss13.0 and Excellare applied to make descriptive statistic analysis. Results:Overall, basic public health service has been carried out well in each area, but there are differences among the application rates of different basic public health service items; basic public health service can be effected by the level of basic public health input and the number of public health workers.