Grassroots medical and health institutions in our country are responsible for providing basic public health services and basic medical services to residents. However, there are still weak service capabilities in grassroots medical care, which cannot truly meet the medical needs of the people. The construction of county-level medical and health sub centers (hereinafter referred to as "sub centers") is an important step for the country to promote the development of grassroots healthcare. The study of whether the medical service capacity has been improved before and after the construction of sub centers has significant practical significance.
To evaluate the medical service capacity of county-level medical and health sub-centers in Sichuan Province, and to provide a reference for continuously promoting the service capacity of sub-centers and primary medical and health institutions.
Taking 135 county-level medical and health sub centers built in Sichuan Province in 2023 as the research object, they were divided into five major regions: Chengdu Plain Economic Zone, South Sichuan Economic Zone, Northeast Sichuan Economic Zone, Panxi Economic Zone, and Northwest Sichuan Ecological Economic Zone. In January 2024, relying on the Sichuan Provincial Health Commission, a survey questionnaire was conducted on each center to obtain the number of beds per thousand population, the number of health technicians per thousand population, the bed utilization rate, the annual number of outpatient and emergency visits, the annual number of traditional Chinese medicine diagnoses and treatments, the annual number of hospitalizations, and the number of common diseases that can be identified and initially treated from 2021 to 2023, in order to evaluate their medical service capabilities. Using TOPSIS and rank-sum ratio (RSR) methods to comprehensively evaluate the changes in medical service capabilities of sub centers from 2021 to 2023, and using multiple stepwise linear regression analysis to identify the influencing factors of medical service capabilities.
The TOPSIS results showed that the Ci values in all regions were the lowest in 2021 and the highest in 2023. Except for the Panxi Economic Zone, there was a significant gap in the ability levels between sub centers within other regions. The RSR results showed that in 2023, the sub center capacity level of Chengdu Plain Economic Zone was the best, followed by the Northeast Sichuan Economic Zone, and the other regions were relatively poor. The results of multiple stepwise regression analysis showed that seven factors, including the number of beds per thousand population, had a positive impact on the evaluation results (P<0.05). Among them, the number of beds per thousand population (B=0.667, t=26.170, P<0.001) and the number of emergency visits (B=0.628, t=21.162, P<0.001) had the most significant impact.
The construction of sub centers has achieved significant results, but there is a significant gap between regions and institutions. Efforts can be made to promote the sustainable development of sub center and grassroots medical service capabilities through reasonable allocation of beds, strengthening talent team construction, and actively guiding grassroots medical treatment.
With the continuous deepening of the family doctor contract service system, how to effectively cover the functional building population with family doctor contract services has become one of the focuses of attention. Effectively understanding the demand characteristics of this group of people is an important means to establish effective strategies.
To understand the demand for family doctor contract services among functional building populations, and provide reference for improving and optimizing family doctor contract services in functional buildings.
In March April 2024, a typical sampling method was used to select 3 functional buildings in the jurisdiction of the research group, and a cluster random sampling method was used to select 396 middle-aged and young people from functional communities for a questionnaire survey. The questionnaire includes general demographic information, KANO questionnaire on the demand for family doctor contract services, the time period of receiving the most family doctor contract services in the past 6 months, and willingness to pay. Conduct reliability and validity analysis of the KANO questionnaire on the demand for family doctor contract services, construct a Better-Worse matrix to analyze the KANO demand characteristics of 19 service items, and conduct sensitivity analysis based on different service periods and payment intentions.
A total of 396 valid survey questionnaires were collected, and the Cronbach's α of the scale formed by 19 signed service items was 0.991. According to the KANO model, a preliminary classification of the items showed that 19 items belonged to the category of undifferentiated attributes. A better worse matrix was constructed to further divide the demand attributes. In the diagnosis and treatment service, 2 items were classified, including "medication dispensing service" and "expert consultation service". In the health management service, 9 items, including "interpretation of physical examination reports and health consultation", "prevention and treatment of eye diseases", and "prevention and treatment of cervical spondylosis", belonged to the category of "expected attributes". In the diagnosis and treatment service, the "extended prescription" service belonged to the category of attractive attributes, while the rest belonged to the category of undifferentiated attributes. Sensitivity analysis shows that the "long prescription" service has the highest SR value one hour before work and on weekends. The service of "TCM constitution identification/massage/moxibustion/cupping/scraping/acupuncture and moxibustion" has the highest SR value in one hour at noon. The SR value of "expert consultation" services is highest when the willingness to pay is between 0-50 yuan/person/year and≥201 yuan/person/year. The SR value of "TCM constitution identification/massage/moxibustion/cupping/scraping/acupuncture and moxibustion" service is the highest when the willingness to pay is 151-200 yuan/person/year.
The functional building population has high expectations for specialized health management services under the contract of family doctors, and the demand content is diversified. At the same time, the contracted diagnosis and treatment services provided by family doctors, such as long prescriptions, drug dispensing, and expert consultations, are the cornerstone of meeting the service needs of middle-aged and young people. Further optimization and improvement of service content design for this type of population should be carried out.
