关键词: 结核, 传染病控制, 卫生服务管理, 结果与过程评价(卫生保健)

Abstract:

Objective To explore and analyze the effectiveness of different tuberculosis prevention and control system models in Guangdong Province.Methods The 2017 indicator data in the Guangdong Provincial Tuberculosis Monitoring Report, the gross domestic product of the cities and towns reported by the Guangdong Provincial Bureau Statistics in 2017, and the work summary of the cities in Guangdong Province, the report of the provincial supervision city and the research report on the models of tuberculosis prevention and control system model in Guangdong Province in 2017, as well as historical record were comprehensively analyzed. The effectiveness of same model under different local government inputs (combination of prevention and control at hospital level) and different models under the same government input (combination of prevention and control at hospital versus outpatient level, and combination versus separation of prevention and control) were evaluated.Results In 2017, the local governments of Guangdong Province invested 1316800 to 36149000 yuan, and the total benefit of the government investment was between 58113900 and 2777636500 yuan. (1) Comparison in effectiveness of same model under different local governments inputs (combination of prevention and control at hospital level) between Shenzhen and Shantou City: the per capita government investment was 3.04 yuan in Shenzhen and 1.41 yuan in Shantou, respectively; the total benefit of government investment in Shenzhen (1347208900 yuan) was higher than that in Shantou (278276100 yuan); the reported incidence rate in Shenzhen (55.3/100000) was lower than that in Shantou (117.8/100000); the registration rate (45.9/100000) was close to the reported incidence rate in Shenzhen, whereas the registration rate (47.6/100000) was far from the reported incidence rate in Shantou. (2) Comparison in different models under the same governments inputs: ① combination of prevention and control at hospital level (Foshan City) versus combination of prevention and control at outpatient level (Zhuhai City): the per capita government investment was 1.89 yuan in Foshan and 1.83 yuan in Zhuhai; the total benefit of the government investment in Foshan (989780600 yuan) was higher than that in Zhuhai (368948100 yuan); the referral rate and successful treatment rate were 93.4% and 94.8% in Foshan, which were close to those in Zhuhai (both were 95.8%); the incidence rate (48.9/100000) and the registration rate (49.0/100000) in Foshan was similar; the reported incidence rate in Zhuhai was 71.3/100000, and the registration rate was 74.6/100000, and the difference between the two indicators was larger. ② Separation of prevention and control (Chaozhou City) versus combination of prevention and control (Maoming City): the per capita government investment was 0.50 yuan in Chaozhou and 0.48 yuan in Maoming; total benefit invested by the Maoming Municipal Government (337232600 yuan) was higher than that of Chaozhou Municipal Government (58113900 yuan); the reported incidence rate in Chaozhou (68.5/100000) was higher than that in Maoming (61.5/100000); the registration rate in Chaozhou (27.7/100000) was lower than that on Maoming (53.8/100000).Conclusion The level of government input has a great impact on the effectiveness of the tuberculosis prevention and control system. Under the same government input, the combination of prevention and control model is better than the separation model (“Trinity” model), and combination at the hospital level is better than that at the outpatient level.

Key words: Tuberculosis, Communicable disease control, Health services administration, Outcome and process assessment (health care)