Objective To analyze and compare the urban-rural difference of health resource allocation of maternal and child health institutions in Sichuan province. MethodsGini coefficient and agglomeration degree was used to analyze the equity of health resource allocation of maternal and child health institutions in Sichuan province. ResultsThe number of maternal and child health institutions per 10 000 population in rural areas was higher than that in urban areas, while the hospital beds and health workers per 10 000 population was lower. In terms of population-based Gini coefficient, the value of three type of health resources of maternal and child health institutions in Sichuan Province were lower than 0.4, indicating a good equity, however, the value of institutions and health workers in urban areas were lower than those in rural areas, the value of hospital beds were higher than those in rural areas. In terms of the difference between HRAD and PAD, there were great differences in the population-based accessibility of health resources of maternal and child health institutions in Sichuan province, relative excess and relative deficiency coexisted in different city (state). Moreover, there were differences in population-based accessibility to health resources of maternal and child health institutions between urban and rural areas in each city (state). ConclusionThere are obvious urban-rural and regional differences in health resources allocation of maternal and child health institutions in Sichuan province. Social factors such as population, geographical area and service radius should be comprehensively considered according to the real needs in the planning of rational health resources allocation of maternal and child health institutions.
Objective To describe the criteria and procedure for defining an essential healthcare package in the developed and developing countries. Method Search words were chosen by both health policy experts and search coordinators after discussion and pilot. We searched electronic databases, websites of health institutions and governments and search engine Google. Any reports of implemented strategy to develope an essential healthcare package were included. Pre-designed data extraction form was used for collecting strategies and study method of included studies. Then the extracted information was analyzed and described. Result One hundred and sixty-six studies covering 72 countries were included, most of which were studies in the middle and low Countries. In terms of study objective,160 articles aimed to describe strategies, 6 articles aimed to evaluate effectiveness of strategies.Five studies evaluating effectiveness were cross-sectionnary data, and one study was time series. Conclusion An appropriate package should be defined according to both technique criteria and social welfare criteria, considering each country’s healthcare system and market structure, characteristics of the demander and provider, capacity of government’s regulation. The experience in transition countries gives us more high lights.
Objective To investigate current situation of medical service and management in Gaozha Central Township Health Center (GzC), so as to provide baseline data for township health centers in both key techniques research and product development of drugs allocation and delivery. Methods A questionnaire combined with a special interview was carried out, which included the general information, human resources, medical service and management, and the practice of essential medicine list. Results a) The hardware condition of GzC was not good enough, and the economic status of the service recipients was lower than the average level of both Wuzhong City and China mainland; b) The constituent ratio of general practitioner (GP) and nurse, and GP and laboratorian were all lower than those of national level, while, the constituent ratio of GP and technician was a little bit higher. GzC was in short of medical technical personnel and, especially, the professional pharmacists. The logistics technical workers were as the same proportion as the nurses. The medical technical personnel without professional education background accounted for 3.4%, and about 38% of the staff members had no college degree, about 86.2% had at most primary profession titles. There was no personnel turnover of GzC in recently years; c) The bed utilization ratio was lower than national level (46.4% vs. 60.7%), while the average duration of stay and the in-patient and out-patient service workload of GP were longer or heavier than national level (8 vs. 4.8, 9 vs. 8.3, 4 vs. 1.3); d) The out-patient service in 2010 decreased 26.9% compared to 2009; and the in-patient service in 2010 decreased 42.4%; e) The average medical expense per outpatient and per inpatient increased 127.3% and 56.2%, respectively in 2010 compared to 2009; and f) Essential medicine list was put into practice in April 1st of 2010 and there was only 195 species available in GzC, which has not met the requirements of the national essential medicine list. Conclusion In order to meet the standards of general rural township health center in western China, GzC needs to cope with challenges of insufficient hardware conditions, short of staff, unreasonable personnel structure, low educational background and professional title of the staff, none human resources flow and low technical level of medical service. GzC dose well in drug expenses control, and the hospitalization costs are lower than those of the national level. However, it increases rapidly in 2010. The management of GzC may be influenced by zero-profit sale of the essential drugs, and appropriate subsidy and policy support are necessary to maintain its service quality. And it is required to complement the medicine based on the evidences, to carry out staff training and usage guidance of essential medicine, and to finally guarantee the safe and reasonable use of medicines.
Objective To understand the current situation of medical service and management in Luxi township health center (LxC) in Yongxin county of Jiangxi province, so as to provide baseline data about drug allocation, logistic key techniques research and products development for township health centers. Methods By means of questionnaire and focus interview, the LxC was investigated from the following aspects: general information, human resources, medicine list, basic device configuration, medical service and management, as well as service efficiency. Results a) Yongxin county including 13 village committees covers an area of 86 km2, with the population of 22 300 in 2009, and it pertains to a backward area with the annual per capita income of RMB 4 100 yuan; b) Among the total 28 staffs in LxC, 78.6% were health workers; the general practitioner (GP)/nurse ratio was about 1?0.58; the proportion of GP, nurses, medical technicians, other staffs was 54.55%, 31.82%, 9.09% and 4.54%, respectively; the proportion of bachelor degree, junior college graduation and secondary technical school graduation was 9.1%, 13.6%, and 77.3%, respectively; and the ratio of elementary, middle, and high professional title of health workers was 15?5?1; c) There were 625 species of drugs in LxC in 2009, and the hospital beds approved by government were 0.69 per thousand agricultural persons, which, however, were 1.15 in fact. The rate of 51 basic equipments shown in national regulation was actually 76.5%, and the readiness and utilization rate of existing 40 equipments was 92.5%; and d) In 2009, the outpatients were 12 150 person-time, with the average cost of RMB 29.39 yuan; the hospital discharge was 1 589 person-time, with the average stay of 12 days and the average cost of RMB 490.05 yuan; the vaccine inoculations were 5 053 person-time; among the total income, the medical service income accounted for 73.2%, while the drug income accounted for 53.7%; the personnel expenditure was 31.0% of the total, and the balance of income and expenditure was RMB –263 500 yuan. Conclusion The hardware condition of LxC is not so good owing to the financial difficulties of Yongxin county and Jiangxi provincial government. In comparison with the whole country, although the professional title structure is ok, health workers are still not enough, with unreasonable specialty structure and low educational background. The rate of basic equipments and the approved hospital beds per thousand agricultural persons are low. There are 625 species of drugs, containing 218 species shown in 2009 national essential medicine list. And the other conditions are as follows: no information system, lack of public health service, short of financial input, high ratio of “running hospital by selling drugs”, and low efficiency of medical service. So the top priority of LxC construction should be figuring out all of the above issues, and better serving the people.
Objectives To describe background, measures and impacts of building essential healthcare system in the developed and developing countries aboard. Methods Search words were chosen by both health policy experts and search coordinators after discussion and pilot. The resources we searched included electronic databases, websites of health institutions and governments and search engine Google. Any reports of implemented strategy to develop an essential healthcare package were included. Pre-designed data extraction form was used for collecting strategies and study method of included studies. Then the extracted information was analyzed and described. Result 166 studies covering 72 countries were included, most of which were studies in the middle and low Countries. In terms of study objectives, many studies (160 articles) aimed to describe strategies, while few studies(6 articles) were to evaluate effectiveness of strategies. Most of studies evaluating effectiveness were cross-sectionnary data, Except one time cohort study with intervention. Conclusions Strategies to implement essential healthcare system varies in the different country because of diversity of political, culture and economic background and different goals. The experience in transition countries gives us more high lights.
Objective To critically appraise and systematically reviewe the economic evaluations of all alternative interventions for hepatitis B in China. Methods We searched MEDLINE and the four largest Chinese electronic databases. The references of eligible studies were also screened. Economic evaluations of any type, which studied interventions for hepatitis B, were eligible for inclusion. A 25-item quality checklist modified from a BMJ checklist was used to appraise the quality of studies. The overall quality score was calculated against 100 points to indicate the risk of bias. Quality appraisal and data extraction were conducted by two independent reviewers. Results Nineteen full economic evaluations and two cost studies were included of which fourteen studies were scored 25-44 points, and seven scored 45-61 points. Most studies adequately documented effectiveness of interventions. However, the costs of interventions were not well reported in over 50% of studies. Many studies inadequately conducted data analysis, particular in sensitivity analysis and discounting. Ten studies compared lamivudine with interferon or conventional therapy for 1-year (or 6-month) effects, which indicated that lamivudine was generally cost-effective. Three evaluations studied 30-year outcomes of interferon compared with conventional therapy, which suggested that interferon usually saved additional costs and years of life. Another three studies compared interferon with less frequently used antiviral agents, however the comparative cost-effectiveness varied. Two cost studies showed the total costs and the percentage of medical costs increased rapidly in proportion to disease severity.Conclusions Of alternative interventions, lamivudine is cost effective for short-term effects. Interferon is superior to conventional therapy for long-term outcomes. However, the long-term economic outcomes cannot be justified by the current evidence. Quality of methods, particularly, that of costing and analytical methods, is a major limitation. There remains a b need to improve the quality of reporting. Careful considerations should be paid before applying the results to decision making.
Objective To systematically review indicators and methods of quality assessment for primary health care, to provide empirical evidence for quality improvement in this area. Methods We electronically searched databases including Proquest Dissertations and Theses, ISI Web of Knowledge, PubMed, EMbase, IDEAS, Jstor, SSRN, Popline and The Cochrane Library (Issue 4, 2014) and network resources on World Bank, World Health Organization and Google from inception to April 2014. Empirical studies about quality assessment of primary care system, organization and personnel were collected. Data was extracted using pre-designed form for qualitative analysis and description. Results A total of 59 studies were included. The quality assessment for primary health care in practice was mainly from four dimensions: (1) emphasize on the implementation of such basic characteristics of primary health care as first contact, coordination, comprehensiveness and continuous; (2) focus on the evaluation of primary care contents, such as basic medical care, preventive care, chronic diseases, etc.; (3) based on the structure, process and outcome quality proposed by Donabedian; (4) emphasize on patients’ perceived quality. Seven relevant tools were widely used in the process of quality assessment in practice. Conclusion The majority of included studies were from developed countries while such empirical studies lacked in developing countries. Included studies varied in the connotation and angel of the primary health care quality, among which, the GPAS (General Practice Assessment Survey) used for evaluating pati ent perceived quality and PCAT (Primary Care Assessment Tools) used for evaluating the basic characteristics of primary care were widely used.
ObjectivesTo understand the current situation of the nosocomial infection management system in maternal and child health care institutions at all levels in Sichuan province, and provide a feasible policy basis for strengthening the nosocomial infection management.MethodsThe expert group members of Sichuan Maternal and Child Health Association Academy Association designed a unified questionnaire, and distributed the questionnaire through “Questionnaire Star” to carry out on-site online survey.ResultsA total of 159 maternal and child health care institutions participated in the survey. Most secondary and below maternal and child health care institutions had not set up professional hospital infection monitoring system. A few secondary and below maternal and child health care institutions did not independently set up a hospital infection management committee, hospital infection management department, full-time hospital infection department head, the inspection team of infection control, monitoring system, and nosocomial infection management system and special supervision had not been established in special departments. There were statistical differences in some jobs in the construction of nosocomial infection management system in different levels of maternal and child health care institutions (P<0.05).ConclusionsThe organizational system construction of hospital infection managemen are at a low level in the second level and below maternal and child health care institutions in Sichuan province. The tertiary maternal and child health care institutions should give full play to the leading role in promoting the standard construction of nosocomial infection management system of maternal and child health care institutions in Sichuan province, and carry out nosocomial infection management of maternal and child health care institutions orderly.
Objective To investigate the situation of human resources of primary health care institutions in Chengdu and provide references for rational allocation of health personnel in primary health care. Methods From October to November 2016, self-administered questionnaire was used to investigate the situation of the human resources of health workers in a total of 390 primary health care institutions in the three circles of Chengdu (including the subsidiary counties, towns, and districts) during 2015. The Health Resources Density Index (HRDI) was calculated and its equilibrium was analyzed. Frequency and constituent ratio were used for descriptive analysis. Results Three hundred and seventy valid questionnaires were recovered. The number of clinical doctors, general practitioners, and registered nurses per 10 000 residents in Chengdu was 5.32, 1.38, and 4.32, respectively. Doctors’ and nurses’ HRDI was 0.52 and 0.42 respectively. The number of intermediate and junior professional titles accounted for 15.91% and 52.13% respectively. The ratio of doctors to nurses was 1∶0.81, and the ratio of general practitioners to nurses was 0.32∶1. Structure rationality of distribution density and professional titles of healthcare personnel showed a decreasing trend from the first circle to the third circle. Conclusions The personnel troop of primary health care service in Chengdu has been formed. However, the professional title structure and the distribution of professional categories still need to be improved. The situation of primary health workers in the third circle is relatively backward compared with other circles in Chengdu. It is suggested that the number of nurses and general practitioners should increase properly, and rational intervation should be carryed out in the distribution of primary health workers, so as to balance and develop the grass-root health personnel in the three circles of Chengdu.