Evaluation of the Implementation and its Influencing Factors of Public Health Services in Kunshan Community Health Center, Jiangsu Province

Abstract

Background: In China, the government is attempting to establish a health care system primarily focused on primary health care to address the issue of uneven distribution of domestic medical resources. Community health centers widely present in various regions are the main providers of primary healthcare in the community. The public health service capacity of community health centers is one of the important indicators for evaluating their service quality. At present, the evaluation of it in China mainly relies on the selection of evaluation indicators that focus on the macro level, but the content is not detailed enough to reflect its ability in a practical and specific way. Methods: This study selected a government managed community in the urban and suburban areas of Kunshan City, and conducted a questionnaire survey on 432 community residents using the satisfaction of family doctor services, residents' willingness to seek medical treatment, and SERVQUAL scale to evaluate the public health service capacity of community health centers. At the same time, perform t-test analysis on the data results to test whether there are differences in the distribution of the results. Finally, regression analysis was conducted using potential influencing factors as independent variables to further explore the impact of these influencing factors on the evaluation process of public health service capabilities in community health centers. Results: Among all participants, 387 had an education level of junior high school or below, accounting for 89.58%, and 46.99% of the household population consisted of 2 people. The monthly income of participants is mainly concentrated between 1001-3000 yuan and 3001-5000 yuan, with 202 and 191 people respectively, accounting for 46.76% and 44.21%. At the same time, the majority of participants were those who did not drink at all and drank every day, with 182 and 119 people respectively, accounting for 42.13% and 27.55%. In Tinglin Community, the proportion of residents aged 65-74 is 70%, the proportion of residents aged 75-93 is 30%, and the gender ratio is 41:59. In Jinxi Community, the proportion of residents aged 65-74 is 55%, the proportion of residents aged 75-93 is 45%, and the ratio of males to females is 52:48. The median scores of the two communities in terms of satisfaction with family doctor services are 6 and 5, respectively, with mean values of 4.16 and 3.81. In terms of willingness to seek medical treatment in community health centers, the median scores of residents in both communities are 27, while the mean scores of residents in Jinxi and Tinglin communities are 28.88 and 23.91, respectively. For the five dimensions of the SERVQUAL scale, the overall median scores for tangibility, reliability, responsiveness, guarantee, and cost acceptability are 21, 12, 6, 18, and 6, respectively; The overall mean scores are 17.94, 11.17, 5.54, 16.85, and 5.63, respectively. Through linear regression analysis, it can be concluded that seven variables, including the number of family members, frequency of alcohol consumption, prevalence of chronic diseases, monthly income, exercise frequency, reimbursement methods for medical expenses, and self-assessment of health status, have an impact on the process of evaluating community service capabilities. The goodness-of-fit of linear regression models are generally strong. Conclusions: Compared with residents in Jinxi Community, residents in Tinglin Community have a younger age structure, higher overall education level, a higher proportion of women, a larger household size, higher monthly income levels, and less frequent drinking. At the same time, the willingness of residents from both communities to seek medical treatment at community health centers is not strong. In terms of family doctor services, both community health centers have good service quality, but their coverage needs to be expanded. At the same time, the public health service capacity of Jinxi Community Health Center is stronger than that of Tinglin Community. Factors such as a large number of household members, frequent drinking, exercise, and multiple chronic diseases can make community residents more passive in evaluating the public health service capabilities of community health centers. When the self-assessment of health status is poor, residents often make a more positive evaluation of the public health service capacity of their community health center. The monthly income and medical expense reimbursement methods have different impacts in the two communities.