China to explore the development of urban community medical services

Abstract: In our comprehensive new round of Health reform context, the development of urban community Health services as the key to solve the Medical problems of which the Medical community as the main community Health services, to alleviate the current doctor-patient conflicts, reconstruction of Health services system, and maintaining people's Health is of great significance, but for various reasons, today's urban community Medical services there are many problems, the government and all sectors of society need to work together to solve, the better to promote health care reform to build a harmonious society.

Keywords: urban, community health, development

1 Overview of China's urban community Medical services

Community Health Services (Community Care), which, compared to traditional primary care services is characterized by: a community-range, the family unit, provide continuous and personalized care. Its main contents are: to carry out common, and more incidence, diagnosis, treatment of specific chronic diseases, endemic, occupational diseases prevention and control, to provide emergency, on-site rescue, family visits and other services.

After the founding of New China, China's planned economy, the implementation of three long-term preventive Medical care system to solve the national basic health issues, there is no objective conditions for the development of community health care is not necessary, so our community health in the 20th century until the mid-90s slow development, however, since the 1990s, with the establishment of China's market economy and urban communities across the country forward, the existing health care system can not adapt to the new era of economic and social development needs, health care resource utilization , is not high level of medical services, health care cost increases, and so the problem is a pressing need to develop community health services.


2 the rise of urban community medical services because

2,1 external factors
Community health services originated in the 18th century, general medical care. General medical training is received and no branch of general medicine primary care doctors to provide medical services mainly general practitioners practice independently in the community to address residents' health problems in the 1920s Since the United Kingdom, the United States, Australia has passed legislation, etc., to establish a community health service in the position of .1978, the World Health Organization requirements, countries in the world to develop community health services since the medical community has become a national health care system base, forming a more stable and mature operation due to their historical background and cultural differences, community health services, content and form are different. in general, residents of the disease first initial diagnosis in the community, if the illness is serious or indeed necessary, after the confirmation of general practitioners, and then go to the corresponding large hospital. the United Kingdom, Japan, Australia and other community health care level is a world leader, while Asia, South Korea, Singapore, India, and China's Hong Kong, Taiwan, is also active in community medical services. "minor illness in the community, serious illness to the hospital," which in foreign countries has become widespread.


2,2 domestic factors
First, community health development is the inevitable requirement for China's medical reform in December .2006, Academy of Social Sciences released the 2007 Social Blue Book <<2007: China's Social Situation Analysis and Prediction of>> pointed out that the urban and rural household per capita total consumption expenses, medical expenses accounted for 11.8%, reflecting the urban and rural households in recent years, the burden of rising health care rapid reality. community health services to address the fundamental problem is the people's "difficult and expensive" problem, which is China's urban health care the most serious problem.

Secondly, regional services and improve community health but also can promote the development of China's community service gradually developed, self-help community residents not only focus on mutual assistance in order to improve the quality of life for the purpose of community residents and the community service and social welfare services as an important cause of part of the community health service is carried out for the actual needs of the residents of convenience services that help people be more concerned about their health, to enhance the community residents' sense of belonging, identity and cohesion, enhance the enthusiasm of the residents, and strengthen community integration connected with the role of stabilizing mechanisms have to ask.


3 status of urban community medical services and cause analysis of problems

Community health services are considered to relieve the "difficult and expensive" problem is one effective way, but in 2006, according to health department statistics, government-run medical institutions only urban community health care institutions 5,5% of total hospital beds accounted for 8,1%, health workers accounted for 2,7% community medical coverage is small, the insufficient number of staff, lack of facilities and equipment, service quality is difficult to obtain public trust, and the people there is still a demand, mainly problems are:
(1) inadequate institutional facilities: comprehensive community health care institutions, general hospitals should be equipped with basic medical equipment and strict disinfection procedures and other essential health conditions, or not eligible to have consultation and some community health care, despite their clean and convenient , but not a complete medical facilities, very concerned for the health of people who prefer to a hospital. This loss of significance of the existence of community hospitals.

(2) Price opaque: community health care institutions should be "parity hospital", but in fact all other medical institutions, drug prices and service prices are often not unified. False high in some places, making the diagnosis is there, according to requirements to reduce prices, it may be because the price is too low can not compensate for other costs and losses.

(3) medical staff quality and service levels to be improved: people tend to still worry about the ability of community physicians, resulting in most community hospitals remained deserted now, and large hospitals and crowded unusual situation for most doctors in terms of their own and general practitioners do not have the required quality, in dealing with all patients, can not be completely handy, in the eyes of some patients can not leave a good impression.

(4) lack of related systems: community health services are located in the "minor illness" and a clear diagnosis of chronic medical care, diagnosis and treatment of major diseases can not afford to go to big hospital in time but the present lack of such a "two-way referral "system, convergence and communication mechanisms have not established a complete, thus making the community the responsibility of health care to extremely limited, and, the current health insurance policy can not effectively solve community medical reimbursement issues.

China's urban community medical services are in the stage of development, focus on community health care network, the lead, in the swing point and surface construction, but lack a solid foundation. Over time, the work tends to be superficial, loss of trust of the masses, is equivalent to plug their own path of development, which is the city communities of the root causes of medical problems. There are a few specific areas:
(1) the traditional sense of the impact of people because of it has long been dependent on the formation of a large mental hospital, that it is more authoritative, and therefore more willing to believe that the hospital specialist clinics, community health care workers the skills coupled with knowledge, attitude, treatment of medical institutions environment, health care reimbursement limits etc can not fully meet the residents of the community health service requirements, and further reinforced the sense of this.

(2) allocation of medical resources limited the government's public investment in health care has long been the city's major hospitals to be too tilted to the lack of compensation mechanisms for community health care institutions, resulting in the majority of community health care institutions make ends meet, working conditions and environment are not improvement. Although local governments have increased investment in community health care, it is still far from adequate, as long as the implementation of community health care organizations are still "drug dependent doctors' medical costs will continue to rise when the residents found that community hospitals and large medical expenses as high as when they no longer identify with the community hospital with limited medical resources the government has not been used to correct market failures, but was used by the market, and ultimately the formation of market failure and government distorted the dual problem.

(3) supervision and management and staff training in place. Community health services, lack of specialized organizations and regulatory authorities. Medical service price is not transparent, less health care, low educational structure, lack the necessary training, poor treatment, development of small, low levels of medical diagnostic capabilities, medical equipment obsolescence. If this trend continues, community medical services will form a vicious cycle, survival difficult.

(4) The current health insurance policy constraints. The Government would be incorporated into community health care services the basic medical insurance for urban workers, the scope of medical institutions, to guide those who participate in community treatment, but this policy in some areas not well implementation and some qualified community health services have not yet incorporated into the health insurance unit were fixed, community medical services and secondary and tertiary hospital Medicare drug directory is inconsistent, there is only entitled to basic medical services, but the difficulties can not be directly reimbursed. turn affixed to the free download http://www.hi138.com 4 development of urban community healthcare services

4,1-led government
4,1,1 efficient allocation of medical resources
Shortage of funds is restricted to the further development of community health services is an important aspect, the government should play a leading role, and gradually establish a government investment as the main multi-channel, multi-way combination of compensation funding mechanisms. To establish a good health service network, so that large hospitals and community health agencies a clear focus on their respective responsibilities, to avoid the waste of medical resources. In order to protect its public service, community hospital's full allocation of government, expenditure management, drug zero difference mode of operation of community health care institutions, community hospitals all turned over to the treasury income, spending, after all audits issued by the government to play the role of general practitioners, focusing on community hospitals to the residents of a healthy lifestyle guidance in Shandong Province will run a government hospital and all hospitals to community health street services, part of the two conditional state-owned hospitals and primary health care institutions owned enterprises, the structure and function through the transformation, but also to achieve transformation, managed by the Government, so that a comprehensive large Shanghai hospital is focused on the treatment of incurable diseases, so community health agencies to better play to common disease diagnosis and treatment capabilities of these different levels are breaking the barriers between the interests of the hospital, is conducive to the integration of the use of medical resources, so that people will be economic, convenient, continuous health care services.

4,1,2 foster the training of community
Most of the existing community health staff in the updating of the knowledge structure and the constraints of the existence of a large, generally known as "GP" is not very appropriate. Nationally, the real general practitioners of the very few So, the establishment of high-level national training base is very urgent, personnel training and education, establish and improve the professional qualifications of prospective human system, are very important, such as Shenyang City, medical experts into the community, services into family activities, high-ranking health technical staff on a regular basis to the community service system for the formal implementation of the provisions of the doctors refused to community service shall not be promoted to title and so on.

Good treatment is to stabilize the fundamental guarantee for community healthcare workers, through the establishment of incentives, promotion systems and to develop appropriate incentives to address community health care worries. Community health service personnel should establish a noble medical ethics, in order to consummate of medicine, quality patient service attitude to win the trust and praise, the human service with patients to establish doctor-patient relationship.

4,1,3 good supervision and management
To establish and improve standards of basic community health care institutions, service standards and management practices, strengthen vocational and technical training and professional ethics, improve service, improve service levels to establish a scientific evaluation system for professional and technical personnel, professional qualifications, service regulate the conduct and management of local government should make this work included in the local economic and social development of the overall planning, attention to the construction of a variety of supporting policies and implementation of Health departments should carry out the work of medical institutions supporting conditions, workflow specifications, quality standard of supervision, to ensure community health services, public welfare and professional level of service quality.


4,2 auxiliary social organization
Government to encourage compliance of the individual clinics and social forces to participate in established community health services, which is "to do the medical community," provides the policy basis and some individuals or social groups to set up the conditions were better funded clinics, they have good service, medical conditions and fair prices, can also provide services to community residents. whether the government or the social forces of community health care institutions, as long as the residents of the community to provide public health services, both should enjoy government subsidies in accordance with relevant regulations, such as the urban community hospital in Suzhou not by government-sponsored, but the introduction of social forces to establish the 通过招投标 Previously, Health and community hospitals signed <<Accountability Documents>> is the executive order, and now into a legally binding contract so that both sides are more clearly aware of their rights and obligations, but also adapt to the "government purchases" in the actual operation.

Urban community medical services is to achieve "universal access to primary health care," the basic way of this goal. Should attach great importance to the development of urban community medical services, and constantly improve their overall level of building community-based health services, community health services and medical rational division of labor organizations, in close collaboration with the new health care system, the urban community medical service has made rapid progress, to facilitate real for the masses.


References
[1] Gao Min, how to make people trust [N], 21 century pharmacy ,2006,9-11
[2] Wei Chi, community health care institutions need to "keep fit" [N], 珠海特区报 .2006,11-20 Links to free download http://www.hi138.com