Comparison of three models of ownership of community health centres in China: a qualitative study
Comparison of three models of ownership of community health centres in China: a qualitative study
复制标题
DOI：
10.1177/1355819615579700
复制
发表时间：
2015-07-01
影响因子：
2.4
通讯作者：
Griffiths, Sian M.
中科院分区：
文献类型：
--
作者：
Wei, Xiaolin;Yang, Nan;Griffiths, Sian M.
目的社区卫生服务中心是我国初级卫生服务的主要形式。有三种模式：政府管理、医院管理和私营。我们的目的是描述和比较初级保健的三个所有制models.Methods四个方面的初级保健进行了研究：服务，组织，融资和人力资源。2010年对珠江三角洲地区13所社区卫生服务中心的60名管理人员和专业人员进行了访谈。在首都选定了三个社区保健中心，在其他五个城市各选定了两个。结果政府管理的社区卫生服务中心获得的公共资金最多，其次是医院管理的社区卫生服务中心，而私营社区卫生服务中心获得的公共资金最少。与其他两种模式相比，私营社区保健中心规模最小，提供的公共保健服务质量较低。尽管政府改善了对预防服务的供资，但患者自付费用占所有社区保健中心模式收入的大部分。一般的挑战，如公共资金短缺，排斥流动人口在预防服务的资金，人力资源能力低，在社区卫生中心的临床和预防保健分离，在所有三种模式的社区卫生中心。结论社区卫生中心的所有权和管理极大地影响它提供的服务。私营社区保健中心在提供高质量的临床和预防保健方面处于不利地位。
Objectives Community health centres are the main form of provision of primary care in China. There are three models: government managed, hospital managed and private. Our aim was to describe and compare primary care under the three ownership models.Methods Four aspects of primary care were studied: services, organization, financing and human resources. Interviews were undertaken with 60 managerial and professional staff in 13 community health centres in the Pearl River Delta region in 2010. Three community health centres were selected in the capital city and two were selected from each of the other five cities. Thematic framework analysis was conducted.Results Government-managed community health centres received the largest public funding, followed by hospital-managed community health centres, while private community health centres received the least. Private community health centres were the smallest in scale and provided lower quality public health services compared with the other two models. Patient out-of-pocket costs accounted for the majority of the revenue in all models of community health centres despite improved government funding for preventive services. General challenges such as the shortage of public funding, the exclusion of migrants in the funding for preventive services, low capacity in human resources and the separation of clinical and preventive care in community health centres were identified in all three models of community health centres.Conclusions The ownership and management of a community health centre greatly influence the service it provides. Private community health centres are in a disadvantaged position to deliver high quality clinical and preventive care.