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The Systematic Review and In-depth Interviews on Financing Mechanism of Community Health Services in China

Author: GaoZuo
Tutor: JiangBaoFa
School: Shandong University
Course: Epidemiology and Biostatistics,
Keywords: Systematic Review Community Health Services In-depth Interview Financing channels
CLC: R197.1
Type: Master's thesis
Year: 2008
Downloads: 590
Quote: 1
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Abstract

Background:In China, there are still many problems in the health service, especially the inequity of health resources utilization. As we know, the large scale economic reform in China has brought a lot of laid-off workers in urban areas, and they are lowest-income population in cities. On the other hand, because of the unsuccessful health reform, the health resources are centralized to the large hospitals, the medical expense of patients has gone up too fast to burden by the common citizens. If those unemployed people are suffering from diseases, it may lead to extreme poverty in those families due to the growing of medical expenditure. As a result, the medical expenditure becomes one of the heaviest burdens and the main cause of poverty among citizens.Chinese government has taken a lot of effective measures to solve the inequity of health resources utilization, one of the solutions is community health service (CHS). The organizations of the CHS spread rapidly in Shandong province in the past decade. However, the development of the CHS is very unbalanced in various areas of the whole province, there are still many problems need to be solved in the implementation process. For example, the population coverage rate is very low in some cities; the financing mechanism is not appropriate; the lag of general practitioner’s training. Consequently, citizens can not benefit from some of the CHS items, and some service functions fail to bring effectively into play. After consulting the senior policy makers, according to our survey results we identified that lack of the ineffective financing mechanism of the CHS is the key factor which blocked the implement of community health service. We need the correct decisions and policies to promote the fundraising so that the community health service can play its functions. Therefore the financing mechanism of the CHS is selected as a priority issue of systematic review for EvipNet-Shandong.According to the criteria set by the Cochrane center, we have conducted this systematic review for more than six months, and we have completed it now. The systematic review can explore the best financing mechanism of the community health service, make full use of the role of the experts, and provide evidence for the policy decision makers. It is conducive to the development of effective policies of the CHS. With our efforts facilitating evidence-informed policy making step by step, we believe that the inequity of health resource allocation will be reduced in Shandong province. At last, to understand the situation of the financing mechanism of the CHS in Shandong province and to provide supplement for the Systematic Review, several experts or officers, who have engaged in studying or managing CHS, were selected and interviewed.Objectives:1. To gather evidences on financing mechanism of the CHS, and conduct systematic reviews;2. To explore the evidences, the proportions, the effects and the advantages or disadvantages of various financing mechanisms of the CHS;3. To put forward suggestions for sustainable development of the Community health services to fill the decision-makers’ requirements;4. To understand the situation of the financing mechanism of the Community Health Services in Shandong province and to provide supplement for the Systematic Review;5. To discuss the ways of using Systematic Review and qualitative study to provide evidence for policy makers.Methods:1. Systematic ReviewWe perform this Systematic Review according to the Cochrane’s criteria. Search strategy: A comprehensive search was performed to avoid both bias in the selection of published articles and bias in the language of publications. We used five various databases. Relevant websites and the online resources of relevant international organizations, consultancy firms and academic and research centers were also searched. Selection of studies: The criteria for considering studies in the reviews were applied in two stages. At the primary stage, titles and abstracts of studies were included on the basis of the type of intervention investigated. The second stage inclusion criterion was based on geography: this review included only those studies undertaken in China. Quality assessment: The conclusions of a systematic review depend primarily on the quality of the studies included. Therefore, an assessment of such quality is an integral part of the analytical process. Each study was independently assessed by two reviewers, who would mark the selected literatures. Synthesis: All studies included in this report were categorized into three groups according to their scores: high quality, moderate quality and low quality.2. In-depth InterviewsTo understand the situation of the financing mechanism of the CHS in Shandong province and to provide supplement for the Systematic Review, 10 experts or officers, who have engaged in studying or managing CHS, were selected and interviewed. The outline of the interviews was developed, and the "snowball" sampling method was used in the interviews, and recordings and transcripts were used to collect the data.Results:1. Finally we include 59 literatures, 58 of which are cross-sectional studies, and one of them is narrative review of experts’ advice. Government financing: Including 19 literatures, 5 of them are high quality. Based on these evidences, we talked about the financing modes and the mechanism of the government financing. User fee: Including 16 literatures, 7 of them were high quality. Based on these evidences, we talked about the financing modes and the charging criteria. Community financing: Including 22 literatures, 11 of them were high quality. Based on these evidences, we talked about the financing modes and the tendency of Community financing. Social medical insurance: We only found only one narrative review. Project funds or donation: Mentioned in seven literatures.2. Some government officials have not recognized the role of medical insurance, and paid insufficient attention to community health services. Currently, when community health service institutions and government departments take in charge of income statistics, they don’t depart social health insurance from ordinary business’s incomes, but simply view the social medical insurance as business income. There are some unfair issues in government financing.Conclusions:1. Government financing: Its proportion in the total income of the CHS is too small, and the proportions in most provinces of China are below 10%, which can hardly satisfy the needs of the development of the CHS.2. User fee: Its proportion in the total income of the CHS is too large, especially the drugs income (one of the fees), which is over 70% on an average.3. Community financing: We have ignored this role, and we can hardly find cases about it.4. Social medical insurance: Most of the provinces of China have not perfect this financing mechanism in the CHS, and its proportion in the total income of the CHS is below 1%. But it is surely an important financing mechanism.5. Project funds or donation: For the whole CHS organizations, it is nearly useless; but for a single one, it is very helpful.Suggestions1. Government financing: The government’s role is the key of the development of the CHS. The government should better use more modes to invest funds for the CHS.2. User fee: According to the current situations, it is particularly urgent to set criteria of the fees for the CHS, and meanwhile administer incomes and expenditures of the CHS in two lines.3. Community financing: Increase the percentage of the community financing part in the whole financing mechanism. Reform the financing modes.4. Social medical insurance: Mobilize and encourage various departments to invest the CHS.5. Project funds or donation: Positively establish various foundations. Conduct the organizations of the CHS to apply for funds from domestic or international research institutions.

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CLC: > Medicine, health > Preventive Medicine,Health > Health care organizations and career ( Health Management ) > Health care systems and institutions > Health care system
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