Comparative analysis of inpatient medical service in primary medical institutions in Chengdu_West China Medical Journal

Authors：

ZHAO Qian ¹ , LIU Qirong ² ,  DAI Hua ¹ , ZHOU Liping ²

1. Department of General Practice, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Shizishan Community Health Service Center, Jinjiang District, Chengdu, Sichuan 610066, P. R. China;

Corresponding author：

DAI Hua, Email: 19541373@qq.com

Keywords：

Inpatient services; Primary care; Health resources

DOI：

10.7507/1002-0179.201706190

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Objective To provide basis to improve the ability of primary care services in Chengdu by comparatively analyzing inpatient medical service of primary medical institutions (community health service centers and township health centers). Methods From October to November 2016, the data of inpatient services in primary medical institutions in Chengdu, including 390 primary medical institutions in 22 districts (cities) and counties, were investigated by questionnaire. SPSS 19.0 was used for data collection and analysis, while the univariate logistic regression and multiple logistic regression were used to analyze the influencing factors. Results It was more common for rural primary medical institutions to carry out inpatient medical services than urban (96.18% vs. 53.84%). The coverage rate of insurance in urban areas was higher than rural areas (98.41% vs. 90.87%), while the rate of adopting clinical pathway of single disease was quite low both in urban areas (23.81%) and rural areas (18.25%). Primary medical institutions in urban areas launched more special projects of inpatient services than those in rural areas (14.29%–17.46% vs. 3.57%–7.54%). The total amount of inpatient medical services in 2015 in rural areas was larger than urban areas (529 611 vs. 103 912), the total number of inpatient services in rural was 5.09 times that in urban primary medical institutions, the average inpatient services in 2015 per one rural primary medical institution was 1.27 times that in urban, per 10 000 residents in rural areas consumed 3.01 times more inpatient medical services than those in urban areas in average, the median beds utilization efficiency in rural areas was better than in urban areas (74.47% vs. 22.47%); work intensity of inpatient medical service in rural areas was greater than in urban areas (234.57 vs. 81.74 cases per year per doctor). The number of inpatient services was positively related to population in service (when less than 100 000 residents), inpatient beds, the number of drugs, the number of medical staff. Conclusions For inpatient medical service, there are obvious differences between urban and rural areas in Chengdu. Therefore, above differences should be taken into full consideration in the allocation of resources in primary medical institutions. Thus more targeted management measures should be formulated.

Citation： ZHAO Qian, LIU Qirong, DAI Hua, ZHOU Liping. Comparative analysis of inpatient medical service in primary medical institutions in Chengdu. West China Medical Journal, 2017, 32(8): 1162-1167. doi: 10.7507/1002-0179.201706190 Copy

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1. 国务院办公厅. 国务院办公厅关于印发深化医药卫生体制改革 2017 年重点工作任务的通知. (2017-04-25) [2017-07-26]. http://www.gov.cn/zhengce/content/2017-05/05/content_ 5191213.htm.
2. 国务院办公厅. 国务院办公厅关于推进分级诊疗制度建设的指导意见. (2015-09-08) [2017-07-26]. http://www.gov.cn/ zhengce/content/2015-09/11/content_10158.htm.
3. 中华人民共和国卫生部, 国家中医药管理局. 关于印发城市社区卫生服务中心、站基本标准的通知. (2006-06-30) [2017-07-26]. http://www.nhfpc.gov.cn/zwgk/wtwj/201304/d63e8544efb046dd8055c32b0b134cb3.shtml.
4. 国家卫生计生委基层卫生司, 中国社区卫生协会. 社区卫生服务质量评价指南(2016 年版). (2016-06-20) [2017-07-26]. http://c1116331637.bj.wezhan.cn/newsitem/277409389.
5. Rothkopf J, Brookler K, Wadhwa S, et al. Medicaid patients seen at federally qualified health centers use hospital services less than those seen by private providers. Health Aff (Millwood), 2011, 30(7): 1335-1342.
6. 相晓妹, 王素卿. 西安市基层医疗机构实行国家基本药物制度状况分析. 国外医学: 医学地理分册, 2017, 38(1): 19-23.
7. 杨才君, 蔡文芳, 沈倩, 等. 基本药物制度对新型农村合作医疗参合农民医疗服务利用率的影响分析. 中国药事, 2016, 30(12): 1171-1175.
8. 许擎鑫. 我国单病种收费制与 DRGs 相关情况述评. 中国卫生经济, 2011, 30(8): 36-38.
9. 杨才君, 蔡文芳, 沈倩, 等. 新型农村合作医疗参合农民住院费用案例分析. 中国药事, 2016, 30(12): 1176-1182.
10. 王明. 社区卫生服务中心安宁舒缓疗护服务现况调查. 中国农村卫生, 2017, 7: 63-64.
11. 卢珊, 牛亚冬, 张研. 农村居民个人年度医疗费用特征分析. 中国卫生经济, 2017, 36(3): 77-80.
12. Evans CS, Smith S, Kobayashi L, et al. The effect of community health center (CHC) density on preventable hospital admissions in Medicaid and uninsured patients. J Health Care Poor Underserved, 2015, 26(3): 839-851.
13. 胡丹, 朱靖, 杨帆, 等. 江苏省城乡居民健康状况及卫生服务利用分析. 中国卫生资源, 2017, 20(2): 158-161, 167.
14. 中华人民共和国国家统计局. 国家数据. [2017-07-26]. http://data.stats.gov.cn/easyquery.htm?cn=C01&zb=A0O0809&sj=2015.
15. Lee JE, Kim TH, Cho KH, et al. The association between number of doctors per bed and readmission of elderly patients with pneumonia in South Korea. BMC Health Serv Res, 2017, 17(1): 393.
16. 张金花, 魏志彬, 向群勇, 等. 湖北省孝昌县农村居民住院卫生服务利用情况及其影响因素. 职业与健康, 2017, 33(6): 823-825.

West China Medical Journal

Comparative analysis of inpatient medical service in primary medical institutions in Chengdu

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