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 elasticity of demand for health care services in China, and to provide suggestions for further studies. Methods Databases including PubMed, The Cochrane Library (Issue 10, 2015), EMbase, CNKI, VIP and WanFang Data were searched from inception to December 2015 to collect studies about price elasticity or income elasticity of demand for health care services. Literatures were screened and related information was independently extracted by two reviewers. Then qualitative approaches were applied to describe the elasticity. Results A total of 31 studies were included. Estimates of the own-price elasticity of demand for health care services ranged from –2.520 to 2.944 in 25 studies; 2 studies estimated cross-price elasticity between outpatient and inpatient service and one study estimated cross-price elasticity between different levels of inpatient services and all estimates were positive; Estimates of the income elasticity ranged from –0.020 to 2.480 in 28 studies. Demand for inpatient services was more income sensitive than the demand for outpatient services and urban citizens were more sensitive to income than their rural counterparts. Conclusion Health service is insensitive to price and belongs to necessity; inpatient service and outpatient service are substitutes for each other and different levels of inpatient services are substitutes for each other; government are supposed to tackle with the unbalanced increase of the demand of outpatient and inpatient services along with the increase of income to guide rational health-seeking behaviors.
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 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 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.
Objective To understand current situation of medical service and management in Yong’an Central Township Health Center (YaC) through on-the-spot investigation, in order to provide references for personal employment and essential medicines list implement in township health centers. Methods Questionnaire and focus interview were carried out, which included the general information, human resources, medical service and management, and the practice of essential medicines list. Results The hardware equipments of YaC were fine, and the target population had fairly good health and economy status. The ratio of General Practitioner (GP)/ nurse and GP/ pharmacist were all above the national average level. The members with college degree and above accounted for 61.6%, and about 88% staffs were with or below primary profession titles. There was a balance between personnel flow out and in. The drug income accounted for 53.6% of the whole in 2009 and the medical expenses increased compared to 2008. Essential medicines list was put into practice in April 1st of 2010 with no relevant technical documents as correspondence. Conclusion YaC, as a good representative of fairly well-off rural Township Health Center in western China, needs to cope with challenges of irrational personnel structure, low educational background and professional title of the staff and human resources flow, and requires developing policy and adopting measures step by step. The management of YaC may be influenced by zero-profit price of the essential medicine, and appropriate subsidy and policy support are necessary to maintain current service quality.
Objective To understand the current situation of medical service and management in Xintian Central Township Health Center (XtC) through on-the-spot investigation, and to provide references for development of key techniques and products for township health centers in medicine allocation and delivery. Methods The questionnaire and the focus interview were carried out, which included the general information, human resources, medical service and management, as well as the practice of essential medicine list. Results a) The hardware conditions of XtC were not good enough, and the income of Lintao county and Gansu provincial government fell short of their needs; b) The General Practitioner (GP)/nurse ratio was higher than that of the national level, the GP/pharmacist ratio was a little bit lower, and the GP/laboratorian ratio reached the national level. There was only one medical technician. There was about 27.5% staff members having no college degree, and about 81% having at most primary profession titles. There were 26 medical workers allocated to XtC in recent two years and only one GP left; c) In 2009, the bed utilization ratio was a little bit higher than the national level (109% vs. 60.7%), while the average length of stay was longer than the national level (6 vs. 4.8); d) The outpatient service in 2010 increased by 17.6% compared to 2009 and the inpatient service in 2010 decreased by 17%; e) The average medical expense per outpatient and per inpatient increased by 23.5% and 14.9%, respectively, in 2010 compared to 2009; f) The essential medicine list (EML) was put into practice in June, 2010. The current count of medicine in hospital was 767, far beyond the EML demand. Conclusion XtC, as a basic rural Township Health Center in Western China, overtakes the burden of healthcare service for local population. The policy of “selecting graduates to work in Township Health Center” made by Gansu government ensures sufficient personnel reserve for rural Township Health Center. XtC needs to cope with challenges of insufficient hardware conditions, unreasonable personnel structure, low educational background and profession title of the staff, and low technical level of medical service. XtC has a big ratio of medicine income and the expense of outpatient is lower than that of the national level. The management of XtC may be influenced by zero-profit price of the essential medicine, and appropriate subsidy and policy support are needed to maintain its service quality. And it is necessary to carry out evidence-based selection of the essential medicine account and develop staff training and essential medicine usage guidance, so as to support the medicine used safely and rationally.
Objective To summarize the research progress of health care transition (HCT) for pediatric liver transplant recipients. Method The literatures of HCT for pediatric liver transplant recipients were reviewed, and the concept, related factors, interventions and methods of health care transition were summarized. ResultsHCT is the process of moving from a child/family-centered model of care to an adult or patient-centered model of health care, and influenced by health care provider, child and caregivers, and other factors such as medical policy and economic level. Personalized transition program has more benefits for improving the experience and health outcomes of patients. Conclusion problem-oriented and demand-oriented transition program is recommended, early intervention to improve self-management abilities of children, information construction of pediatric medical system and multidisciplinary team building are important for improving health outcomes of patients.
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.