China Study

WP/2006/CHN/HSP/3.
1/001
AC: 02.02.01.AW.01
Study Report on Urban Medical Service

System
in Mianyang Municipality
Medical Association of Mianyang Municipality

Study Report on Urban Medical Service in Mianyang Municipality
April 23, 2007
CONTENTS
Catalog of Figures
Acknowledgement
Abstract
Chapter I Introduction
1. Background of the Study
2. Purposes and Significant of the Study
3. Study Contents
4. Relevant Notions
5. Orgnization of the Study Project
Chapter II Material Source and Methods
1. Targets
2. Methods
3. Statistics Analysis
4. Technology Route
Chapter III Result and Analysis
1. Current Administrative Sketch Map Mianyang
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　2
Municipality
2. Structure Figure of Current Urban Medical Service
System of Mianyang Municipality.
3. The Main Results of the Survey to Medical

Institutions
4. The Survey Results of the Basic Situation of Urban
Community Healthcare Institutions in Mianyang
Municipality
5. The Survey Results of the Health Administrators,
Managing Personnel of Medical Institutions and Healthcare
Professionals
6. The Main Results of the Interviews with Key Informants
Chapter IV Discussions
1. The Understanding of the Connotations of Urban
Medical Service System
2. Comments on the Current Urban Medical Service

System in Mianyang Municipality
Chapter V Conclusions
1．General Conclusions：
2. Some Specific Suggestions
Chapter VI Reform Plan of Urban Medical Service
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1．The Guiding Thoughts of Reform
2. Principles of Reform
3. Reform Goals
4．Current Tasks
Reference
Appendix
Figures and Tables

Figure 1 Map of China
Figure 2 Administrative Sketchmap in Mianyang
Figure 3 Sketchmap of Urban Area of Mianyang
Figure 4 Location of Urban Medical Institutions in Mianyang Municipality
Figure 5 Technology Route Map of the Study on Urban Medical Service System
Figure 6 Sketchmap of Current Administrative Management System on
Healthcare in Mianyang Municipality
Figure 7 Structure of Current Urban Medical Service System of Mianyang
Municipality
Figure 8 Types of Medical Institutions in Mianyang
Figure 9 Beds’ Proportion
Figure 10 Proportion of Staff
Figure 11 Proportion of Medical Professionals
Figure 12 Proportion of Registrated MD
Figure 13 Housing Construction Areas
Figure 14 Proportion of Fixed Assets
Figure 15 Revenues in three years（10,000yuan）
Figure 16 Expenditure in three years（10,000yuan）
Figure 17 Proportion of Patient Visits in 2005
Figure 18 Proportion of Discharging Patients from Hospitals in 2005
Figure 19 Operational Compensation in Municipal Public Hospitals
Figure 20 Operational Compensation in District Public Hospitals
Figure 21 Operational Efficiency of Urban Private Medical Institutes
Figure 22 Debt Ratio of Municipal Public Medical Institutes in Mianyang
Figure 23 Preferences for Medical Service of Community Residents in
Mianyang Municipality
Figure 24 Reasons of Preferences for Medical Service of Community Residents
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Figure 25 The Survey Illustration of the Situation of Cognition of Urban Medical

Service System of the Community Residents in Mianyang Municipality.
Figure 26 The Situation of Cognition to Deficiency of Urban Medical Service
System by Community Residents in Mianyang Municipality.
Figure 27 Survey Results of Cognition to Contents of Urban Medical Service
System by Health Administrators, Managing personnel and Healthcare
Professionals in Medical Institutions
Figure 28 Expectation to Government Inputs by Health Administrators,
Managers and professionals in Medical institutions
Figure 29 Data on Medical Insurance Participated by Staffs of Government
Institutions
Figure 30 Sketch Map of”One-level Management
Figure 31 Sketch Map of “Two-layer Structure
Figure 32 Sketch Map of Public Medical Group
Figure 33 Mianyang Municipal Public Health Service Center
Figure 34 Municipal Logistic Service Group Illustrations
Table 1: Major Indexes on Economic and Social Development in Minayang
Table 2 General Information of Urban Medical Institutes in Mianyang
Municipality
Table3 Properties of Urban Medical Institutes in Mianyang Municipality
Table 4 Survey Results of Resource Ultilization on Urban Medical Service in
Table 5 Operational Efficiency of Urban Public Medical Institutions in Mianyang
Municipality
Table 6 Basic Situation of Urban Community Healthcare Institutions in
Table 7 General Information of Questionnaire to Community Residents
Table 8 Awareness of Community Residents to Primary Medical Services
Table 9 Results of Satisfaction of Residents to Medical Service in Peicheng and
Youxian Districts
Table 10 Results of Random Sampling Survey to Health Administrators,
Managing Personnel and Healthcare Professionals of Medical Institutions
Table 11 Survey Results of Cognition to Contents of Urban Medical Service
Table 12 Survey Results of Cognition to Functions of Urban Medical Service
Table 13 Expectation to Cost Composition of Urban Medical Services
Table 14 The Allocation of Large-sized Medical Equipments in Urban Medical
Institutions in Mianyang Municipality
Appendix 1 1 Study on Urban Medical Service System in Mianyang

Municipality（Project Serial Number：WP/2006/CHN/HSP/3.1/001）Appendix
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　5
Appendix 2 Expert Group of the Project of Study on Urban Medical Service

Appendix 3 Research Group of the Project of Study on Urban Medical Service
Appendix 4 List of Project Documents
Appendix 5 Working Photos
Appendix 6 Figures of Survey of Medical Institutions in Mianyang Municipality
Appendix 7 Questionnaires on Medical Service for Community Residents in
Appendix 8 Questionnaires for Community Healthcare Administrators,
Managing Personnel of Medical Institutions and Medical Staff in Mianyang
Municipality
Acknowledgement
This research project has been supported by the
Department of International Cooperation of Ministry of
Health, Health Department of Sichuan Province, the
People’s Government of Mianyang Municipality and Ms.Sun
Jing,the Project Officer of World Health Organization. For
their support, we are appreciated.
Abstract
Aim The study of the current situation of the urban
medical service system in Mianyang Municipality may
provide the policy reference for making urban medical
service system of the middle-sized cities in economically
less developed regions.
Methods (1) In accordance with the MOH’s definition of
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medical institutions, we have studied the healthcare
statistics information, financial reports and cost accounting
information of various medical institutions through general
survey to obtain an understanding of the resources,
management system and the current operation of the
medical institutions and then made an assessment.
(2) We have conducted a survey to the community
residents on the cognition of medical service system by
method of random sampling with equal interval.
(3) We have conducted a questionnaire survey to urban
residents, healthcare workers, health administrators,
managing personnel of medical institutions and
government officials and also conducted deep interviews
with those key informants
Results We have found groups surveyed have
conspicuous different opinions on the connotations of
medical service system. ； The urban area in Mianyang
Municipality is rich in medical service resources and some
of the disciplines developed fast with outstanding
characteristics and sound base of community medical
service. In the meantime, some problems still exist
including the disposition of layout of the medical
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institutions, the complexity of management systems and
the low coverage of medical insurance. Therefore, the
project group presents the suggestions on the reform of
the medical service system policy in Mianyang
Municipality, that is, the Mianyang Model with the
characteristics of sole management system, two-level
structure, three key points and multiple developments.
Chapter I Introduction
China is now in the transformation period of medical
service reform. With the commencement of the New Rural
Cooperative Medical Service System and urban community
healthcare service, the urban medical service system,
which should be compatible with the China’s social,
economic and cultural development and the social
insurance system, is now at the stage of re-evaluation and
policy adjustment.
WHO endorsed the project group to conduct the study
on urban medical service system in Mianyang Municipality
(Project NO. WP/2006/CHN/HSP/3.1/001 ) by funding this
research project.The aim of the project is to provide the
policy reference for the middle-sized cities for making
urban medical service system through the study and re-
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evaluation of the management system and current
operation of medical institutions in Mianyang Municipality.
1. Project Background
Mianyang Municipality is located northwestern part of
Sichuan Basin covering an area of more than 20,000 KM2,
with a population of 5.3 million, governing 9 counties
(cities,districts),namely,
Peicheng,Youxian,Jiangyou,Anxian, Santian, Yanting,
Zitong, Pingwu and Beichuan. The Planned coverage of the
urban area of Mianyang Municipality is 80 KM2,
with a population of 800,000 and the constructed area of
it is 55 KM2, with an urban population of 550,000. It is
connected by road, railway and airlines. Mianyang
Municipality has won many titles such as National Sanitary
City，National Environmental Protection Model City,
National Garden City，National Civilized City，China’s Best
Tourist City and UN Best Model City Prize of Human
Settlement Environment and it is also named as “China
Science and Technology City” with the approval of the
State Council.
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Figure 1 Map of China
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Figure 2 Administrative Sketch map in Mianyang
Figure 3 Sketch map of Urban Mianyang
Figure 4 Location of Urban Medical Institutions in Mianyang
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Municipality
Table 1: Major Indexes on Economic and Social Developmentin

Minayang
Indexes 2003 2004 2005
1 Total Population (10,000) 527.52 529.07 530.7

1
2 GNP(100 million RMByuan) 355.68 415.05 482.5
3
3 GNP Per Capita(RMByuan) 7151 8398 9774
4 Per Capita Income of Urban 7179 7708 8201
Residents
5 Per Capita Income of Rural 2551 2902 3179
Residents (RMByuan)
6 Municipal Financial Revenues 27.04 27.96 47.04
7 Municipal
(100Financial Expenditures
Million RMByuan) 32.45 41.28 34.14
(100 Million RMByuan)
8 Financial Budgets on Educaion, 7.75 8.24 9.04

Sciences, Culture and Healthcare
(100 Million RMByuan)
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9 Invests on Haelthcare by Miniciapl 7450 8447 12872

Finance (10,000 RMByuan)
10 Paticipants to Basic Medicial 346518 358561 38362

Insurance 7
Mianyang Municipality enjoys a sound base to
implement the reform of urban medical service system
since it is the pilot city of the national urban medical
insurance system reform and the national demonstration
area of urban community healthcare service. In 2005, the
Ministry of Health intended to list Mianyang Municipality
with the other three cities as the pilot cities of reform of
national urban medical service system. In January 2005,
the People’s Government of Sichuan Province held a
Conference on Health Reform and Development with the
attendance of the Minister of Health, Mr. Gao Qiang.
However, Mianyang, just like other cities in China, has its
own problems, namely, multiple hierarchy of
administration, the complexity of classification of medical
institutions, heavy expenses on medical service, the
insufficient investment from governments as complaint by
medical institutions, the low efficiency of medical service
as rebutted by the governments and insufficient
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competition of the medical market while lacking the
emphasis of medical service and characteristics.
With the intense focus on urban healthcare service
and the featured advantages, Mianyang Municipality of
Sichuan Province applied to the WHO and conducted
significant work in advance. In November 2006, with the
approval of the WHO, Mianyang Municipality of Sichuan
Province formally started the Project of the Study on Urban
Medical Service System in Mianyang Municipality.
2. Aim of the Study
Through survey and analysis, we shall present the
“Mianyang Model” to provide reference for the reform of
urban medical service system of the middle-sized cities,
which is in compliance with the social economic
development, satisfies the multiple demands on
healthcare of the urban residents, establishes the
reasonable structure and function and improves the
efficiency of medical service of the urban medical
institutions.
3. Study Contents
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3.1 The Development and Current Situation Survey of the
Urban Medical Service System of Mianyang Municipality
3.2 The Survey and Analysis of the Current Situation of the
Public Medical Institutions in Mianyang Municipality
Private Medical Institutions in Mianyang Municipality
Municipality
Clinics in Mianyang Municipality
Operation, Funding and Expenditure of the Medical
Insurance System in Mianyang Municipality
3.7 The Questionnaires on the Basic Medical Service, the
Utilization of Medical Service, Preference and Medical Cost.
3.8 The Questionnaires on the Hierarchy of Health
Administration, the Structure of Recognition of Urban
4 .Relevant Notions
4.1 Medical Service System: it refers to the medical
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institutions in the planned area of Mianyang Municipality
which provide health education, healthcare of disease
prevention, disease control, emergency and first aid and
medical and rehabilitation service to the urban residents.
4.2 Medical Institutions: Medical institutions refer to the
general hospitals, hospitals of Traditional Chinese
Medicine, hospitals of combination of western medicine
and Chinese medicine, specialized hospitals, rehabilitation
hospitals; general outpatient department, specialized
outpatient department, outpatient department of TCM,
outpatient department of the combination of western and
Chinese medicine clinic, clinic of TCM, clinic of the ethnic
medicine; healthcare station, medical room, medical care
station; specialized hospitals for specific diseases,
healthcare station for specific diseases and other medical
institutions, which are registered according to the
Implementation Rules of Medical Institution Management
Regulation, issued by the Ministry of Health.
Among them, the notion of public hospitals and
private ones is defined based on the ownership, that is,
medical institutions established by government shall be
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recognized as public ones while the medical institutions
established by non-governmental elements shall be
recognized as private hospitals.
Community Healthcare Institutions: the community
healthcare institutions refer to the community healthcare
centers or community healthcare stations which are
registered at the district-level health administrations
according to the Controlling Regulations of Urban
Community Healthcare Institutions issued by the MOH.
5. Project Organization
Health Department of Sichuan Province is in charge of
the project. Health Bureau of Mianyang Municipality is the
implementation organization. The WHO provides funds for
the Project.
The study report is divided into five chapters. The first
chapter is the introduction which introduces the
background, aim and significance of the research project.
The second chapter introduces the resource of materials
and methods. The third chapter is the result and analysis,
which mainly introduces the result of the survey of the
medical institutions and the result of interview with the
urban residents, health administrators, managing
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personnel of medical institutions, healthcare workers and
other key informants. Chapter IV is the discussion on the
results. Chapter V is the conclusion and suggestion.
We try to every means to put all the details found into
the appendix of this report, including survey figures, the
policy documents issued by national, provincial and
municipal governments and the particular results of the
questionnaires.
Chapter II Material Source and Methods

1 Target
All the medical institutions in the urban area in
Mianyang Municipality and the urban residents, health
administrators, managing personnel of medical
institutions, healthcare workers, government officials and
the key informants , who meet the selection requirements.
2 Methods
2.1 General Survey
We have conducted a general survey over every
medical institution in the urban area. The content of the
general survey includes the basic situation, the income
and expenditure, the utilization of its medical service
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resources, the compensation of its operation, the
efficiency of its operation and its assets and debts.
In order to keep the coherence of the data and
materials, we set the criteria that the data we chose is
from the health statistics, financial reports, fixed assets
statistics and cost accounting of the every medical
institution as well as the per capital GDP, per capital net
income, the input to health sector from government
finance and the medical expenditure of the urban
residents from the year 2003 to 2005, issued by Mianyang
Municipal Government.
2.2 Sample Survey
2.2.1 The Questionnaire on Medical Service for Communal
Residents in Mianyang Municipality
For the selection of communities, we used the method
of random sampling with equal interval to choose the
target communities from 139 communities in 8 sub-
districts of the urban area in Mianyang Municipality.
For the selection of families, in the selected
community, we used the method of random sampling with
equal interval to choose 200 families with 625 persons as
targets to be surveyed. And then, we listed all the families
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according to the street, number and street and family size
and then to produce a random number by computer. If the
family information is matched with the number, it will be
the first family to be surveyed. And then, choose other
families by using the same method of random sampling
with equal interval. At last, we made interviews with those
families with the self-made Questionnaire on Medical
Service for Communal Residents in Mianyang Municipality
2.2.2 Questionnaires for Health Administrators/Managing
Personnel from Medical Institutions/ Healthcare workers
65 health administrators are selected from the Health
Bureau of Mianyang Municipality, the Health Bureaus of
Peicheng and Youxian Districts and the managing
personnel from their attached organizations by using the
method of random sampling. And the targets to be
surveyed are middle or above-middle level managing
personnel from 2 municipal-level general hospitals, 1
municipal-level specialized hospital, 2 district-level
medical institutions from Peicheng District, 2 private
medical institutions, 1 from Peicheng District and 1 from
Youxian District respectively.
In the above mentioned 10 hospitals, we choose 10
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healthcare workers from each hospital as targets to be
surveyed. We conduct face to face interviews by using
self-made Questionnaire for Health Administrators,
Questionnaire for Managing Personnel from Medical
Institutions and Questionnaire for Healthcare Workers
respectively.
In order to keep the compatibility of the results, the
project group employs experts to train the personnel of
the survey team. The training contents include the aim of
survey, survey design, questionnaire design, the methods
and techniques of survey and analysis, the techniques of
field survey (including the techniques of interview for
questionnaire and task group). As a part of the training
program, every survey team conducted pre-survey to 50
families; however, the results of pre-survey are excluded
in the formal results. At the end of the training program,
we conduct a compatibility check to the surveyors (Kappa
Value=0.85). Those who passed the test will participate in
the formal survey. During the process of data compilation,
gathering, input and analysis, we implement an overall
quality control to ensure the completion and reliability of
the data. All the questionnaires shall be filled in by the
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trained field surveyors. Every surveyor has to check the
completion of the questionnaires every day and the team
leaders shall check the completed questionnaires
regularly. If necessary, the surveyor shall re-survey the
targets to correct the wrongly filed answers. The team
leaders shall independently re-survey 5% of the targets by
random sampling.
3. Statistics Analysis All the materials shall be put into
computer by designated personnel to conduct the
statistics analysis by utilizing Epidata software bundle.
4. Technology Route
Figure 5: Study Procedures
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Project Initiation Review of Historic Data Initiation Assessment
Project Design Design &plan Survey Handbook Design of Questionair
Training Pro-Survey
Review Reviseof Questionair

Implementation
Questionaire Interview To Residents
To Managers
To Medical Staffs
Interview by Topics
Sorting out Data Concluding Data Data Analysis
Conclusion Report Writing Evaluation Filing
Extending&Applying
g
Chapter III Result and Analysis

1. Current Administrative Sketch Map Mianyang
Municipality
Figure 6 Sketch map of Current Administrative Management System
on Healthcare in Mianyang Municipality
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Mianyang Municipal Govern

ment
Mianyang Municipal
Health Bureau
Health
Municipal CDC Education
Hucheng District Governme Youxian District Governme
市级
nt nt
Municipa
Municipa Mternal&Childr Family Planning l Family
l Health
Bureau
en Healthcare Planning
Office
Hucheng District Youxian District

Health Bureau
3-class Hospitals Health Bureau
2-class Hospitals
Remarks: ： Full line stands for leading relationship while
hidden line stands for guiding relationship

区级
2. The Current Urban Medical Service System Structure
District Districtl
Health Mternal&Childr Family
Family Planning
Bueau en Healthcare Planning
Office
Figure 7 Structure of Current Urban Medical Service System of

District CDC
Centers of Community Stations of Community

社区　　　　　　　　　　　　　　　　　　　　　　　　　　
Healthcare Healthcare
　　 Page　24
Remarks: Leadership Guidance

3. The Main Results of the Survey to Medical

Institutions
Table 2 General Information of Urban Medical Institutes in Mianyang
Municipality
Types No. Bed Staff Technician Registrate Assistan Registrated
No.
No. s d M.D. t M.D. Nurses
Total 38 5 5649 4509 1936 141 1799

1 538
Public 8 3 3988 3297 1174 61 1466
Healthcar 782
e
Municipal 4 2 2938 2408 901 12 1077
Hospitals 883
District 4 899 1 889 275 49 398
Hospitals 050
Community 35 147 547 414 173 20 57
Healthcare
Centers for 9 147 233 196 82 9 25
Health
Service
Stations 26 0 314 219 91 11 32
for Health
Service
Private 7 550 690 438 169 56 276
Hospitals
Medical 21 64 60 4
Institutes
Affiliated
to
Enterpris
es
Clinics 31 360 360 360
0
From Table 2, we can see that the total number of
urban medical institutions in Mianyang Municipality is
381. The majority of them are 310 clinics (including
outpatient departments, medical rooms and
healthcare stations), which accounts for 81%. There is
1 clinic in every 1900 urban people. The composition
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of the institutions, beds and healthcare workers is as
illustrated in Chart 8,9 11.
Figure 8 Types of Medical

Institutions in
2% Mianyang
9% 2%
Public
6% Communit
y
Private
Affiliated
Hospitals
Clinics
81%
Figure 9 Beds’
Proportion
12%
3%
Public
Communit
y
Private
85%
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Figure 10 Proportion of Staff
6%
1%
12% Public
Community
Private
10%
Affiliated
Hospitals
71%
Clinics
Figure 11 Proportion of Medical

Professionals
8%
0%
10%
Public
Community
9%
Private
Affiliated
Hospitals
73% Clinics
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Figure 12 Proportion of
1174 Registrated MD
1200
1000 Public
800 Community
360 Private
600 173 Affiliated
169 Hospitals
400 Clinics
60
200
0
Table3 Properties of Urban Medical Institutes in Mianyang

Municipality
Types of Housing Total Fixed Value of Total Liquid
Urban Constructio Assets(10,000yu Medical Assets
Medical n Areas (m) an） Equips（10,
Institutes 000yuan） (10,000yua
n）
Total 336184 107631.5 34003.49 2163.34
Public Medical 260950 97064 28480.49 27916
Institutes
Municipal- 185776 81120 23381.33 21557
level
District-level 75174 15944 5099.15 6359
Private 47600 10318.5 5523 2042.34
Medical
Institutes
Community 27634 249 121
Medical
Institutes
The construction area of the urban medical institutions
is 336184 （㎡） , among which the public medical
institutions, private medical institutions and
community healthcare institutions account for 77.62%,
14.15% and 8.21% respectively. The total amount of
the fix assets is RMB 1076315 thousand Yuan, among
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which the assets of public medical institutions and that
of the private ones accounts for 90.00% and 10.00%
respectively.
Figure 13 Housing Construction
Public
Private
Community
8%
14%
78%
Figure 14 Proportion of Fixed
Public
Private
0% Community
10%
90%
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Fi gure 15 Reve nues in th ree

year s （ 10 ,000 yuan ）
44876.4 48176.19 52244.68
60000
50000
40000
30000
20000 4793.17
2962.38 3321.69
10000
0 Public Medical Private Medical Institutes
Institutes
Year 2003 Year 2004 Year 2005
Fi gure 15 Expe ndit ures in th ree

year s （ 10 ,000 yuan ）
58166.28
60000 49629.13 51137.68
50000
40000
30000 3519.1
3476.7 4864.5
6
20000 4 4
10000
0
2003
2004
2005
Public Institutes Private Institutes
Table 4 Survey Results of Resource Utilization on Urban Medical

Service in Mianyang Municipality
Types of
Urban Visits of Average Discharging Daily A Bed
Medical patients Daily from LOS Usin
Institutes Visit per Hospital Beds g
(10,000 Doctor per Rate
person/time (person （10,000） docto (%)
) /time) r
Total 268.73 11.21
Public 178.76 3.66 8.17 2.43 1 73.9
Medical 3.1 0
Institutes 2
Municipal 140.24 4.90 5.95 2.85 1 83.6
Level 3.5 1
0
District-level 38.52 2.90 2.22 2.02 1 64.2
3.3 1
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　30
6
Private 32.41 4.57 1.036 2.05 8 50.9
Medical .97 0
Institutes
Community 36.96 2.00
Medical
Institutes
Clinics 20.60
In 2005, the number of visits to urban medical
institutions is 2687.3 thousand person-times
accounting for 24.72% of the total visits in the
municipality. The hospital discharge number is 112.1
thousand person-times, accounting for 37.11 % of the
total discharge in the municipality.
Fi gure 17 Prop orti on of Pa tien t Vi sits

in 200 5
Municipal
8% Hospitals
14% District Hospitals
Private Medical Institutes

12% 52%
Community Medical Institutes
14% Clinics
In 2005, according to the data publicized by the
MOH, the ALOS is 9.2 days. And the ALOS in the
municipal level hospitals, district-level and private
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　31
ones are 13.5>13.36>8.97 respectively in Mianyang
Municipality. Daily visits per doctor are 5.3 times while
in Mianyang Municipality, that of the municipal level,
private and district level hospitals are 4.9>4.57>2.9 in
respect. Daily impatient per doctor is 1.7. In Mianyang
Municipality, the daily impatient of municipal level,
private and district level hospitals are 2.85>2.05>2.02
respectively. The utilization rate of beds is 62.90%. In
Mianyang Municipality, the utilization rate of municipal
level, district level and private hospitals are
83.61%>64.21%>50.9%respectively.
Figur e 18 Pro port ion of Disch argi ng Pat ient s from

Hospi tals in 2005
53%
Municipal
Hospitals
District Hospitals
Private Medical Institutes
20% Community Medical Institutes
18% 9%
3.5 The Operational Compensation Situation of Urban
Public Hospitals in Mianyang Municipality
From 2003-2005, the subsidiary from the municipal
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level and district level finance to the hospitals
occupies proportions of the total income of the
hospital, the total expenditure of the hospitals and the
expenditure on human resources of the hospitals as
shown in Figure 19, 20.
Fi gure 19 Op erat iona l Comp ensa tion in Muni cipa l

Pu blic Hos pita ls
35 Percentage in
29.96
30 28.32 Total Income
25 23.55
20 Percentage
in Total
15 Expenditure
10 5.57 5.46 4.78 4.37
5.29 5.18 Percentage in
5 Total Expenditure
0 on Human Resources
Figur e 20 Ope rati onal Compe nsat ion in Distr ict Public
Hospi tals
Percentage in
25 20.13 19.21 Total Income
20 15.02
Percentage
in Total
15
Expenditure
10 4.92 4.57 3.84

4.34 4.18 Percentage in
3.25 Total Expenditure
5
on Human Resources
Table 5 Operational Efficiency of Urban Public Medical Institutions in

　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　33
Public Medical Municip District Municip District Municip District

Institues al al al
% Human 20.00 27.00 22.00 28.00 23.00 28.00
Resource Cost
in Total
Expenditure
% Management 18.67 23.69 19.40 25.56 20.70 24.58
Cost in Total
Expenditure
Rate of Asset 22.98 26.69 23.60 27.05 24.81 24.70
Debts
Rate of Floating 189.65 203.56 266.95 218.96 116.07 243.75
Capitals
Quick Ratio 246.11 196.56 256.43 204.65 104.42 226.11
Figure 21 Operational Efficiency of Urban Private Medical

Institutes
150
100 Year 2003

Year 2004
50 Year 2005
0
1Humare2 、管、流3 4 、资 5 、流 6 、速
员经费理费用动资金产负债动比率动比率
2003 26.64 16.63 14.36 68 67 54
2004 27.25 23.49 4.46 54.86 122.2 116.5
2005 32.09 23.4 18 38.36 65.21 60.64
3.7 Survey Results of Asset Debts in Urban Medical
Institutes of Mianyang Municipality
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　34
Fi gure 22 Debt Rat io of Mu nici pal Publ i Me dica l In stit utes

in Mia nyan g Mianyang Municipal
54.66% Center Hospital
60% 43.28% 43.67%

Mianyang Municipal
50% Third Peoples’
40% 22% Hospital
30% Mianyang Municipal

No. 404 Hospital
20%
10% Mianyang Municipal
Hospital on Chinese
0%
De bt Medicine
Ra tio
3.8 The Survey Results of the Basic Situation of Urban
Municipality (As illustrated in Table 6).
Table 6 Basic Situation of Urban Community Healthcare Institutions in

Types Number Average Staff Observin Beds Revenues Costs
s Service g Beds
(RMB10,00 (RMB10,00
Populatio
n 0 0
yuan) yuan)
Community 9 39900 233 82 132 824.90 777.90
Healthcare
Centers
Commnity 26 9600 314 163 133 976.10 806.10
Health care
Stations
Total 35 547 245 265 1801.00 1584.00
3.8.1 Population Served by Community Healthcare
Institutions：
The total population served by 35 community
healthcare institutions is 609.1 thousand people. The
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　35
largest population served by one healthcare institution
is 71 thousand, while the smallest is 3 thousand and
the average is 17.4 thousand (Median 0.8). Among
those healthcare institutions, 9 community healthcare
centers are responsible for a total population of 359.2
thousand. And the largest one serves a population of
71 thousand, while the smallest is 61 thousand and
the average is 39.9 thousand. However, the
community healthcare stations are responsible for a
population of 249.9. And the largest one serves a
population of 42 thousand, while the smallest is 3
thousand and the average is 96 thousand.
3.8.2 Survey Results of the Working Staff in
Community Healthcare Institutions
The total number of healthcare professionals in
community healthcare institutions is 547 persons,
among which the largest one has 64, while the
smallest 3 with the average of 15.63.
3.8.3 The Survey Result of Outpatient Workload and
Cost of Community Healthcare Institutions
The Largest outpatient workload per year for 35
community healthcare institutions is 41202 persons
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　36
while the smallest is 2300 persons and the average is
16560 persons (Median 10200). For the outpatient
cost(RMB yuan per person), the highest amount is
RMB 80.61 yuan while the lowest is RMB 7 yuan and
the average is RMB 27.76 yuan.
For 35 community healthcare institutions, the
largest outpatient workload per day is 113 persons
while smallest is 6 persons and the average is 35.18
persons.
3.8.4 Survey Results of the Income and Expenditure of
Community Healthcare Institutions
The annual income of the 35 community
healthcare institutions is RMB 18009.3 thousand yuan
and per person annual income is RMB 32.9 thousand
yuan. The highest annual income of the community
healthcare institution is RMB 　 2200 thousand 　 while
the lowest is RMB 30 thousand and the average is RMB
514.5 thousand yuan. Among them, the annual
income of the 9 community healthcare centers is RMB
8249 thousand yuan and per person annual income is
RMB 35.4 thousand yuan. The highest annual income
of the community healthcare center is RMB 　 1974
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　37
thousand　while the lowest is RMB 329 thousand and
the average is RMB 916.5 thousand yuan.
The annual expenditure of the 35 community
healthcare institutions is RMB 15844.5 thousand yuan
and per person annual expenditure is RMB 28.9
thousand yuan. Among them, the highest annual
expenditure of the community healthcare institution is
RMB 　 1954 thousand 　 while the lowest is RMB 301
thousand and the average is RMB 452.7 yuan. Among
them, the annual expenditure of the 9 community
healthcare centers is RMB 7779 thousand yuan and
per person annual expenditure is RMB 33.4 thousand
yuan. The highest annual expenditure of the
community healthcare center is RMB　1954 thousand
while the lowest is RMB 206 thousand and the average
is RMB 864.3 thousand yuan.
3.8.5 Survey Results of the Working Room Situation of
the Community Healthcare Institutions
The general area of working room of 35
community healthcare institutions reaches to 27634 ㎡
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　38
and per person area 50.51 ㎡. The largest working area
of the healthcare institution reaches 4400 ㎡ while the
smallest 60㎡ and average 789.54㎡.
4 The Survey Results to Community Residents
4.1 General Information (Table 7)
Table 7 General Information of Questionnaire to Community

Residents
Items Case Percenta
s ges（%）
Sex Male 334 53.44
Female 291 46.56
Location Youxian 304 48.64
Fuchen 321 51.36
Nationalities Han 613 98.08
Qiang 12 1.92
Marriage Unmarried 144 23.04
Status
Co-inhabited 40 6.40
Married 308 49.28
Re-married 46 7.36
Seperate\Divorced 66 10.56
Widowed 21 3.36
Professionals Managers of Government Institutions 21 3.36
Senir/Middle Level Managers in 12 1.92
Large/Middle Sized Enterprises
Owners of Private Enterprises 33 5.28
Technical Professionals 44 7.04
Clerks 49 7.84
Individual Industrial &Commercial 26 4.16
Units
Commercial Service Workers 66 10.56
Industrial Workers 74 11.84
Temporary Workers in Urban Areas 30 4.80
Temporary Workers in Rural Areas 54 8.64
Agricultural workers 88 14.08
Students 28 4.48
Retired 44 7.04
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　39
　 Unemployed/Half-employed in 56 8.96
Urban/Rural Areas
P.s.The average education time is 13.42±4.67 years。
4.2 The Survey Result of the Community Residents in
Mianyang Municipality on Primary Medical Service (see
Table 8)
Table 8 Awareness of Community Residents to Primary Medical

Services
Items Cases Preportion (%)
Needs of Primary Extremely Need 128 20.48
Medical Services
Very Need 269 43.04
Need 184 29.44
Normal 581 1.60
No Need 44 7.04
Contents of Primary Primary Medicine 96 15.36
Medical Services
Medical Aids 55 8.80
Public Health 43 6.88
Service
All above 431 68.96
Contents of Primary Lists of Primary 71 11.36
Medicine Medicines
Items for Primary 38 6.08
Diagnosis and
Treatment
General Procedure 69 11.04
for Diagnosis and
Treatment
All above 447 71.52
Service Model for Community 101 16.16
Primary Medicine Healthcare
Regional Medical 117 18.72
Centers
Two-level Service 225 36.00
Model with
Regional Medical
Center and
Community
Healthcare
Three-level 182 29.12
Management
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　40
Model simply with

Medical
Institutions
Element Points of Meet Basic Needs, 456 72.96
Primary Medical Cover Common
Services Population
Special Cares for 169 27.04
Key Groups
Organization of Primary Government 511 81.76
Medical Services
NGOs 83 13.28
Others 31 4.96
Expenditure Sources Government 523 83.68
for Primary Medical
Services
Patients 79 15.11
Others 23 1.21
Contents of Public Immunization 41 6.56
Health Services Planning
Communicable 39 6.24
Disease Control
Maternal and Child 37 5.92
Healthcare
Profession Health 56 8.96
Environmental 35 5.60
Health
Health Education 28 4.48
All above 389 62.24
As shown in Table 8, 92.96% of the community
residents expect to enjoy the primary medical service.
Those who believe that the primary medical service
should include primary medical treatment, first aid
and public health account for 68.69%. Those who
reckon that primary medical service should include
primary drug catalog, primary healthcare and regular
healthcare accounts for 71.52%, 81.76 and 83.68
respectively. The people surveyed believe that
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　41
government should provide the primary medical
service and bear the personnel and operation cost of
those who provide the primary medical service,
however, their understanding of medical service
model is quite ambiguous. In the meanwhile, as shown
in the figure, their expectations on public health are
quite high and 75.84% of the community residents
reckon that the primary medical service should include
the public health.
4.3 The Survey Result of Satisfaction of Medical
Service of the Residents in Peicheng and Youxian
Districts (See Table 9)
Table 9 Results of Satisfaction of Residents to Medical Service in

Peicheng and Youxian Districts
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　42
Items Cases X2 p
　　 Fucheng Youxian（n= 　
（n=321 304）
）
Medical Clinics 16 22
Institutions Township 37 32
Hospitals/Community
Visited Healthcare Centers
County/District Level 23 19
Hospitals
Municipal Hospitals 181 177 0.59 0.44
Provincial Hospitals 33 29
County/Up Level TCM 14 11
Hospitals
Others 17 14
Reasons for Closer 52 40
Selection Lower Price 46 34
Good Quality 35 46
Contracted Hospitals 39 42
Having someone known 41 33 1.30 0.25
Reliable Doctors 49 41
Good Service Altitude 37 39
Other 22 29
Time Cost on Trip Very Long 21 26
to Hospital Relatively Longer 56 49
Normal 146 152 1.50 0.22
Shorter 79 63
Very Short 19 14
Time Cost for Visit Ver Long 15 11
in Hospitals Relatively Longer 61 53
Normal 155 139 0.97 0.32
Shorter 63 80
Very Short 27 21
Respects Very Bad 11 8
Received during Bad 25 33
Visit Normal 153 133 0.40 0.53
Good 89 75
Very Good 43 55
Privacy Very Bad 8 11
Respected during Bad 35 27
Visits Normal 91 88 0.21 0.65
Good 134 117
Very Good 53 61
Explanation of Very Bad/ No Explaination 21 18
Medical Bad 16 19
Professionals Normal 94 101 0.10 0.75
during Visits of Clear 156 129
Patients Very Clear 34 37
Ask for Patients’ Very Few / Never 14 9
Opinions by
Doctors
Few 18 21
Normal 86 92 0.05 0.83
Good 150 121

　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　43
From Table 9, it shows that the degree of
satisfaction of the community residents in Peicheng
and Youxian Districts is approximately similar. There is
no significant difference in terms of travel time for
visiting doctors, waiting time, respect for the patients
rights of informed and their privacy. (P>0.05)
4.4 The Survey Results of the Preference for Medical
Service of Community Residents in Mianyang
Municipality (See Figure 23 and 24).
Figure 23 Preferences for Medical Service of Community Residents in

Integrated TCM and Western Medicine

132, 21%
Western Medicine
Western Medicine
TCM
TCM,145,23 348, 56%
Integrated
TCM
and Western
Medicine
Figure 24 Reasons of Preferences for Medical Service of Community

　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　44
140
120
100 系列
80 系列 2
60
40
20
0
Clo Lowe Bett
Doctor ive
Negat n
s r er Oppointed Someone Better
Dis er\ ts ers
tan Pric Trea Habi io Oth
Reliable Service
ce e tmen Hospitals Known c t
t Re a
From Figure 23, it shows that among the
community residents in Mianyang Municipality, 56%
people prefer the western medicine while the 44%
prefer Traditional Chinese Medicine (Integrated TCM
and western medicine), which shows that the
traditional medicine plays an important role. Figure 24
shows the important reasons influencing the
community residents to choose TCM are good effect,
slight side effect, reliable doctors, customs, good
service and comparatively cheap price.
4.5 Survey Results of the Medical Consumption of the
Community Residents in Mianyang Municipality
The annual medical cost is RMB (14.38±56.67)
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　45
yuan and RMB (67.34±29.15) yuan can be
reimbursed. The transport cost for visiting doctors is
RMB (132.96±56.77) yuan.
4.6 The Survey Results of the Situation of Cognition of
Urban Medical Service System of the Community
Residents in Mianyang Municipality (As shown in Figure
25, Figure 26)
Figure 25 The Survey Illustration of the Situation of Cognition of

Urban Medical Service System of the Community Residents in
Mianyang Municipality.
120
100
80
60 系列2
40
20
0
）
构
构
心
构
所
生
机
机
机
中
机
机
机
诊
计
疗
制
疗
疗
救
（
医
监
控
服
保
0急
务
位
法
防
区
幼
12
服
单
预
社
导
业
病
事
疾
企
生
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　46
As shown in Figure 25 and 26, the community
residents’ choices of items of medical service system
are scattering. 30.88% and 29.76% of the residents
believe that the major deficiencies of the current
medical service system are the disposition of
resources and unsound system respectively
Figure 26 The Situation of Cognition to Deficiency of Urban Medical

Service System by Community Residents in Mianyang Municipality.
基本适应，无
其他, 65 明显缺陷, 89
体系的内涵建
设不够, 92
,体系不合理
186
资源分布不合
理 , 193
5 The Survey Results of the Health Administrators,
Managing Personnel of Medical Institutions and Healthcare
Professionals
5.1The Basic Situation of the Targets Surveyed
There are totally 225 people surveyed including health
administrators, managing personnel of medical institutions
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　47
and healthcare professionals, among whom there are 132
males and 93 females with age ranging 24 years to 58
years and education duration ranging (14.83±3.12) years.
The survey is conducted by face to face method and the
answer rate reaches 100%.
Table 10 Results of Random Sampling Survey to Health

Administrators, Managing Personnel and Healthcare Professionals of
Medical Institutions
Regions Health Managers of Medical Total
Administrators medical Professionals
Institutions
Municipal 28 30 40 98
Fucheng 20 15 30 65
Youxian 17 15 30 62
Total 65 60 100 225
5.2. The Survey Results of Situation of Cognition of the
Contents of Urban Medical Service System
From the survey results, we can see that over half of
the health administrators, managing personnel of medical
institutions and healthcare professionals hold the view
that the medical institutions of municipal and district
levels, community healthcare centers and 120 emergency
centers are the members of the urban medical service
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　48
system, while 44.89%,42.67%,31.11% and 44.22% of the
targets surveyed believe that CDCs, health inspection and
supervision organizations, maternal and children
healthcare institutions and family-planning techniques
guidance institutions should be included as members of
the urban medical service system respectively.
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　49
Table 11 Survey Results of Cognition to Contents of Urban Medical Service System by Health Administrators,
Managing personnel and Healthcare Professionals in Medical Institutions
Composed Health Administrators Managers of Medical Medical Professionals 合计(%,n=225)

Institutions in the (%,n=65) Institutions(%,n=60)
System (%,n=100)
Yes No Yes No Yes No 是否
CDCs 32.31（21 67.69（44） 30.00（18 70.00（42） 38.00(38) 62.00(62 44.89（101 55.11（124
）） ) ））
Health Law 29.23（19 70.77（46） 33.33（20 66.67（40） 37.00(37) 63.00(63 42.67（96 57.33（129
Enforcement & ）） ) ））
Supervision
Maternal &Child 26.15（17 73.85（48） 36.67（22 46.67（28） 25.00(25) 75.00(75 31.11（70 68.89（155
Healthcare ）） ) ））
Family Planning 25.00（16 75.00（49） 35.00（21 65.00（29） 30.00(30) 70.00(70 42.22（95 57.78（130
Services ）） ) ））
Municipal Medical 92.31（60 7.69（5） 80.00（48 20.00（12） 40.00(40) 60.00(60 65.78（148 34.22（77
District Medical 76.92（50 23.08（15） 55.00（33 45.00（27） 31.00(31) 69.00(69 50.67（114 49.33（111
Community 93.85（61 6.15（4） 73.33（44 26.67（16） 22.00(22) 78.00(78 56.44（127 43.56（98
Healthcare ）） ) ））
Services
120 Emergency 80.00（50 20.00（13） 60.00（36 40.00（24） 48.00(48) 52.00(52 60.44（136 39.56（89
Private Clinics 15.38（10 84.62（55） 11.67（7） 88.33（53） 5.00(5) 95.00(95 9.78（22） 90.22（203
） ) ）
Affiliated 7.69（5） 92.31（60） 8.33（5） 91.67（55） 3.00(3) 97.00(97 5.78（13） 94.22（212
Hospitals ) ）
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　50
Table 12 Survey Results of Cognition to Functions of Urban Medical Service System by Health Administrators,
Managing personnel and Healthcare Professionals in Medical Institutions
Functions Health Administrators Managers of Medical Medical Professionals Total(%,n=225)
Institutions(%,n=60)
(%,n=65) (%,n=100)
Yes No Yes No Yes No Yes No
Disease 69.23（4 30.77（20） 58.33（35） 41.67（25） 44.00（4 56.00（56 55.11（124） 44.89（101）
Prevention 5） 4））
&Control
Primary 86.15（5 13.85（9） 96.67（58） 3.33（2） 88.00（8 12.00（12 89.78（202） 10.22（23）
Medical 6） 8））
Services
Maternal 80.00（5 20.00（13） 91.67（55） 8.33（5） 82.00（8 18.00（18 84.00（189） 16.00（36）
&Child 2） 2））
Healthcare
Rehabilitation 55.38（3 44.62（29） 81.67（49） 18.33（11） 65.00（6 35.00（35 66.67（150） 33.33（75）
6） 5））
Health 50.77（3 49.23（32） 53.33（32） 46.67（28） 52.00（5 48.00（48 52.00（117） 48.00（108）
Education 3） 2））
Family 56.92（3 43.08（28） 56.67（34） 43.33（26） 49.00（4 51.00（51 53.33（120） 46.67（105）
Planning 7） 9））
Guidance
&services
　　　　　　　　　　　　　　　　　　　　　　　　　　　　 Page　51
Study Report on Urban Medical Service System of Mianyang Municipality
5.35.3 The Survey Results of the Situation of Cognition of “Six
Integral One” Functions of Urban Healthcare Institutions
The “Six Integral One” functions include disease prevention,
primary healthcare, maternal and children healthcare, health
education and family-planning techniques guidance service.
Among the 225 people surveyed, 89.78% people believe that
the main function of urban healthcare institutions is primary
healthcare. Over half of the people surveyed did not choose
the items of disease prevention, rehabilitation, health
education and family-planning guidance and their occurring
rates are 55.11%、66.67%、52.00%、53.33% respectively. The
results are shown in Figure 12 and Figure 27.

Figure 27 Survey Results of Cognition to Contents of Urban Medical
Service System by Health Administrators, Managing personnel and
Healthcare Professionals in Medical Institutions
知晓率
100
卫生行政管
90
医疗机构管理
80
医务人员
70
60
50
40
30
职能
20
10
0
务
防
育
复
服
预
教
保
导
病
指
疾
育
生
Page　52　Total　131
5.4 The Survey Results of the Degree of Expectation of
Medical Service Expenses
Among 225 people surveyed consisting of health
and healthcare professionals, over 90% of them expect the
public health agencies of disease prevention, health education
and family-planning guidance should be totally funded by
government. 82.22% (185/225) of the people surveyed hold
the view that government should cover all cost of primary
healthcare (slight illness) and 96% expect government to bear
no less than 60% of the medical expenses of non-primary
healthcare (serious illness) while 90% hold the view that the
individuals should bear no more than 20% of all the cost in
the field of disease prevention, maternal and children primary
healthcare, rehabilitation, health education and family-
planning guidance.
Table 13 Expectation to Cost Composition of Urban Medical Services

Service Expectation to Government Preportion Accepted to be
Contents Investment（%，n=225） Covered by
Individuals（%，n=225）
10 -8 -60 -4 -2 0 0- 20- 40 60 80 10
0 0 0 0 - - - 0
Disease 97.7 1 0 0 0 0 1 0 0 0 0 0
Prevention 8 .78 .44 00.
&Control
00
Primary 82.2 9 6 1 0 0 9 4 0 0 0 0
Medical 2 .33 .67 .78 5.1 .89

Services 1
NonPrimary 16.4 2 5 4 2 5 1 6 0
Medical 4 6.2 3.3 .00 0.4 9.1 2.8 .67 .89
Services
2 3 4 1 9
Maternal 79.5 1 5 2 0 0 9 8 0 0 0 0
&Child 6 2.4 .33 .22 .44 0.2 .89
Healthcare
4 2
Rehabilitatio 72.8 1 1 1 1 0 9 6 0 0 0 0
n 9 1.1 2.0 .78 .33 .89 2.8 .67 .44
1 0 9
Health 96.8 0 2 0 0 0 1 0 0 0 0 0
Education 9 .00 .67 .44 00.
00
Family 91.1 2 4 1 0 0 9 4 1 0 0 0
Planning 1 .22 .89 .33 .44 3.7 .44 .78
Guidance
8
Figure 28 Expectation to Government Inputs by Health Administrators,

Managers and professionals in Medical institutions
100%
90%
80%
70%
0
60% -20
50% -40
-60
40% -80
30% 100
20%
10%
0%
疾病预防基本医疗非基本医疗妇幼保健康复健康教育生育指导服务项目
5.5 The Survey Results of the Health Administrative Structure
80.00% of the people surveyed hold the view that one-
level management system is superior to two-level one. The
main reasons are firstly one-level management system of
municipal health administration may greatly improve the
overall management level; secondly, it may implement
unified and standard management model, avoiding multiple
management and thirdly, it may optimize the Distribution of
Resources, saving the financial expenditure of district level
government.
The survey results of the organization structure of urban
medical service systems show that 62.22% believe that two-
level management system is superior to three- level one,
while 23.56 think there is no difference between the two and
14.22 hold the view that three-level management system is
better than the two-level one.
6. The Main Results of the Interviews with Key Informants
(Interviewees: Government officials in Mianyang
Municipality, officials from health administration, managing
personnel from medical institutions, healthcare
professionals and urban residents)
The Layers of Urban Medical Administration
Among officials from the municipal and district
governments and their health administrations and the
managing personnel from medical institutions, the
majority hold the view that in a middle-sized city, it is
unnecessary from two levels of governments to supervise
different medical institutions according to their grades.
A director of a district-level hospital mentioned “under
this system, the district-level hospital has to struggle for
its survival.”
An official from the municipal health administration
said “it is unfair for both the kinds of hospitals, because
the different levels of management may lead to the
different requirements for them.”
An official from Peicheng District mentioned ”if the
Peicheng District does not hold district level hospital, it
will save RMB 10 million Yuan annually. If we invest this
fund into rural and urban healthcare, that may be great. ’
A leader from health law enforcement and supervision
mentioned:” Health law enforcement and supervision in
Mianyang Municipality should be conducted by both
municipal and district level governments, however, since
the establishment of the health law enforcement and
supervision institutions, the municipal one insisted that it
is responsible for the urban area while the one of
Peicheng District can only conduct its work in the rural
area” For this, though the municipal government was
inquired by the Representatives from Peicheng District at
the Municipal People’s Congress, it still sticks to its policy.
What is the result? The health law enforcement and
supervision has played significant role in winning special
awards such as national sanitary city, which attracts more
than 300 groups of people to lean the experience from
Mianyang Municipality”.
A government official said “in the middle-sized city, the
district level governments should not hold district-level
hospital, which is the general trend in the future.”
The Structure of Medical Institutions
The opinion of an official from municipal health
administration is same with that of many health
administrators. The official said “In middle-sized cities,
the structure of medical institutions owned by
government should be a two-level system instead of a
three-level or multiple level one. Municipal government
is the center for medical service, bearing the
responsibilities of providing non-primary medical
service including the outpatient and impatient service
for difficult and complicated diseases, while the
community healthcare institutions are the base,
providing primary medical care and healthcare
services. ”
An official from the municipal government mentioned
“the government has limited financial resources and
therefore, it should focus on facilitating several municipal
hospitals while give priority to the development of
community healthcare service.”
A director of district-level hospital complained “the
institutions like ours, it is inferior to municipal hospital in
terms of its size, technology and government funding,
inferior to private hospitals and clinics in terms of
flexibility. Therefore, the best way is to develop
community healthcare.”
How to Develop Urban Community Healthcare Well
The people surveyed, especially the officials from
government and health administration are quite clear
about the importance of urban community healthcare
service however, residents, community healthcare
professionals and medical professionals feel
unsatisfactory in some fields of community healthcare
service.
A resident from Chengxiang Community said “we felt
there is no difference between the community healthcare
institutions and the individual clinics and middle or small
sized hospitals”
A leader of Liuli Community Healthcare Station
mentioned “Even the cleverest housewife can’t cook a meal
without rice. The investment from government is insufficient,
which is just like you cannot make your horse run without
feeding her. ”
A community healthcare worker said “If a large
hospital reduces to construct a new building, the fund is
sufficient for total construction of an urban community
healthcare institution. If a large hospital reduces to buy a
large-sized equipment, the fund is sufficient to equip all
community healthcare centers with primary facilities.”
The leaders of 3 community healthcare stations
reflected that the community healthcare institutions not
only lack funding and equipments but also technology
and professionals. If the hospitals in second grade can be
converted into community healthcare centers, the
community healthcare service will surely be improved
significantly.
An official from community healthcare administrations
mentioned “The community healthcare service not only
includes primary medical care but also other basic health
work as the disease prevention, healthcare, rehabilitation
and family-planning guidance.” Community health
workers should act as “health managers” for the
residents. This is the difference in nature between
community healthcare institutions and private hospitals or
clinics. Therefore, government should bear all the
expenditures for community healthcare service. The
government should pay equal attention to urban
community healthcare as it does to the new rural
cooperative medical system.
Government Should Increase Investment to Health
Sector
A director of municipal level hospital said “ The
investment to health sector from government is not
sufficient. The hospital has to run in debt and is often
troubled by paying the bank interest of its loan.”
A government official mentioned “Government has
limited financial resources and the health sector is too big
so we cannot cover all. The government own does not
necessarily mean the government is responsible for
everything.”
A leader from center for disease control mentioned
“good steel is used as a knife edge. Government investment
should have its own emphasis. The investment to the field of
public health such as disease control, health education shall
bring the maximum effect with minimum investment and
therefore, there is no reason that this field is not regarded as
the emphasis of investment.”
An official from health administration said “the
government investment to public health and primary
medical service is concerned with the people’s well-
being”, which reflect the idea of human-centered and
constructing the harmonious society.
A health professional noted “The government’s
investment to health sector should be regulated by law
just like its investment to education sector.”
Urban Medical Service Market Needs to Be Regulated
A managing professional from a municipal hospital
mentioned “A long-term effect mechanism is needed to
supervise the medical service market. The situation that
some private hospitals and individual clinics boasted they
can cure any diseases should be changed.”
A medical expert noted “The chances are we may
receive some patients suffering from erroneous diagnosis
and treatment at small hospitals or individual clinics daily’
A doctor from individual clinic said “The hospitals in
third grade treat common diseases and patients in
recovering stage are not transferred to community
healthcare institutions just like using a sledge hammer to
crack a nut.”
An official from health administration mentioned “We
have excised stronger supervision over the medical
service market. During the reform process of medical
system, the supervision has to be strengthened.”
Complaints of Residents on Overly Expensive Medical
Services
A patient complained “Seeing a doctor in a large
hospital, you are required to undergo several medical
checks. Apart from the tardy procedures, the expenses on
medical check and medicines are unbearably high. The
medical fare for treating cold is equal to the living
expenses for half a month. Therefore, it is cheaper and
more convenient to buy some medicine at the drug
store.”
A patient mentioned “Same medicine, same type and
same manufacture, its price is quite different in big and
small hospitals. Media believes this situation is caused by
abnormal high of medicine price but I reckon it is due to too
high markup ratio of the hospitals. ”
A dean of pharmacy department of a municipal
hospital said “it is normal that the medicine price in big
hospitals is higher than in small medical institutions
because we purchase medicine from formal channel in
accordance with government bidding price and regular
markup ratio instead of from informal channel, in addition,
operation expense of a large-sized hospital is high.”
A hospital director said “no one will complain the
expenses in big hotel is higher than in fast food restaurant
however, there are some people who complain the higher
cost in seeing a doctor in large-sized hospital than at
clinic. Is this faire? ”
A white-collar mentioned “If I feel ill, I will choose a
large-sized hospital and be checked by good equipment,
which may make a clearer diagnosis though the medical
cost is higher but medicine quality is reliable.”
A health administrator mentioned “Government is
trying to solve the problems of overly expensive medical
service and abnormal high of medicine price. The question
is the hospitals have to rely on the incomes to support
themselves and develop. The question of medicine price
is very complicated. Government has lowered prices for
many times but the medicine will disappear from the
purchasing catalog after its price was lowered. When it re-
appears after changing its name by the pharmaceutical
factory, the price will be higher than before. The problem
of drug-maintaining-medicine is an objective one mainly
because of the insufficient government investment.”
Residents’ Preference Over Traditional Chinese
Medicine
A reputable senior expert in TCM of Mianyang
Municipality mentioned “TCM has been withstood of test
of time over thousands of years, which has made
significant contribute to the reproduction and prosperity
of Chinese people. Mianyang is a place where the famous
doctors were born. In early last century, Dr. Xiao Longyou,
a person from Mianyang, was listed as the top of four
most reputable doctors in Beijing. In the middle of last
century, the healthcare doctor for national leaders, Dr. Pu
Fuzhou, was also from Mianyang. It is rich in Chinese
herbs medicine resources with over 1000 species, among
which there are more than 10 native species. The people
in Mianyang have special sentiments over TCM. Although I
am in my old age and can only receive patients twice per
week, the reservation lasts for three months, which shows
trust of Mianyang people in TCM.”
A director of municipal TCM hospital said “The most
special thing is something with national characteristics.
Many countries attach great importance to TCM. TCM
hospital in Mianyang Municipality is quite strong among
the middle-sized cities in western part of China and
therefore, it is eligible to be constructed into a top-quality
TCM hospital in China.”
An old patient commented “Western medicine alleviates
symptoms and Chinese medicine cures diseases.”
A staff in sub-district government said “The price of TCM
can only accounts for that of western medicine in one
prescription and TCM seldom has side effect, which is why I
choose TCM.”
A middle-age patient said “TCM has its special effect
in treating chronic and functional diseases as well as
rehabilitation.”
An official from health administration said “It is
important to develop TCM well to solve the problem of
expensive medical expenses and satisfy the people’s
needs for medical service.”
In municipal TCM hospital, the people are lined up ,
waiting for diagnosis. And TCM physician said it is the
same situation daily.
Chapter IV Discussion
We have conducted surveys and analysis of the
connotations of urban medical service system, the current
situation of urban medical service in Mianyang
Municipality and how to construct a reasonable urban
medical service system in economically less developed
middle-sized cities like Mianyang Municipality. The
discussions on the following contents are listed below:
1 The Understanding of the Connotations of Urban
The survey shows this connotation is very ambiguous.
The dispersion of survey data is quite high. Whoever the
community residents, professionals or health
administrators made different choices.
China is a society with the characteristics of urban-
rural dual structure. Urban medical service system is
presented with comparison to rural medical service
system. The special status of urban medical service
system can not be neglected because of its guiding,
stimulating, supporting and demonstrating roles.
On January 15 1997, the term “urban medical service
system” first appearing in official document was in the
Decision on Health Reform and Development issued by
the State Council.
On July 1, 2005, in his article “To develop medical
service and to make contributions to the construction of
communist harmonious society”, the Minister of Health,
Mr. Gao Qiang holds the view that the establishment of
urban and rural health service systems are the great
achievements in development of the health sector in
China. In the meanwhile, he also maintains that medical
service system can not cater for the needs of health
service of the people. The problems of difficult and
expensive in seeing doctors are still obvious. Although the
medical service system in China has made great
development, it still needs significant improvement when
compared with the people’s expectation of health service.
At present, we can not find the relevant explanations and
interpretations of the terms of urban health service
system, health and medical service system and medical
service system.
2. Comments on the Current Urban Medical Service

Some maintain the basic characteristics of the reform of
recent years are that government loosed the interference
and control over medical service system. Its development
more and more relies on market. These phenomena are
listed as bellows: Nearly all the entry requirements have
been eliminated; all medical institutions have become
independent organizations with their interests, awareness
and goals; The construction and development of medical
service system have gradually become the one selected
by market and decided by the market supply and
demands. In the field of micro-organization and
management, the medical institutions generally adopted
the enterprises model of management; the price
mechanism has gradually become a sort of market
pricing. Therefore, the major problems of this

transformation are as follows: firstly, price of medical
service and medical expenses have increased rapidly so
that many people especially poor residents are denied the
access of medical service, fairness of medical service
disappears; Secondly, the structure of medical service
system has gradually become unreasonable, which
reduces the availability of medical service. Thirdly, the
emphasis of medical service and technology route is
steering away from basic demands of the society and the
goal of the development of medical service is not in
consistence with that of the social demands.
Therefore, do those problems exist in the urban
medical service system in Mianyang Municipality? When
government makes out the future urban medical plan and
policy, what should be its focuses? What can be done to
ensure the fairness, accessibility and efficiency of medical
service? Those questions above are what we want to
obtain when we study the urban medical service system.
According to survey results, we identified the
following characteristics of the urban medical service
system in Mianyang Municipality.
2.1 Rich in Urban Medical Service
2.1.1 Institutions: There are total 9 hospitals in Mianyang
Municipality, among which there are 4 municipal level
hospitals (3 Grade III-A hospitals, 1 Grade III-B hospital), 5
district-level hospitals (3 Grade II-A hospitals).
2.1.2 Professionals
In urban medical institutions, there are 364 people with
senior academic titles, 1173 people with intermediate
ones, 11 professionals with doctoral degrees and 98 with
mater degrees. Medical resource in per thousand people
is higher than the average level in Sichuan Province.
2.1.3 Medical Facility and Equipments In public hospital,
per hospital beds occupy an area of 25 ㎡ . In urban
medical institutions, there are 3 sets of MRI, 9 sets of CT
and 1 set of Gamma Stereotax Head Radiotherapy
Equipment and Gamma Stereotax Body Radiotherapy
Equipment respectively. The large equipments in urban
medical institutions are listed as below:
Numbers
Name of Equipment Numbe Name of Numbe
rs Equipment rs
Medical diagnostic X-ray 8 ultrasonic cardiogram 11

equipment800MA or above (including)
Medical diagnostic X-ray 4 ICU Monitor System 22
equipment800MA or above (not
including)
Medical diagnostic X-ray 14 ECG Monitor 184
equipment800MA or above500MA-
750MA
MRI 3 High Pressure Oxygen 6
System
High Sipped CT 3 Full auto- 12
biochemical analyzer
Color Doppler Ultrasonic Detection 9 blood gas analyzer 4
Machine
Ultrasonic Detection Type B 34 electronic endoscope 30
X- ray Radio surgery Treatment System 1 Artificial aemodialysis 10
equipment
X-ray CT 6 electric dental chair 18
Single Photon Emission Computed 1 ambulance 17
Tomography
Co-60 Treatment Machine 1 Mobile X-ray 7
Diagnosis Equipment
Stereo-orientation Gamma Rays 2 Breathing 19
System machine(With wound)
Picture Archiving and transmission 6 Breathing 13
System Machine(without
wound)
2.2 Rapid Development of Some Disciplines with Obvious
Characteristics
Among the urban medical institutions in Mianyang
Municipality, the provincial level and municipal level
medical centers are Mental Health Center of Sichuan
Province, Clinical Tests Center of Mianyang Municipality,
Intervening Radiology Center of Mianyang Municipality,
the Prevention and Treatment Center for Digestion
Diseases and the Prevention and Treatment Center for
Alzheimer Disease. There are 1 provincial level discipline, 16
municipal level specialized departments and 35 national and
provincial famous TCM doctors and provincial level medical
talents.
The TCM Hospital of Mianyang Municipality was first
granted as Grade III-A TCM hospital among all the
municipalities and prefectures in Sichuan Province. The
No.3 People’s Hospital enjoys the leading role in field of
mental health in terms of its size and technology.
2.3 Rapid Development of Private Medical Institutions
Some private enterprises in Mianyang Municipality
entered into medical sector. There are now 7 private
hospitals, 310 clinics, accounting for 83% of total number
of medical institutions. The private medical hospitals
provide large amount of medical services for urban
residents, among which the stomatological and
ophthalmology hospitals have developed into considerable
scale.
In 2005, there are 324.1 thousand person-time
outpatient visits to private hospitals, accounting for
12.06% of the total volume of outpatient visits of urban
medical institutions. And there are 10.4 thousand person-
time of hospital discharge of private hospitals, accounting
for 9.27% of the total volume of hospital discharge.
The large number of private medical institutions has
catered for the needs of residents for seeking healthcare
service nearby; however, it also brings difficulties for the
supervision of health administration.
2.4 Sound Base for Urban Community Healthcare Service
At present, there are 9 community healthcare centers
with average 25.89 staff, 23.7 hospital beds, 1700 ㎡
operational area, serving a population of 39.9 thousand
people.
There are 26 community healthcare station with
average 12.1 staff, 11.4 hospital beds, 347 ㎡ operational
area, serving a population of 9.6 thousand people. In
2005, there are 369.6 thousand person-time outpatient
visits to community healthcare institutions, accounting for
13.75%. And there are 20 thousand person-time of
hospital discharge, accounting for 17.84%
2.5 High Expectation for the More Investment in Medical
Care from Government
However, some problems still exist in community
healthcare institutions in terms of small scale, poor
service capacity, low social reliability, lower level of
management and financial support. Nearly 60% of
community healthcare institutions have less than 10 staff
and 300 ㎡ of operational area, which greatly limits the
functions. And the service capacity is no more than that
of a clinic and therefore, it is difficult for the community
healthcare institutions to act as the door keeper of the
health of residents.
The survey shows 81.76% and 83.68% of the
community residents hold the view that government
should bear all medical service.75.84% of the community
residents maintain that primary medical service should
cover public health.
Among 225 people surveyed consisting of health
and healthcare professionals, over 90% of them expect the
public health agencies of disease prevention, health education
and family-planning guidance should be totally funded by
government. 82.22% (185/225) of the people surveyed hold
the view that government should cover all cost of primary
healthcare (slight illness) and 96% expect government to bear
no less than 60% of the medical expenses of non-primary
healthcare (serious illness) while 90% hold the view that the
individuals should bear no more than 20% of all the cost in
the field of disease prevention, maternal and children primary
healthcare, rehabilitation, health education and family-
planning guidance.
Such expectation of high investment in medical sector
reflects demands of the public, while on the other hand,
reflects the public mentality that government should be
responsible for major part of medical expenses. Since this
expectation can not be realized in the near future, it is
necessary to communicate with the public in order to
reduce their expectations of the medical investment,
because the proportion of national investment to medical
sector is still in question and it has to be compatible to
the overall national situation and abide by the law of the
development of health, while dealing with relationship of
medical purchasing capacity and public demands and
relationship of development of medical sciences and
public needs.
In fact, since 1997, the commencement of medical
insurance system for urban residents, the number of
participating residents is on the rise every year. Currently,
there are 360 thousand people participating in the
medical insurance system, accounting for 27.07% of the
total population. There are also some other solutions to
the poor residents, for instance, measures taken by the
Mianyang Municipality to alleviate the problems of
difficulties and expensive in seeking medical service of
the poor residents, Regulations on medical debt
management of joint social security 110 in the urban area
of Mianyang Municipality issued by municipal Public
Security Bureau, Financial Bureau and Health Bureau;
Regulations on Aids to Beggars issued by Municipal Civil
Administration Bureau; Policies of to Benefit People when
Poor People Seeking Medical Service issued by the
municipal Health Bureau and Finance Bureau; Notification
of Establishment of People Beneficial Hospitals and
Medical Aid Centers for Poor People issued by municipal
Health Bureau, however, the major problems are that
scope of medical insurance is too narrow and degree of
medical insurance is too low.
Figure 29 Data on Medical Insurance Participated by Staffs of

Government Institutios
112147 116498
120000 107288
100000 89298
80000
56402
60000 55376 Employed
43898 49935
Retired
40000
20000
0
2003 2004 2005 2006
2.6 Lower Accessibility of Medical Institutions
During the survey of community residents, 30.88%
and 29.76% of the community residents maintain that the
layout of the medical resources is unreasonable. Due to
the historic reasons and the municipal development plan,
majority of medical institutions are concentrated in the
down area. In some streets, the medical institutions are
crowded, for example, the distance between the
municipal TCM hospital, stomatological hospital and
Peicheng District hospital is less than 500 meters. Among the
community healthcare institutions, 18 of them cover no more
than 8 thousand people. And therefore, the layout should be
adjusted.
2.7 Three –Level Service Structure Distracting the
Government Investment and Reducing the Investment
Efficiency
Mianyang Municipality is a city with districts. The health
system is managed by both municipal and district
governments. There is no unified and concerted urban
medical service management system, which increases the
difficulties of management for the whole health sector.
2.8 Increase of Debts of Public Hospitals
The survey results shows from 2003 to 2005, the financial
assistance from municipal government to municipal
public hospitals occupy 5.57%,5.46% and 4.78% of their
total income, respectively, while the finance assistance
from district governments to district public hospitals
occupy 4.92%,4.57% and 3.84% of their total income. The
general trend is downward every year. In 2005, the total
debts of municipal public hospitals reach RMB 295134.5
thousand yuan with debt rate of 32.94%. The major
reason of the debt is infrastructure construction for
improving the hospital conditions. During the interview,
nearly all the hospital managing personnel hold the view
that to improve the infrastructure by using debts is the
measure to improve the conditions and reduce the
complaints from the patients despite that it may cause
the decrease in the staff income and may receive less
financial assistance. But, fixed assets of the infrastructure
construction still belong to the state-owned assets.
Chapter V
1．General Conclusions：
●Rich mdical resourcs, which can basically satisfy the
medical needs of the residents.
●Abundant Medical research achievements and rapid
development of medical technology.
● Abundant professionals with degrees and senior
titles in medical institutions with strong technology.
● In the same city, municipal and district level
governments administer different medical institutions,
which may lead to the separation and segregation
●Lacking coordination among the three grades
hospitals；
● The unreasonable location of hospitals and
excessive concentration of medical resources in large
hospitals.
● Small scale of community healthcare institutions
with poor service capacity.
● Noticeable advantages of traditional medical and
mental health, but their roles should be strengthened.
2． Some Specific Suggestions
2 ． 1 Noticeable Wastes due to the Two-layer
Administration
In the same commerciality, there are two layers of
administration. From the survey to administrators,
administratees, service targets, it is believed that this
structure is not suitable in middle-sized cities. And the
most conspicuous problems are the wastes of
human, financial and material resources.
2 ． 2 Lacking Coordination among Three Grades of
Hospitals.
In Mianyang Municipality, ， there are 4 Grade III
hospitals,5 Grade II hospitals and 35 community
healthcare institutions. Through the survey and
interview to those professionals in different levels, the
majority think it is not necessary to have three grades.
Managing personnel and professionals in Grade II
hospitals complain it is hard it is hard for them to
survive. Therefore, some of them have been
transformed to specialized hospitals. Most of complaints
from the three grades of hospitals are the disorderly
competition and wastes of medical resources. And
community healthcare institutions cannot meet the
needs in terms of technology and human resources,
which needs the support from the hospitals of Grade II
or above.
However, in Mianyang Municipality, apart from the
municipal hospitals, there are 5 district-level hospitals
are run by Peicheng and Youxian district governments.
In the two districts, the satisfactory rates of medical
service of their residents show no conspicuous
difference while the investment from their governments
is quite different.
2.3 The Residents’ High Expectation of Community
Healthcare Capacity
Through the survey to residents, 80% of the residents
expect the government should run the community
healthcare institutions well. But, when they are asked why
not choose the medical service in communities, the
majority believe the medical service is so good. Many
believe their technology is not as good as that of grade II
hospitals while their service altitude is not as good as that
of private hospitals.
2.4 Residents’ Profound Sentiments to Traditional
Medicine
Mianyang Municipality is a city with profound TCM
culture, famous doctors in history and rich in traditional
medicine resources. At present, it has the national and
provincial level TCM experts. Through the survey to the
residents, 44% of them maintain they are willing to
choose TCM or combined TCM and western medicine,
especially the middle and old aged people, who believe
TCM more.
2.5 Residents Hope Government May Strengthen its
Intervention to Private Hospitals and Clinics
Simple procedures, good service altitude and lower price
are the main reasons for why the residents choose private
hospitals and clinics. Among the expectations of private
hospitals and clinics, 85% of the residents maintain that
government intervene the profit-making medical
institutions in various aspects such as the contents and
ways of their service. The intervention should be focused
on those questions, namely, to raise the entry standard,
to solve the untrue advertisements, to regulate the
medical activities, to overcome the family-run
management, to perfect the financial rules, to raise the
legal awareness and improve the quality of the
professionals.
Chapter VI Reform Plan of Urban Medical

Service System in Mianyang Municipality
Based on the problems and conclusions mentioned
above through this study, the reform plan is presented as
follows:
1. The Guiding Thoughts of Reform
1.1 According to the Development Plan Year 2005-2010 of
Mianyang Science and Technology City, in 2010, the urban
area of Mianyang Municipality will reach 80 km2 with a
population of 1 million. Therefore, the plan of urban
medical service system in Mianyang Municipality should
be in compliance with the demand of development of the
whole city.
1.2 According to the decision on establishment of primary
medical care system covering the residents in cities and
townships by the state, when designing the plan of urban
medical service system in Mianyang Municipality, we have
to take this key reform in to consideration.
1.3 The funds from private sector are the important
source of the construction of urban medical service
system. Therefore, we should fully absorb and strengthen
guidance to them, which may make them become integral
part of urban medical service system in Mianyang
Municipality.
2. Principles of Reform
2.1 Unified Planning
All the medical institutions regardless of their
administrative regions, grades, sizes and ownerships in
the urban are of Mianyang Municipality are uniformly
planned by the municipal government according to the
whole sector management.
2.2 Classification and Grading
With l orientation of two-level structure consisting of
community healthcare service chain centers and
municipal medical service group, 381 medical institutions
in urban area of Mianyang Municipality will be re-
organized, classified, which may lead to an urban medical
service system with clear division of responsibilities and
complimentary to each other.
2.3 Incremental Control
The hospital sizes and large-sized medical equipments
should be tightly controlled and the new medical
institution should be in compliance with the plan. At the
same time, high-end medical technology should be
developed reasonably, while the development of suitable
technology and community primary medical service
should be emphasized.
2.4 Revitalize the Stock Resource
The majority of resources is concentrated in municipal
and district level public hospitals in terms of human
resources, expertise, fixed assets and medical
equipments. By adjusting and optimizing, it may give full
play to the stock resource.
2.5 Equal Emphasis on Chinese and Western Medicine
All the hospitals and community healthcare institutions
should practice the traditional Chinese medicine apart
from their functions.
2.6 Convenient and Fast
We should reasonably lay out the new medical and
community healthcare institutions and construct a “15-
minute service circle”, that is, the residents may reach
the medical institutions within the distance of 15-minute
walking, which will bring convenience for residents
seeking medical service.
3. Reform Goals
The goal of the reform of urban medical service
system in Mianyang Municipality is by the end of 2010,
the urban medical service system with the characteristics
of “one-level management, two-layer structure, three key
fields and multiple modes.”
3.1 One-level Management refers to in the middle-sized
cities with districts like Mianyang Municipality, the
urban medical service function should be uniformly
performed by the municipal government while the
district-level governments’ responsibility of
healthcare function should be performed by
collecting fund for health work, supporting public
health projects and providing aids to poor people.
This arrangement is conducive to the
implementation of whole sector management,
improving efficiency, reducing administrative cost
and changing government function.
Figure 30 Sketch Map of”One-level Management”
Municipal
Health
Administration
Public Community Loggistical Private

Public Health
Medical Service Centers
Health Service Service Medical
Chain Centers
Group Group Institutions
3.2 Two-Layer Structure refers to the planning of
construction of two service systems of urban primary
medical care and urban non-primary medical care by
utilizing the current medical service resources.
Figure 31 Sketch Map of “Two-layer Structure” Service
Public Medical
服 Group
Public Health Service
务
中
Centers
心
Institutiona
Private Loggistic
公
Medical
Service
共 Group
卫
生 Community Health
Service Group
Double-direction Flowing Guidance
The particular measures to construct the two-layer
structure are as follows:
3.2.1 Establishment Leading Group of the Reform of Urban
Medical Service System in Mianyang Municipality
The leading group consists of health bureau,
development and reform committee, finance bureau,
personnel bureau, national assets committee and labor
and social security bureau while the government leaders
will be the group leaders. The main task the leading group
is to make the reform plan of urban medical service
system, to construct the framework of urban medical
service system reform and coordinate the specific issues
during the reform process.
The office of the leading group will be set up in health
bureau, shouldering the daily routines of the leading
group and implementing the decisions made by the
leading group.
3.2.2 To Establish Public Medical Group in Mianyang
Municipality
Figure 32 Sketch Map of Public Medical Group
Mianyang
Municipal Center
Hospital
Mianyang Mianyang
Municipal Municipal No.3
TCM Hospital Hospital
Mianyang Mianyang Mianyang

Municipal MunicipalPublic Municipal
Cancer Hospital Medical Group No.404 Hospital
Mia ny an g
Mianyang
Co lo n&
Orthopedics
Hospital Re ct al
Hos pi ta l
Mianyang
Municipal
Peoples’Hospital
In the near future, the public medical group will adopt a
“loosely combined” mode with Mianyang Municipal Central
Hospital at the core. The group consists of the No.3 People’s
Hospital, 404 Hospital, TCM Hospital, People’s Hospital,
Orthopedics Hospital, Colon & Rectal Hospital and Cancer Hospital
in Mianyang Municipality.
The main tasks of the public medical group are as
follows: firstly bearing the responsibilities of emergency,
clinical medical treatment, clinical teaching and research;
secondly, taking the responsibilities of providing technical
support to the county-level hospitals and community
medical service group, developing high, accurate and
advanced technology; thirdly, providing non-primary
medical service to the residents, receiving the patients
transferred from community medical institutions and
transferring patients at the recovering stage to
community medical institutions.
The public medical group is run under the principles of
government authorization, project subsidiary, uniform
management, group cooperation, independent ownership,
autonomous operation, legal person administration,
assets value-keeping, general control over salary,
specialization and paid utilization.
3.2.3 To Form the Community Healthcare Service Chain
Center in Mianyang Municipality
The community healthcare service chain centers will
be established on the basis of separation from public
medical resources, adopting “assets re-organization and
chain operation” model. The chain center includes all
community healthcare service institutions.
The main tasks of the community healthcare service
chain centers are the “six in one” primary medical service
for community residents including disease prevention,
primary medical treatment, maternal and children
healthcare, health education and family planning
guidance. In addition, they take the responsibilities of
transferring severe patients to municipal hospitals and
receiving the patients at recovering stage from municipal
hospitals.
Community healthcare service chain center will be
run under the principles of government ownership, unified
control, same brand, legal person management, unified
personnel management and Two Lines of income and
expenses. In the group, the professional qualifications are
mutually recognized, the results of examinations and
information mutually shared and the logistics is separated
from it.
Community healthcare service chain center will
attract the residents and provide primary medical service
by taking the advantages of medical service price,
discounts of medical expenses for residents, door to door
service, uniformed service logo, standard service and
service procedures.
3.3 Three Key Points
Three Key Points refer to government will take public
health, primary medical care and traditional medicine as
the key points of medical resources allocation.
3.3.1 Focusing on Supporting Public Health. To establish
public health service center in Mianyang Municipality
(Prevention and Healthcare Center)
Figure 33 Mianyang Municipal Public Health Service Center
Mianyang
Municipal CDC
Municipal Mianyang Municipal

Central Blood Maternal &child
Station Healthcare Hospital
Mianyang Municipal
Public Health
Service Center
Mianyang Municipal
Fucheng Distric Health Education
CDC Institute
Municipal Family
Youxian District Planning Guiding
CDC Institute
We should establish the municipal public health service center
including the municipal hospital for maternal and children
healthcare, municipal health education station, municipal
family planning station, municipal blood center, municipal 120
emergency center, the centers for disease control and
prevention of Peicheng and Youxian Districts with the
municipal CDC at the core.
The main tasks of the municipal public health center are
to provide public heath service including disease prevention,
chronic disease prevention and treatment, public health
emergency disposal, health supervision, vocational diseases
prevention and treatment, maternal and children healthcare,
health education, family planning guidance.
The public health service center is run under the
principles of government ownership, whole government fund
support, resources sharing, unified management, agreement
regulation, legal person management. The center will take a
structure of “assets re-organized” form.
3.3.2 Focusing on Development of Primary Healthcare.
Primary healthcare is the main task of community healthcare
service institutions with the primary medical care as the key
point, facilitating the residents seeking for medical service
and controlling medical prices as the targets, which may
represent the government’s policy of constructing harmonious
human-based society and caring the underprivileged people.
●Based on the community healthcare chain center, by 2008,
the urban community healthcare service system shall be
established to provide “low standard, wide coverage” primary
prevention medical service with reasonable structure, overall
service functions, high quality personnel, scientific operation
mechanism, regulated supervision system, funding system
and policy measures.
●The community healthcare service institutions should the
main responsibilities of providing public health service and
primary medical service. The service targets are urban
communities, families and residents with the focus on women,
children, senior citizens, chronic disease patients, disabled
people and people under poverty. The active service should
be conducted including door to door service, health education,
prevention, rehabilitation, family planning guidance and the
treatment to common and popular diseases. The extended
service should be conducted urban community healthcare
institutions such as family sick-beds, elderly nursing and
hospice care.
●The operation area of the urban healthcare service
institutions will be included in the urban public facility
construction plan. When the newly built resident area covers
more than 5,000 people, the community health institutions
should be completed in accordance with the urban community
health service development plan.
●Apart from national and provincial subsidiaries to
community health service, the municipal and district
government finance will provide 5 yuan subsidiary per person
annually, among which the municipal government provides no
less than 2 yuan while the district one provides no less than 3
yuan. The personnel training expenses will be subsidiarized by
municipal finance.
●The drugs in the community healthcare institutions will be
uniformly distributed. According to the community healthcare
primary drugs catalog issued by the national and provincial
health administrations, we will ensure the medicine to be run
at low cost and the medicine price will be charged reasonably.
Thus, we can physically reduce the medical expenses of the
people.
●Caring the Underprivileged Group. The “Love Doorbell”
which connects the lonely elderly people and the community
healthcare institutions are installed. We will implement a
policy of medical aid to people under poverty, that is, we will
issue a love certificate. With this certificate, the medical cost
of the poor people will be partly reimbursed. Also, we will
implement a system of Area Responsible Doctor, which
consists of a group of doctors, nurses, healthcare workers. The
photos and mobile numbers are publicized in each courtyard
and the healthcare professionals are ready to provide 24 hour
telephone consultation and door to door service. The Internet
Health Consultation Platform will be established, through
which the community residents can ask questions and
community doctors will provide answers 24 hour a day.
3.3.3 Give Full Play to Traditional Medicine. Chinese medicine
has a history of thousands of years with the characteristics of
simplicity, convenience, cheap and good effect. Therefore, We
listed the traditional medicine as the emphasis, which may
cater for the medical demand and sentiments of the residents.
●We may make out the Development Plan (2007-2015) for
Urban Chinese Medicine, which will specify the goals and
emphasis.
●To Set up Special Fund for the Development of TCM. The
municipal government will set up special fund for the
development of TCM annually, which be included in the
financial budget with an expectation of increase annually,
compatible to the increase of finance every year.
●We will strengthen the comprehensive support to the TCM
Hospital of Mianyang Municipality in terms of personnel
allocation, department establishment, TCM technical service,
TCM featured inpatient department, striving for “Excellent
TCM Hospital” , which is a national wide famous and first class
in western part of China.
●The TCM department will be established in community
healthcare centers with a standard TCM Pharmacy
department. The TCM professionals in each community
healthcare center will account for no less than 20% of the
total healthcare professionals. In each healthcare station,
there will be at least 1 TCM doctor. The amount of TCM service
will reach around 40% of the total service volume.
●To Strengthen the Personnel Training and Specialized
Department Construction. We will select around 15 potential
TCM talents and train them into academic leaders in the field
of TCM. Additionally, we shall designate senior TCM doctors as
teachers for those who just participate in the TCM. Lastly, we
shall establish a group of TCM specialized departments in
municipal TCM hospital and TCM departments in various
hospitals.
●To Explore and Utilize Chinese Medicine Resources in a
Scientific Way. We will forge the Miangyang made brand of
local Chinese herb medicine and establish a group of herb
medicine processing enterprises, which will be built into a TCM
processing center and produce leading products with
independent property rights.
3.4 Various Forms, it refer to the variety of ownership of
medical service institutions. The detailed measures are listed
as follows:
3.4.1 Adjust Stock Resources. We will tightly control the
hospital sizes, the number of large-sized medical equipments,
new medical institutions and will reasonably develop high-end
medical institutions and focus on developing suitable
technology. Based on those, we may gradually separate some
stock resources through the flat-oriented reorganization of the
municipal and district medical institutions. By 2010, the
service resources in public medical institutions will be reduced
by 10%-15% in terms of hospital beds, human resources, fixed
assets and medical equipments. The total volume of
community healthcare service institutions and private medical
institutions will increase by 20% respectively.
3.4.2 Optimize the Added Number. We shall make out a policy
to encourage the private fund to invest in the field of medical
service and to establish medical institutions (including foreign
fund).
●We shall stick to the policy of combined development of
non-profits and profit medical institutions, which may lead to
a sort of order of reasonable competition and co-development
among medical institutions of various nature and ownership,
which will provide multiple medical services to residents.。
●We shall stick to a policy of integration of promoting
development and regulating management, perfecting
auxiliary policies and measures, strengthening government
adjusting and administrative function to create a fair and
orderly market environment. We shall put equal focus on the
social interests as well as economic interests, while protecting
the legal interests of the social investors.
●Any qualified overseas investors can apply for establishment
of various medical institutions in the planned area in
Mianyang Municipality. Enterprises, social groups and citizens
can apply for establishing non-public medical institutions by
wholly funding, incorporation, partnership, cooperation and
sino-foreign join venture in accordance with law. We shall
encourage the overseas organizations and individuals to
cooperate with the medical institutions and other social
organization to set up high quality medical institutions
according to the law and qualification requirement, under the
examination and approval of relevant authorities.
●We shall provide equal treatment to private medical
institutions. The private medical institutions shall enjoy the
same standard, conditions and supervision with the public
ones. The government shall provide suitable subsidiary to
private medical institutions when they conduct primary
medical service and public healthcare service. The private
medical institutions shall enjoy the same treatment in terms
of introducing talents, applying professional titles,
participating in academic organizations and conferences. They
can apply for the qualified hospitals of social insurance. The
working staff employed by private medical institutions shall
be paid according to employment contract and have the
access to participating in various social insurance including
pension, unemployment insurance, medical insurance, injury
and reproduction insurance.
●The private medical institutions shall enjoy some taxation
reduction policy according to different types, after obtaining
the medical institution license.
●Private medical institutions shall receive the routine
supervision of relevant government departments including
heath, drug administration, taxation, industry and commerce
administration and civil affairs. The private medical institution
association shall be established and perfected to strengthen
self-discipline and coordination while protecting the legal
rights of non-public medical institutions. Any organization or
individual shall not intervene the legal medical activities and
normal medical order of the private medical institutions.
3.4.3 To Establish Medical Logistics Service Group in
We shall separate those non-key business from the medical
institutions of municipal and district levels to establish
socialized service organizations including the clinical
examination center of Mianyang Municipality, the health
laundry service center, the health commodity supply center
(health service logistics distribution center), health
information center, health real estate management center
and hospital 制剂 center of Mianyang Municipality through the
ways of joint venture of public medical institutions, wholly
funded by private medical institutions, incorporation etc.
Figure Municipal
34 Logistic Service
Group Illustration
Municipal Community Municipal

Medical Service Group Municipal Medical
Group
Logistic
Service Group
Private Medical
Service Municipal Public
Institutions Health Service
Group
Municipal Municipal Municipal

Municipal Municipal Supply
Service Center Management Service Center
Medical Laundry Center for
for Health Center for for In-hospital
Center Medical Goods
Information Medical Property Preparation
4. Current Tasks
Prior to submitting this study report, some of the
research results have been adopted in following documents:
● Mianyang Municipal Government’s Decision on Speeding up
the Development of Urban Community Healthcare.
●Mianyang Municipal Government’s Decision on
Strengthening Traditional Chinese Medicine.
● The Plan of Establishment of Urban Medical Institutions in
●The Plan of Establishment of Urban Community Healthcare
Present Undertakings
●The municipal and district governments have begun
studying on the one-layer management, two-layer structure
system.
●The government has started to study counter-measures of
strengthening various public health work.
●The government has begun to make out the Construction
Criteria for Community Healthcare Service Institutions.
●A district level Grade II hospital named Colon & Rectal
Hospital in Mianyang Municipality will start system reform
soon.
Reference
1. National Health Service Research- Analysis Report
on the Second National Health Service Survey.
Ministry of Health, 1999.
2. The Survey Plan and Guidance Manuel of the Third
National Health Service Survey, Ministry Of Health,
P.R. China, 2003.
3. The Statistic Publication on the Development of
Health Sector 2005, Statistics Information Center of
Ministry of Health.
4. The Review and Reflection on Reform Model of
Public Hospital—the Deficiency of Theory of the Public
Hospital Reform Model that the Public Hospital Reform
Borrows the of the State Enterprise Reform Model, by
Ma Liping, China Health Economics, Second Edition,
2006. 5. German Hospital Management and its
Enlightenment to China’s Health Reform, By Hou
Jianlin, China Hospital Management Journal, 9th
Circulation,2002.
6. Various Theoretic Questions on Hospital Ownership
Reform, by Du Lexun, 22(6),1, China Health
Economics,2003.
7. Investigation Report on Medical System Reform of
Suqian Area, Jiansu Province, by Medical and
Healthcare Reform Research Group of China Economy
Research Center, Peking University
8.The Statistic Publication on China Health
Development, 2005, Statistic Information Center,
Ministry of Health.
9. How to Gather and Distribute Medical Resources
Reasonably, by Li Jiange, Finance, 4th circulation,
10.The Challenges of China’s Medical and Healthcare

Reform, Financial and Economic Circle, 10th
Circulation,2005, by Research Group of Development
Research Center, State Council.
11.To Be Conscious of the Problems in Constructing
Urban Medical Insurance System, China Economy
Times, Dated 7th , June 2005, by Gong Shen and Ge
Yanfeng.
12.New Proposal on Hospital Operation, by Yi lihua,
People’s Health Publishing House, Beijing, 2002.
13. Ownership Management and Reform of Public
Hospitals, by Huang Xuanyin, China Hospital
Management Journal, 11(10)th Circulation,1995.
Appendix
1 Study on Urban Medical Service System in Mianyang
Municipality （ Project Serial Number ：
WP/2006/CHN/HSP/3.1/001）
2 Expert Group of the Project of Study on Urban Medical
Group Leaders： Yan Bingyue, Vice Director General of Health
Department of Sichuan Province
Zhao Wanhua, Vice Director General of
Health Department of Sichuan Province
Huang Zhengliang, Deputy Major of
Mianyang Municipal Government
Members ： Jiao Yunzhi, Chief of International Cooperation
Division of Health Department of Sichuan
Province
Liang Zhi, Chief of Medical Administration
Division Of Health Department of Sichuan
Province
Li Hong, Deputy Chief of International
Cooperation Division of Health Department of
Sichuan Province
Xian Ming, Deputy Chief of Medical
Adminisration Division Of Health Department
of Sichuan Province
Chen Hong Chief of Reseach Section of
Mianyang Municipal Government
Jiang Ling Chief of Finance Bureau of Mianyang
Municipality
An Xiaorong Deputy Chief of Reform and
Development Committee of Mianyang
Municipality
Yang Rong Deputy Chief of Bureau of Justice, of
Zhou Wenyi Deputy Chief of Social Insurance
Center of Mianyang Municipality
Wang Tao Chief of Urban Statistics Team
Mianyang of Municipality
Tang Rulin Section Chief of Price Administration of
Mianyang Municipaliyt
Li Qiande Director of Mianyang Central Hospital
Tang Kexin Director of Mianyang NO.3 Hospital
Wang Limin Director of Hospital 404 of Mianyang
Municipality
Li Pei Director of Mianyang Municipal Hospital for
TCM
Hou Zaijin Director of Center or Disease Control
and Prevention of Mianyang Municipality.
3 Research Group of the Project of Study on Urban Medical
Group Leader ： Lei Bailing Chief of Health Bureau of
Members：Huang Xuanyin from No.3 Hospital of Mianyang
Municipality
Zeng Xijiang from Center or Disease Control
and Prevention of Mianyang Municipality
Han Sirun from Health Law Supervision and
Enforcement of Mianyang Municipality
Yu Ruojiang from Health Bureau of Mianyang
Municipality
Ma Qiang from Health Bureau of Mianyang
Municipality
Zhou Yun from Center or Disease Control and
Prevention of Mianyang Municipality
Xiang Hu from No.3 Hospital of Mianyang
Municipality
Chen Hong from Health Bureau of Mianyang
Municipality
Address of Project Office ： 4th floor of Health Bureau of
Telephone Number of Project Office ：（ 0816-
2222910）（Fax）
Email Address：scmyxmb@126.com
4 List of Project Documents
4.1 The Notice of Establishment of Leading Group of Project
of Study on Urban Medical Service System in Mianyang
Municipality Issued by Health Bureau of Mianyang Municipality
4.2 Outline of the Survey Plan of Project of Study on Urban
Medical Service System in Mianyang Municipality
4.3 Plan for Activities of Project of Study on Urban Medical
4.4 Implementation Plan for Project of Study on Urban Medical
4.5 Notice of Commencement Conference of Project of Study
on Urban Medical Service System in Mianyang Municipality by
Health Bureau of Mianyang Municipality
4.6 Summery Report of the Seminar on Commencement
Training of the Project of Study on Urban Medical Service
4.7 Summery Report of Mid-term Assessment of the Project of
Study on Urban Medical Service System in Mianyang
Municipality
5 Working Photos
Project Commencement
Project Training
Mid-term Assessment
Expert Guidance
Project Research
Project Survey
6 Figures of Survey of Medical Institutions in Mianyang
Municipality
6.1 The General Table of the Basic Information of Urban
Medical Institutions in Mianyang Municipality

Name of Hospit Beds Staff
Numb
Health Practisin Assista Registere Rema
Medical al Numb Profession g Doctor nt d Nuses
Institutions Numbe er er
al Number Number Number s
r Doctor
Number
Total 381 5538 5389 4140 1566 141 1799
Public 8 3782 3988 3297 1174 61 1466
Medical
Institutions
Municipal 4 2883 2938 2408 901 12 1077
Hospitals
Mianyang 933 1170 996 340 0 496 General
Municipal Hospital
Central
Hospital
No.404 Hospital
Hospital
Mianyang 1000 633 542 233 2 224 Mental
No.3 Health
Hospital
Mianyang 400 383 317 163 4 92
TCM
Hospital
Distric Level 4 899 1050 889 275 49 398
Hospitals
People’s Hospital
Hospital
Mianyang 200 251 209 79 0 90 Cancer
No.2
Hospital
Mianyang 152 101 86 43 0 28
Orthopedics
Hospital
Mianyang 101 77 60 19 9 20
Colon &
Rectal
Hospital
Community 35 147 547 415 173 20 57

Healthcare
Institutions
Healthcare 9 147 233 196 82 9 25
Service Center
Healthcare 26 0 314 219 91 11 32
Service
Station
Private 7 550 690 438 169 56 276

Hospitals
Fulin 200 171 137 32 15 90 综合医院
Hosptial
Xiehe 100 196 156 44 15 97 综合医院
Hospital
Detal 40 106 62 29 6 27
Hospital
Plastic 50 41 29 8 3 6
Surgery
Hospital
Wanjiang 60 68 40 19 3 18
Ophthalmolo
gy Hospital
Meikang 50 85 6 21 6 24 综合医院
Hospital
Tiancheng 50 23 8 16 8 14 综合医院
Hospital
Medical 22 64 60 4
Institutions
Run by
Enterprises
Clinics 310 360 360

(Outpatients
Department)
Medical Room,
Healthcare
Station
6.2 General Table of Uban Medical Resources Situation in
Seerial Name of Constructio Fixed Medical 流动资产总
Numb Institutions n Assests （ Equipmen 值（万元）
10000 ts
er
Yuan）（ 10000
Area（㎡）
Yuan）
I Public Medical 93750 97064 27916

Institutions
Municipal 185776 81120 21557
Hospitals
1 Mianyang 50437 44599 9410
Central Hospital
2 Mianyang 32789 13721 3519
No.404 Hospital
3 Mianyang No.3 50825 12586 4232
Hospital
4 Mianyang TCM 51725 10214 4396
Hospital
District Level 75174 15944 6359

Hospitals
5 Mianyang 51542 11131 2866
People’s
Hospital
6 Mianyang No.2 12757 3008 959
Hosptial
7 Mianyang 6711 1321 2133
Orthopedics
Hospital
8 Mianyang Colon 4164 484 401
& Rectal Hospital
II Private 47600 10318.5 5523 2042.34

Hospitals
1 Fulin Hospital 15000 4317 2600 880.74
2 Xiehe Hospital 16000 4160 1500 205
3 Detal Hospital 4500 457 350 318
4 Plastic Surgery 3500 190 120 70
Hospital
5 Wanjiang 2100 918 742 102
Ophthalmology
Hospital
6 Meikang 5500 181 135 349
Hospital
7 Tiancheng 1000 95.5 76 117.6
Hospital
Commnunity 27634 249 121

Healthcare
Institutions
Healthcare
centers（total）
Healthcare
stations（total）
6.3 The General Table of Utilization of Urban Medical
Service Resources in Miangyang Municipality
Name of 200 5 年
Institutions Visits Daily Discharge Daily ALOS Hospital
Serial
Number visits d number impatien Beds
numb per ts per Utilizati
er （10000 doct （万） doctor on
） or Rate%
Total 268.73 11.21 66.24
一 Public medical 178.76 8.17 73.9
institutions
Total
Municipal 140.24 4.9 5.95 83.61
hospitals
1 Mianyang 68.21 6.1 2.61 2.9 12.4 106.69
Central 3
Hospital
2 Mianyang 14.96 2.6 1.08 2.2 11.5 63.33
NO.404 6
Hospital
3 Mianyang No.3 20.09 2.4 1.5 3.9 16.4 87.07
Hospital 9
4 Mianyang TCM 36.98 0.76 2.4 13.5 71.35
Hospital
District Level 38.52 2.9 2.22 64.21
hospitals
5 Mianyang 28.16 5.9 1.53 2.6 7.85 76.78
People’s
Hospital
6 Mianyang No.2 5.96 2.1 0.38 1.9 13.3 73.63
Hospital 6
7 Mianyang 2.63 1.5 0.21 2.3 18.2 72.71
Orthopedics 4
Hospital
8 Mianyang 1.77 2.0 0.095 1.3 11.5 33.7
Colon & Rectal 6
Hospital
二 Private 32.41 1.036 50.9

hospitals
total
Fulin Hospital 12.20 8.6 0.35 2.4 9.8 58.4
Xiehe Hospital 1.7 1.28 0.06 2 15 30
Detal Hospital 3.5 4.02 0.036 1 10 98
Plastic Surgery 0.95 3.96 0.25 3.7 5 9
Hospital
Wanjiang 2.76 4.84 0.18 1.3 4 60
Ophthalmology
Hospital
Meikang 10.5 7.7 0.16 1.9 10 50
Hospital
Tiancheng 0.8 1.6
Hospital
三 Community 36.96 2.0

Healthcare
Insitutitons
Healthcare
Centers（total）
Healthcare
Service
Station（Total）
四 Clincs(Outpati 20.6
ent
Department、M
edical Room
and Medical
stations
6.4 The General Table of Compensation for the Operation
of Urban Public Medical Institutions in Mianyang
Municipality
Item Year 2003 Year 2004 Year 2005 Remar
ks
Compensatio Municip Distri Municip Distri Municip Distri
n Value from al level ct al level ct al level ct
Finance level level level
Accountin 5.57 4.92 5.46 4.57 4.78 3.84
gfor the
total income
%
Accountin 5.29 4.34 5.18 4.18 4.37 3.25
g for the total
expenditure
%
Accounting 29.96 20.13 28.32 19.21 23.55 15.02
for the total
human
resources
expenditure
%
Accounting 7.29 19.56 5.36 14.41 0.28 －
for the total 2.42
balance of
medical
treatment %
Accounting 17.62 7.53 12.22 4.48 13.40 15.77
for total
balance of
medicine %
6.5 Operation Efficiency of Urban Public Medical
Urban Public Municip Distri Municip Distric Municip Distric

Medical al level ct al level t level al level t level
Institutions level
1 、 Human 20 27 22 28 23 28
Resources Cost
accounting for %
of total
expenditure
2 、 Management 18.67 23.69 19.4 25.56 20.7 24.58
cost accounting
for % of total
expenditure
3、Floating assets 22.98 26.69 23.6 27.05 24.81 24.70
turnover times
4 、 Floating 189.65 203.5 266.95 218.9 116.07 243.7
Ratio（%） 6 6 5
5 、 Quick 246.11 196.5 256.43 204.6 104.42 226.1
Ratio（%） 6 5 1
6.6 Operation Efficiency of Urban Private Medical

2003 年 2004 年 2005 年
1、Human Resources Cost 26.64 27.25 32.09

accounting for % of total
expenditure
2 、 Management cost 16.63 23.49 23.4
accounting for % of total
expenditure
3 Floating assets 14.36 4.46 18
turnover times
4 、 Ratio of debts to 68 54.86 38.36
assets（%）
5、Floating Ratio（%） 67 122.2 65.21
6、Quick Ratio（%） 54 116.5 60.64
6.7 Populaton Served by Urban Community Healthcare

Institutions Population served（10000 ）
Year 2003 Year Year
2004 2005
Served by 32.51 33.42 35.92
community
healthcare centers
Served by 13.807 15.652 24.99
community
healthcare station
Total 46.317 49.072 60.91
6.8 The Beds Allocation of Urban Community Healthcare

Institutions Year 2003 Year 2004 Year 2005
B Observatio Beds Observatio B Observati
eds n Beds n Beds eds on Beds
Community 102 66 112 67 132 82
healthcare
centers
Community 95 106 95 111 133 163
healthcare station
Total 197 172 207 总计 265 245
6.9 Staff Number in Urban Community Healthcare
Institutions
Institutions Year200 Year200 Year200
3 4 5
Community healthcare 189 195 233
centers
Community healthcare 219 261 314
station
Total 408 456 547
6.10 Outpatient Situation of Urban Community Healthcare

Institutions Annual total outpatient Average daily visits
visits（人次）
Year Year Year Year Year Year
2003 2004 2005 2003 2004 2005
Community 11345 12658 14110 318 378 400
healthcare 8 3 5
centers
Community 19827 22456 24929 555 629 831.5
healthcare 4 4 5
station
Total 31173 35114 39040 873 1007 1231.
2 7 0 5
6.11 Medicine Distribution of Urban Community Healthcare
Institutions Year 2003 Year 2004 Year 2005

Chinese Western Chinese Wester Chinese Wester
Medicin Medicin Medicin n Medicin n
e e e Medicin e Medicin
e e
Community 2127 2507 2122 3063 2515 3725
healthcare centers
Community 4980 5986 5520 6746 7117 9050
healthcare station
Total 7107 8493 7642 9809 9632 12775
6.12 Medical Fee Charged by Urban Community Healthcare
Institutions Outpatient Medical Medicine Charges

Charges（yuan/person）
Year200 Year200 Year200 Year200 Year200 Year200
3 4 5 3 4 5
Community 352.96 296.89 389.74 223.03 181.68 230.08
healthcare centers
Community 379.85 468.98 582.14 286.34 351.17 452.43
healthcare station
Total 366.41 382.94 485.94 254.69 266.43 341.26
6.13 The Income of Urban Community Healthcare Institutions
Institutions Annual Income（10000 Income from

yuan） medicine（10000 yuan ）
3 4 5 3 4 5
Community 606.78 668.54 824.9 314.1 302.36 351.24
healthcare centers
Community 730.106 815.06 976.02 421.124 494.987 591.053
healthcare station 4
Total 1336.89 1483.60 1800.92 735.22 797.35 942.29
6.14 Expenditure of Urban Community Healthcare Institutions
Institutions Annual total Medicine

expenditure（10000yuan ） expenditure（10000yuan）
3 4 5 3 4 5
Community 586.23 645.74 777.9 263.59 270.19 335.86
healthcare centers
Community 593.056 669.496 806.558 378.315 439.509 529.958
healthcare station 2 7 1
Total 1179.29 1315.24 1584.46 641.91 709.70 865.82
6.15 Total Building Area of Urban Community Healthcare
Institutions Total Building Area Working Space（square

meters）
2003 年 2004 年 2005 年 2003 年 2004 年 2005 年
Community 15820 12748 17228 12246 11864.8 15304
healthcare
centers
Community 7697.52 8451.3 10406.1 6734.5 7484.3 9030.1
healthcare station
Total 23517.5 21199.3 27634.1 18980.5 19349.1 24334.1
2 0 0 0 0 0
7 Questionnaires on Medical Service for Community

Serial Number： Name： Sex：male/female Age： Phone Number：
Family Address： Working Place：
1. Ethnics：[1=Han；2=Tibetan 3=Qiang；4=Others]
2.Marital Status ： [1=Unmarried ； 2=Co-inhabited ； 3=First Marriage ； 4=Second
Marriage；5= Separated\Divorced；6=Widowed；8=Others(Description )
3．Education Length： years
4.Occupation ： [ （ 15 years or above ）： managing professionals ⑵executive
personnel
Of enterprises （ not owners ） Owners of Private Enterprises ⑷Technical

Professionals ⑸staff ⑹Individual industrial and commercial units ⑺staff in
service area ⑻industrial workers ⑼rural workers in urban area ⑽rural workers
in rural area ⑾agricultural workers （agriculture, forestry grazing and fishing）
⑿students ⒀the retired ⒁ the unemployed, half unemployed）
5．How many members（living with you）in your family______
They are your （ multiple choices ） [1=spouse ； 2=daughters and sons ；

3=grandchildren ； 4=mother or father in law ； 5=parents ； 6=grandparents ；
7=brothers and sisters；8=others（Description ）]
6．Annual Family Income per person about： yuan
The major income coming from （ multiple choices ）： [1=salary ； 2=farming ；

3=working；4=commercial trade；5=raising；8=others（Description ）
What is your family financial status？[1=good；2=medium；3=poor]
7. （medical service demand）
7.1 ． Do you think you need primary medical service? ： [1 ＝ extremely

necessary ， 2 ＝ very necessary ， 3=necessary ， 4=it doesn’t’
matter，5=unnecessary]
7.2．Do you think what contents should be included in primary medical service ：
[1 ＝ primary medical service ， 2 ＝ medical aid ， 3 ＝ public health including
vaccination、communicable diseases control、maternal healthcare、occupational
healthcare 、 environmental sanitation and health education ， 4 ＝ all above
mentioned]
7.3 ． What do you think primary medical care should include ： [1 ＝ primary
medicine catalog，2＝primary treatment items，3＝regular treatment，4＝all
above mentioned]
7.4 ． What do you think primary medical service should be ： [1 ＝ community
healthcare service ， 2 ＝ regional medical center ， 3 ＝ The two-layer service
model of regional medical center and community healthcare center，4＝pure
three-lay model of medical institutions
7.5．What do you think the notion of primary medical service should include：[1＝
primary medical care with wide coverage，2＝caring the key target group]
7.6 ． What do you think the organizers of primary medical service ： [1 ＝
government ， 2 ＝ non-governmental organizations ， 3=others （ description
）]
7.7 What do you think who will bear the cost of medical professionals and
business cost：[1＝government，2＝patients，3=others（description ）]
7. 8．What do you think public health service should include：[1＝vaccination，2
＝ communicable diseases control ， 3 ＝ maternal healthcare ， 4 ＝ vocational
healthcare，5＝environmental sanitation，6＝health education，7＝all above]
8．（Degree of Satisfaction of the Residents for Medical Service ）

8.1．In what district do you live ：[1＝Peicheng，2＝Youxian]
8.2 ． Where you do see a doctor commonly ？ [ （ if you see doctors in different
institutions ， choose the highest grade one ） 1=various outpatients
department clinics and community healthcare stations ， 2=Township hospital
or community healthcare center ， 3=county/district/city level hospitals ， 4 ＝
municipal/prefecture level hospitals ， 5 ＝ provincial level hospitals ， 6 ＝ TCM
hospitals county or above county level，8＝others（description ）]
8.3．Why you choose the above institutions：[1=close，2＝lower price，3＝good
quality ， 4 ＝ designated hospitals ， 5 ＝ with familiar people ， 6 ＝ with reliable
doctors，7＝good service attitude，8＝others（description ）]
8.4．When seeing a doctor, are you informed of relevant healthcare knowledge of
your diseases by the doctors or nurses？
yes (2)no
8.5．When seeing a doctor，how long you may spend on traveling？
⑴very long ⑵ comparatively long ⑶normal ⑷comparatively short
⑸short
8.6．When seeing a doctor，how long you may wait？
⑴very long ⑵ comparatively long ⑶normal ⑷comparatively short
⑸short
8.7．When seeing a doctor, to what degree, do you think you are respected during
the conversion？
⑴very poor ⑵poor ⑶normal ⑷good ⑸very good
8.8 ． When seeing a doctor, to what degree, do you think your privacy is
respected during the diagnosis and treatment？
8.9 ． When seeing a doctor, to what degree, do you think the doctors or nurses
explain to you？
⑴very poor or no explanation ⑵poor ⑶normal ⑷good ⑸very good
8.10 ．． When seeing doctors, they have listened to your opinion or not when
designing the healthcare or treatment plan？
⑴very poor or nearly no ⑵poor ⑶normal ⑷good ⑸very good
8.11 ． When seeing doctors, what do you think about the facilities or
environment(including toilet)?
8.12．When seeing doctors ，to what degree do you think you are convenient to
check
your medical expenses?
8.13 ． When seeing doctors, to what degree do you think you are convenient to
complain？

8.14．For what you are most unsatisfied with the hospitals？
⑴ no ⑵poor service attitude ⑶poor technology ⑷poor environment
⑸unnecessary service provided （ including medicine and examination ）
⑹ unreasonable charge ⑺high medical expenses ⑻ no on the cuff ⑼tedious
procedures ⑽waiting time is too long ⑾inconvenient to reach the hospital
⑿others
9．（The Medical Service Preference of Residents）
9.1 ． When seeing doctors, you may choose ： (1)western medicine (2)TCM
(3)integral western medicine and TCM
9. 2. Main Reasons for such choices ： (1)close (2)low price (3)good effect
(4)contract institutions (5)with acquainted people (6)reliable doctors
(7)good service attitude (8)accustomed to （ 9 ） slight side effect
（10）others
10．（Medical Expenses of Residents）
10.1．Within one year， how much do you spend on medical expenses ___ yuan。
10.2 ． Among the medical expenses, how much shall be reimbursed __ yuan
(0 means all can be reimbursed)
10.3 ． Within one year, how much shall be spent on traveling in order to see
doctors_ __yuan
11（Residents’ Cognition on Urban Medical Service System）

11.1．Urban medical service system shall include ？（Multiple choice. Circle the
letter. If you have something to say, just write in the blanket area）
1 Disease control and prevention institutions 2 health law supervision and
enforcement 　　 3 Maternal and children healthcare institutions 4 family
planning guidance （family planning）　　5 municipal medical institutions 　6
district-level medical institutions 7 community healthcare centers 8 120
Emergency Center ９ Food and drug administration 　１０ Pharmacy(medical
equipment organizations) 　１１ enterprise’s internal medical institutions 　１２
private clinics
11.2．What do you think are the major deficiencies of present medical system：（
）
1basically suitable, no obvious deficiencies 　 2unreasonable system
3 misallocation of medical resources 4Unsufficient construction of the
5 Others（Please write it out）
11.3 ． What are your specific suggestion on the medical service system （ please
write it out）？
8. Questionnaires for Community Healthcare Administrators,
Managing Personnel of Medical Institutions and Medical Staff
A 基本情况
Serial Number： Name： Sex：male/female Age： Phone Number：
Family Address： Working Place： Title
1. 1. Ethnics：[1=Han；2=Tibetan 3=Qiang；4=Others]
2. Marital Status ： [1=Unmarried ； 2=Co-inhabited ； 3=First Marriage ；
4=Second Marriage ； 5= Separated\Divorced ； 6=Widowed ；
8=Others(Description )
3．3．Education Length： years
4. 。 Occupation ： [ （ 15 years or above ）： managing professionals
⑵executive personnels
Of enterprises （ not owners ） Owners of Private Enterprises ⑷Technical

Professionals ⑸staff ⑹Individual industrial and commercial units ⑺staff in
service area ⑻industrial workers ⑼rural workers in urban area ⑽rural workers
in rural area ⑾agricultural workers （agriculture, forestry grazing and fishing）
⑿students ⒀the retired ⒁ the unemployed, half unemployed）
5．How many members（living with you）in your family______
They are your （ multiple choices ） [1=spouse ； 2=daughters and sons ；

3=grandchildren；4=mother or father in law；5=parents；6=grandparents；
7=brothers and sisters；8=others（Description ）]
6．Annual Family Income per person about： yuan
The major income coming from（multiple choices）：[1=salary；2=farming；

3=working；4=commercial trade；5=raising；8=others（Description ）
What is your family financial status？[1=good；2=medium；3=poor]
B The cognition of urban medical service system
B1 Do you think the following institutions belong to urban medical service
system？
1 ． Disease Control and Prevention Institutions
[1=Yes，2=No，3=Unknown，99=No Response]
2 ． Health Law Supervision and Enforcement

3 ． Maternal and Children Healthcare Institutions
4 ． Family Planning Guidance （ Family Planning ）
5 ． Municipal Medical Institutions
6 ． District-level Medical Institutions
7．Community Service Center [1=Yes，2=No，3=Unknown，99=No
Response]
8 ． 120Emergency Center [1=Yes ， 2=No ， 3=Unknown ， 99=No
Response]
9．Individual Clinics [1=Yes，2=No，3=Unknown，99=No Response]
10 ． Enterprise’s Medical Institutions
B2What do you think whether the community healthcare service institutions
have the following functions ？
1 ． Disease prevention [1=Yes ， 2=No ， 3=Unknown ， 99=No
Response]
2． Primary Medical care [1=Yes ，2=No ， 3=Unknown ，99=No
Response]
3 ． Maternal and children healthcare
4 ． Rehabilitation [1=Yes ， 2=No ， 3=Unknown ， 99=No
Response]
5 ． Health education [1=Yes ， 2=No ， 3=Unknown ， 99=No
Response]
6 ． Family planning guidance [1=Yes ， 2=No ， 3=Unknown ， 99=No
Response]
B3 What is the proportion do you expect the government to invest in sharing
the
urban medical expenses？
1 ． Disease prevention
[1=100% ， 2=>80% ， 3=>60% ， 4=>40% ， 5=>20% ， 6=0 ， 99=no
response]
2 ． Primary medical care
[1=100% ， 2=>80% ， 3=>60% ， 4=>40% ， 5=>20% ， 6=0 ， 99= no
response]
3 ． Non-primary medical care
[1=100% ， 2=>80% ， 3=>60% ， 4=>40% ， 5=>20% ， 6=0 ， 99= no
response]
[1=100%，2=>80%，3=>60%，4=>40%，5=>20%，6=0，99=不应答]
5 ． Rehabilitation
[1=100% ， 2=>80% ， 3=>60% ， 4=>40% ， 5=>20% ， 6=0 ， 99= no
response]
6 ． Health education
[1=100% ， 2=>80% ， 3=>60% ， 4=>40% ， 5=>20% ， 6=0 ， 99= no
response]
7 ． Family planning guidance （ family
planning）[1=100%，2=>80%，3=>60%，4=>40%，5=>20%，6=0，9
9=no response]
B4 What proportion do you think individuals should bear in urban medical
expenses is acceptable？
1 ． Disease prevention
[1=<100% ， 2=<80% ， 3=<60% ， 4=<40% ， 5=<20% ， 6=0 ， 99= no
response]
2 ． Primary medical care
[1=100% ， 2=<80% ， 3=<60% ， 4=<40% ， 5=<20% ， 6=0 ， 99= no
response]
3 ． Non medical care
[1=100% ， 2=<80% ， 3=<60% ， 4=<40% ， 5=<20% ， 6=0 ， 99= no
response]
[1=100% ， 2=<80% ， 3=<60% ， 4=<40% ， 5=<20% ， 6=0 ， 99= no
response]
5 ． Rehabilitation
[1=100% ， 2=<80% ， 3=<60% ， 4=<40% ， 5=<20% ， 6=0 ， 99= no
response]
6 ． Health education
[1=100% ， 2=<80% ， 3=<60% ， 4=<40% ， 5=<20% ， 6=0 ， 99= no
response]
7 ． Family planning guidance (family
planning）[1=100%，2=<80%，3=<60%，4=<40%，5=<20%，6=0，9
9= no response]
C The attitude to the structure of urban medical service system

（ Directions ： the structure of urban medical service system includes
administrative system structure and service structure . The administrative
system structure is divided into one-lay administration (directly administered
by municipal health administration)and two-layer administration(the
municipal-district health administration ）； Service structure refers to the
accessibility of urban medical structure which can be divided into a two-layer

service structure (municipal medical institutions, community healthcare
service centers)and three-layer service structure(municipal medical
institutions, district-level medical service institutions and community
healthcare service centers
C1What is your opinion on one-layer administration and two-layer
administration of urban medical institution administration ： [1= one-layer
administration is better than two-layer administration；2=no difference；3=
two-layer administration is better than one-layer administration ；
99=unknown]
C2What do you choose in C1___ What are the following factors you took into
consideration ？ [1=administrative level 2=the degree of standardized
administration；3=Resource allocation；4= Principles of local management ；
5=source of funding；6=government burden；7=others ]
C3．What is your opinion on two-layer urban medical service and three-layer
a urban medical institution service：[1=two-layer is better than three-layer；
2=no difference；3=three-layer is better than two-layer；99=unknown]
C4What do you choose in C3 ，What are the following factors you took into
consideration ？？ [1=medical service quality ； 2=close or far ； 3=service
attitude；4=medical environment；5 medical service price；6=others ]

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WP/2006/CHN/HSP/3.

Study Report on Urban Medical Service

Medical Association of Mianyang Municipality

April 23, 2007

1. Background of the Study

2. Purposes and Significant of the Study

5. Orgnization of the Study Project

Chapter II Material Source and Methods

Chapter III Result and Analysis

1. Current Administrative Sketch Map Mianyang

2. Structure Figure of Current Urban Medical Service

System of Mianyang Municipality.

3. The Main Results of the Survey to Medical

Community Healthcare Institutions in Mianyang

5. The Survey Results of the Health Administrators,

Managing Personnel of Medical Institutions and Healthcare

6. The Main Results of the Interviews with Key Informants

1. The Understanding of the Connotations of Urban

Medical Service System

2. Comments on the Current Urban Medical Service

2. Some Specific Suggestions

Chapter VI Reform Plan of Urban Medical Service

System in Mianyang Municipality

1．The Guiding Thoughts of Reform

Figures and Tables

Figure 25 The Survey Illustration of the Situation of Cognition of Urban Medical

Appendix 1 1 Study on Urban Medical Service System in Mianyang

Appendix 2 Expert Group of the Project of Study on Urban Medical Service

Department of International Cooperation of Ministry of

Health, Health Department of Sichuan Province, the

People’s Government of Mianyang Municipality and Ms.Sun

Jing,the Project Officer of World Health Organization. For

their support, we are appreciated.

medical service system in Mianyang Municipality may

provide the policy reference for making urban medical

service system of the middle-sized cities in economically

less developed regions.

Methods (1) In accordance with the MOH’s definition of

medical institutions, we have studied the healthcare

statistics information, financial reports and cost accounting

information of various medical institutions through general

survey to obtain an understanding of the resources,

management system and the current operation of the

medical institutions and then made an assessment.

(2) We have conducted a survey to the community

residents on the cognition of medical service system by

method of random sampling with equal interval.

(3) We have conducted a questionnaire survey to urban

residents, healthcare workers, health administrators,

managing personnel of medical institutions and

government officials and also conducted deep interviews

with those key informants

Results We have found groups surveyed have

conspicuous different opinions on the connotations of

medical service system. ； The urban area in Mianyang

Municipality is rich in medical service resources and some

of the disciplines developed fast with outstanding

characteristics and sound base of community medical

service. In the meantime, some problems still exist

including the disposition of layout of the medical

institutions, the complexity of management systems and

the low coverage of medical insurance. Therefore, the

project group presents the suggestions on the reform of

the medical service system policy in Mianyang