| After the establishment of People's Republic of China, great progress had been made in public health enterprise. China's average life expectancy had increased from around 35 years before 1949 to 71.8 years in 2001, higher than the average for the whole world (65 years) and for middle-income countries (69 years). At the same time, the infant mortality rate (IMR) had decreased from about 200 deaths per thousand live births (200‰) before 1949 to the 28.4‰ in 2000;the world average IMR was 44‰, and for middle income countries it was 30‰. However, along with the reform of economic system and the financial system, and with the market transformation of hygienic domain in our country, the current public health service system was confronted with many problem. In the year 2000, The World Health Organization had carried out the analysis of the world's health systems, using five performance indicators to measure health systems in 191 member states. China was ranked 144th for overall health system performance, and was ranked 188th for fairness in financial contribution. These results were full of thinking.The key points of public health system reform and construction was how to determine the relationship between the government and the market. Therefore, establishing a cost estimation system, classifying and ranking the service items, and reforming financial mechanism in public health services system were become more and more important. These were also expected to can resolve "market failure" and "government failure", to deal with public health resources shortage question, and to improve performance and fairness of public health services delivering, et al. As a developped province in China, great progress had been achieved in health enterprise of Zhejiang province in these decades. In the year of 2004, average life expectancy in Zhejiang province was 75.97 years, and the infant mortality was 10.63 ‰. We can see the success of publichealth system in Zhejiang province from these two indicators since liberation. However, the input of rural public health services was incompatible with economic development in these years in accordance with reforming and opening up policy. Based on the national average level, the gap of rural public health service funds in our province was 440 million Yuan in 2001. As a result of lack of financial investment, the rural public health services were carried out irregularly and with lowly efficiency. Therefore, the rural public health service system should be strengthened and improved urgently in Zhejiang province.Objectives1. To estimate the cost of rural public health service items in different social economy level of Zhejiang Province.2. To rank the important degree of rural public health service items, and to classify the public health service items, quasi-public health service items and private health service items.3. To explore the suitable rural basic public health service "package" in Zhejiang province.Materials and MethodsFive counties includes Tongxiang, Shaoxing, Chun'an, Kaihua and Taishun were selected by the characteristics of population, the development of society and economy, the geographical position, and public health service system. Focus group disscussion, questionnaire survey, organization investigation and existence information collection and so on were applied to obtain the involved data.1. Centers for Disease Control and Prevention, Health Supervision Institute, Maternal and Child Care Service Centre, 5 representative public health institute of town' level, 5 representative public health institute of country' level in each county were investigated by accounting questionnaire.The cost of rural public health service items ( "actual cosf'or "shadow price") was estimated by evidence based pricing.2. Public health service items, quasi-public health service items and private health service items were classified by the public goods theory and the health economics theory, meanwhile, the current situation of our province were also considered. In addition, 96 objects including health administrator, public health expert and worker, et al. in five counties were selected to rank the important degree of public health service items, according to the current rural public healthproblem in our province.3. Under the frame of evidence based public health decision, the suitable rural basic public health service "package" in Zhejiang province was determined based on the rank of public health services items and main rural public health problem.ResultsThis research results can be divided into three main parts, including the cost estimation of rural public health service items, the ranking of important grade and the classification of public health service items, and the verification of basic rural public health service "package" in Zhejiang province.1. In Tongxiang, Shaoxing, Chun'an, Kaihua and Taishun's three levels (county, town and village) of public health organizations, the average per capita cost of 90 public health service items was 79.520 Yuan, 54.084 Yuan, 52.342 Yuan, 85.821 Yuan and 49.134 Yuan respectively. Among them, the per capita cost in two levels of towns and the villages health organization was 67.822 Yuan, 50.050 Yuan, 40.158 Yuan, 71.092 Yuan and 36.302 Yuan respectively. In terms of human resource cost, the proportion of which in total cost was 85.29%, 92.54%, 76.72%, 82.83% and 73.88% respectively in five counties. Based no the results gotten from aggregating the five counties, the average per capita cost of three levels of health organizations was 68.663 Yuan. In which, two levels of towns and the villages health organization had 56.441 Yuan (82.20%), the level of countys health organization (Centers for Disease Control and Prevention, Health Supervision Institute, Maternal and Child Care Service Centre) had 12.222 Yuan (17.80%).2. According to the important ranking of public health service items, " vaccination (five vaccine against seven diseases)", "the report and management of public health emergencies" and " the prevention and management of tuberculosis " was in the front three order. In terms of classification, 54 item were classified into the public health service project, 33 items were classified into the quasi-public health service project, and the rest 3 items were classified into private health service project.3. 66 service items were determined as rural basic public health service "package" in our province. In which, the public health service project had 43 items, the quasi-public health service project had 22 items, and the rest 1 item was the private health service project. As a result of costestimation, the per capita cost of rural basic public health service "package" was 52.907 Yuan. In which, two levels of towns and villages health organization had 41.916 Yuan (79.23%), and the level of countys health organization had 10.990 Yuan (20.77%). As regards to 43 public health service project in "package", the per capita cost was 26.578 Yuan. In which, two levels of towns and villages health organization had 20.690 Yuan (75.85%), and the level of countys health organization had 5.887 Yuan (24.15%).In the two levels of towns and villages organizations, the per capita cost of 43 public health services project was 23.992 Yuan, 21.704 Yuan, 16.671 Yuan, 21.638 Yuan and 14.781 Yuan respectively in Tongxiang, Shaoxing, Chun'an, Kaihua and Taishun.ConclusionsThere is a great disparity in the cost of rural public health service items of different areas in Zhejiang province, and which has many influencing factors. Meanwhile, the most important construction in public health system is infrastructure institute, especially on towns and villages public health organizations. Moreover, the government should play the leading role in the rural public health service financing and delivering. Therefore, the following suggestions are provided by this study: Firstly, the appropriate, scientific, acceptable and practical cost estimation systems of rural public health service item should be established in our province. Secondly, the multiplicate, multi-channel, sustainable financical pattern of rural public health services system should be developped. Thirdly, the important grade of rural public health service items should be ranked, and the dynamic basic rural public health service "package" should be formed. Fourthly, the channel of public health service delivering can be expanded, and the way that the government purchase the public health services should be developped. Consequently, the results of our project can provide reference for public health reimbursement system, and help to verify the important grade of diflferenct public health service items. Thus, the necessary investment of public health can be accounted, and the important public health services will be given special consideration. Furthermore, our suggestions can also help to optimize the current public health resources allocation, to relieve the short question effectively, to safeguard the harmonious development of the rural public health enterprise, and to improve the rural public health service systems comprehensively. |
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