Liu Shuo, Lin Jintao, He Yiwen, Xu Junfang
School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China.
Healthcare (Basel). 2022 Feb 10;10(2):335. doi: 10.3390/healthcare10020335.
Primary health institutions (PHIs) are the foundation of the whole health system and the basic link to achieve the goal of all people enjoying primary health care. However, the service capability of primary health institutions is not under the hierarchical medical system.
Data were collected from the between 2014 and 2020. PHIs included community health centres, community health stations, and township hospitals in our study. The service capability of primary health institutions was analysed from the perspective of structure, process, and results. Structure capability was evaluated using the number of beds, number of personnel, number of health technicians, and proportion of the number of personnel in PHIs accounting for the total number of health personnel. Process capability was evaluated using the number of general practitioners. The number of outpatients and inpatients, medical income, the proportion of drug income, and the average number of patients and beds served by physicians in PHIs per day were employed to evaluate the resulting capability.
From 2014 to 2020, the number of community health service centres/stations increased, while the number of township health centres decreased. In the aspect of structure capability, the total number of personnel and health technicians in community health centres/stations and township hospitals both increased during 2014 and 2020. However, the increasing rate in PHIs was a little bit less than that of general medical institutions. The proportion of male health technicians in community health centres and township hospitals both decreased, while the proportion of female technicians in both increased. From 2014 to 2020, the number of beds in PHIs also increased from 138.12 × 10 to 164.94 × 10. However, the proportion of beds in PHIs accounting for the total number of beds in medical institutions decreased. For the resulting capability, from 2014 to 2019, the proportion of diagnosis and treatment times in PHIs decreased from 57.41% to 51.96%, although it increased in 2020. The proportion of inpatients in PHIs decreased from 20.03% to 16.11%. From 2014 to 2020, the utilisation rate of hospital beds in PHIs decreased (from 55.6% to 34% for community health centres and 60.5% to 53.6% for township hospitals). The average daily bed days of doctors in township hospitals was higher than that of doctors in community health service centres. However, the average medical cost of outpatients and the per capita medical cost of inpatients in community health service centres were higher than in township hospitals.
In recent years, although the service capability showed an increasing trend in PHIs, the growth rate was lower than the general health institutions. The utilisation rates of PHIs, including beds and physicians, were decreased. Among PHIs, the utilisation in township hospitals was higher than in community health centres with a relatively low price. Under the hierarchical medical system and normalisation period of the COVID-19 epidemic, it is important to improve the service capability to achieve its goal of increasing PHI utilisation and decreasing secondary and tertiary hospital utilisation.
基层医疗卫生机构是整个医疗卫生体系的基础，是实现人人享有基本医疗卫生服务目标的基本环节。然而，基层医疗卫生机构的服务能力不在分级医疗体系之内。
收集2014年至2020年期间的数据。本研究中的基层医疗卫生机构包括社区卫生服务中心、社区卫生服务站和乡镇卫生院。从结构、过程和结果三个维度分析基层医疗卫生机构的服务能力。结构能力通过床位数量、人员数量、卫生技术人员数量以及基层医疗卫生机构人员数量占卫生人员总数的比例来评估。过程能力通过全科医生数量来评估。基层医疗卫生机构的门诊人次、住院人次、医疗收入、药品收入占比以及医生每日服务的患者和床位数平均值用于评估结果能力。
2014年至2020年，社区卫生服务中心/站数量增加，而乡镇卫生院数量减少。在结构能力方面，2014年至2020年期间，社区卫生服务中心/站和乡镇卫生院的人员总数和卫生技术人员数量均有所增加。然而，基层医疗卫生机构的增长率略低于综合医疗机构。社区卫生服务中心和乡镇卫生院男性卫生技术人员的比例均下降，而女性卫生技术人员的比例均上升。2014年至2020年，基层医疗卫生机构的床位数也从138.12×10增加到164.94×10。然而，基层医疗卫生机构床位数占医疗机构总床位数的比例下降。在结果能力方面，2014年至2019年，基层医疗卫生机构的诊疗人次占比从57.41%降至51.96%，尽管2020年有所上升。基层医疗卫生机构的住院患者占比从20.03%降至16.11%。2014年至2020年，基层医疗卫生机构的病床使用率下降（社区卫生服务中心从55.6%降至34%，乡镇卫生院从60.5%降至53.6%）。乡镇卫生院医生的日均床日数高于社区卫生服务中心医生。然而，社区卫生服务中心门诊患者的平均医疗费用和住院患者的人均医疗费用高于乡镇卫生院。
近年来，虽然基层医疗卫生机构的服务能力呈上升趋势，但增长率低于综合医疗机构。基层医疗卫生机构包括床位和医生的使用率均下降。在基层医疗卫生机构中，乡镇卫生院的使用率高于社区卫生服务中心，且价格相对较低。在分级医疗体系和新冠肺炎疫情常态化时期，提高服务能力对于实现提高基层医疗卫生机构利用率和降低二级及三级医院利用率的目标至关重要。
