| As the most basic medical service organization in the city, Community Health Center (CHC) has the responsibility to supply public health service and primary health care. More and more attention is in the model of how CHC act and which is the best way supplying the basic public health goods. Meanwhile, it is wildly proved that the development of CHC is the key way to solve "difficult and expensive when getting medical care". The fundamental functions of CHC are supplying elementary public health care and basic primary medical care.In fact, the definition of public health is a dynamic conception in the world. However, there is a common view for this definition, the concept is defined as: public health is preventing disease, prolonging the life and promoting the status of health. In China, there is not a precise definition until the breaking up of SARS in2003, Vice Primer Wu Yi announced that:Public health is whole process which is organized the social participation to improve environment and medical condition, be aimed at prevention for controlling infectious disease, training healthy habit and civilization life style. Meanwhile, offering medical treatment in order to preventing disease and promoting people’s health. But we should have a development view in this concept, especially in CHC, it is influenced by social factor, economic situation, population feature, illness and other elements. In different countries, the concept and the function of public health are different. In this study we using New Public Health theory to enlarge the functions of CHC, the basic functions of community health centre are prevention, primary treatment and health promotion.Community public health services has strong public goods properties, in this study, we get use of welfare economics, finance and public economics theory, and government must bear this responsibility in supplying of community public health services. In China, reform and opening up did not lead a comprehensive community health service development but a market oriented profit purchasing. The functions of government are absence to construct a basic medical public health service network. As we realized what happened, the market failure had caused failure behavior in community health services which made public welfare loss, and diversification of community health’service model has not been established at the same time, the Government’s financial compensation also failed to place in time, community health services into an awkward dilemma.In this study, we define the element concept of Community Public Health Service based on the New public health theory and the actual function of CHC, we catalog the content and nature of the public health product, then we can analyze the government functions and mechanism in pushing how motivated behave in CHC to improve their efficiency and equity. Firstly we use Lorenz Curve and calculate Gini-coefficient and Theil index on financial compensation, community health institution, medical technical personnel, beds amounts. We found that the situation of community public health service was not so good. Secondly, we adopt Data Envelopment Analysis (DEA) to compare the efficiency of CHC by classification of CHC’s properties. Finally, we discuss the financial reform policies of the Government in supplying community public health services, we use Different In Different Model to measure the effects of different compensation policy and discuss the incentive effects of the conduction path of CHC, we are trying to find the optimal design of the system of financial compensation mechanism for supply of community public health.In this study, we use2007-2009CHC statistic data in Chengdu. We find131CHCs’micro-data and do some interview for this empirical study, we tested the following main questions:(1) In2009, Gini coefficient of financial compensation, community health institution, medical technical personnel, beds amounts are0.63122,0.5155,0.50585,0.44939. it is far away from the warning line (Gini=0.4) in measure resource allocation inequality. Theil index for these indicators are0.46378,0.45405and0.37336in2009. The allocation for public health resource is lack of equlity.(2) It is a low efficiency behavior in Chengdu’CHCs as a whole. The mean score in Constant returns to scale of DEA result were0.5196786and0.5200828in2007,2009. The amounts of effective CHCs were respectively9and10. In the DEA variable returns to scale model, the average DEA efficiency in two years are0.673113,0.6519794, there are22effective but non-DEA efficient institutions in2009. There are22institutions are DEA efficiency and56%institutions founded CHC standing on the produce frontier, which the DEA score is higher than the average. In second rank is Private-owned CHCs, there are43%private-owned CHCs are in the production frontier. However, as technology advanced, the change of output pattern, we didn’t find the evidence of overall efficiency improvement in CHCs, even the tiny efficiency drop. It did not increase in quantity of DEA efficiency. Relatively, it is not good performance which organized by government department or social institution. We can easily find the main reasons caused low efficiency are outdated technical equipments, behind ideas and so on. But the effectively performance in institution founded CHCs partly because they have technique background and own government resources at the same time, with part of the market assessment indicators, tasks and work content, so they have driving force in technological progress.(3) In2009, Chengdu government issued several policies in order to improve public health services quality and quantity in CHCs. Including financial compensation and personnel performance measurement methods. In this study, we use Difference-In-Difference model to test the effects of all the policies. We test how public health service changing according to the new concept of public health in CHC, and we find that the effects are different. We focus on three policies which is two lines on revenue and expenditure, basic drug system reform and personnel performance evaluation reform. Two lines on revenue and expenditure is positive effect on improving prevention function and health promotion, but negative effect on Primary treatment. However, personnel performance evaluation can improve prevention and primary treatment in CHCs, but it is not solution in health promotion function. In our study, we can see that the higher ratio of financial compensation in total income, the better performance in public health performance. There is a significant relationship in finance status in CHCs role playing. Meanwhile, technical personnel ratio is important in achieving the goal. The more medical technical personnel, the better for primary treatment and health promotion function.The main innovation of this study: (1)To redefine the concept of community public health services and main functions. We based on comparative analysis of international and domestic study, using the concept and view of New Public Health theory. The public health service in CHC is summarized for the three categories, which are prevention, primary treatment and health promotion functions.(2)Using data envelopment analysis method to study the efficiency of CHCs, which we analysis it systematic and comprehensive comparison of the technical efficiency of community health agencies in Chengdu, we compare the impact results of different CHC with different properties.(3)Combined with practical policies, comprehensively evaluate health care reform in Chengdu, using DID model to see the effects of the financial compensation mechanism for CHCs. |
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