A Study On Payment Mechanism For Primary Health Institutions In China

Health is a vital interest of the people of a very important issue, but also to build a harmonious society important element. Basic health care system is a government organization, to all the residents to safe, effective, convenient and inexpensive public health and basic medical services protection system. The essence of the system is to strengthen the public health system and rural health system and urban community health system construction, and sound financial mechanism to ensure funding for, improve public health agencies and health institutions in urban and rural grassroots public service functions. All of this system to basic health care for targets to public health agencies, health care institutions and the rural urban community health services for the main body used for essential drugs and medical technology, borne by the government for staff and operational expenses. This system persist in focusing on prevention and control of, and pay attention to equity and efficiency, to reduce the people's basic health services gap. Keynote has admitted to the future location for universal access to basic health services. Government should bear all public health and basic medical care, this is the Ministry of Health is actively promoting the health reform ideas. The national health work conference on in-depth study to determine the health system in 2007 will focus on three aspects focus on promoting basic health care system: strengthening the public health system; To strengthen the building of rural health service system; Accelerating the development of urban community health services.We should establish and improve the basic universal coverage health care system, the reform of the health challenges facing the mainly reflected in the health services management and supply departments to effectively control costs, reasonable and effective use of limited health resources to meet urban and rural residents equal access to basic health services. Basic health services payment is closely around "Everyone has a right to basic health care" and the actual set. Payment of health services is health reform and development process to study the important issues. Payment direct impact on the health institutions and health workers in the supply, and cost control, resource allocation, quality of service and health service efficiency in the process of a clear orientation fair or constraining role of health reform is one of the core issues. Payment of the effectiveness of the reform to a large extent also decided to reform the health smoothly or not, the quality of service and health service agencies and the level of the management information system and the other. The purpose of this study is to explore and establish national and basic health care system suited to payment programs, as well as the matching of payment reform policies and specific measures for the establishment of basic national health care system in experimental research theory, and empirical basis for policy. Design 2-3 applicable to nationals of basic health services (mainly primary health services), the payment option programs.Through analysis of China from 1994 to 2006 full-text databases and journals in the database retrieval pay Wei-pu, basic health services, community health services, rural hospitals, financial compensation, financial input by MeSH literature, manual retrieval by the Foreign Languages and Literature forum agencies interviews with key players in Shandong Province, Tianjin, and the autonomous region of Ningxia Hui Autonomous Region field research, and other forms of basic health services and payments related aspects of the progress of the study, analysis of primary health services in the financial and payment status. Information on the financial income and expenditure, a part of the income and the proportion of expenditure, particularly subsidies or financial income and expenditure ratio. The general areas of payment, summed up its current payment status, impact and future direction of reform or proposals. The reform of the payment system, case studies, summarized his reform behind the practice, the impact and the pros and cons of reform and the effectiveness of the problems in need of supporting policies for further research and provide a reference from. The following key elements:1. Payment of health services, the health institutions to provide health services and the amount of human, material and financial compensation system, also known as the way of compensation and health services. Payment of health services should include the traditional sense of health insurance payments, public health and sanitation funds allocated, such as service charges. Basic health services payment includes two aspects of meaning, first of grassroots health institutions payment; Two of these agencies provide health services payments.Take basic health services for rural and urban residents in providing basic health services, the responsibilities of various health institutions in the most grass-roots units, but also nationals of the most basic of basic health services, the main providers. Primary health services in rural areas, including rural two health institutions (that is, township hospitals and village clinics) and the urban areas of community health service institutions (ie community health service centers and community health service stations). Generally, these agencies provide health services into primary health care and public health services, two categories.2. Current domestic health services to rural grassroots organizations payment related research, and more focused on the township hospitals throughout the financial payments, structure and specific ways. Based on multi-angle analysis of the financial health of rural insufficient input from the perspective of qualitative and quantitative accompanied argumentation; And mostly inputs to the health of urban and rural differences in the comparison at the moment, financial and health services for rural grass-roots organization and not enough intensity and the structural imbalance in the corresponding recommendations and responses.Right around in the rural grassroots health services payment matching policy research, macro, from the rural integration, THCs two lines of income and expenditure management, microeconomic reform THCs internal management and distribution systems were analyzed. But these methods only on the economic operation of township hospitals and specific functions improved. Based on the improvement of basic health services in rural payments by supporting policy research, not only need to study the specific implementation of these policies, but the policies need to focus on the essence of the theoretical and practical issues and related reforms as a way to pay the significance of the policy.The financial situation of the rural health work and the importance of the different villages in different parts of the two financial institutions to pay health status vary widely. Overall, the right main THCs funds mainly to pay, payments into full grant payment, the difference basically no subsidy payments and pay three conditions, payment methods vary. The grass-roots health services (including urban community health service institutions) specific payment methods are: per capita fixed standards and the number of paid staff, in accordance with the entry pay special operations budget funds, in accordance with the quantity of work performance and pay special combination of operational funds, End pay special performance by the whole of the total budget on the payment of salaries and other performance mixed or single payment.The township hospital staff is basically the structure of payment of wages; Rural health integration in the implementation of the regional rural doctors, wage structure is implemented; Integration of a rural health areas, rural doctors is still the main economic self-financing. The township hospital staff payment reform, basically adopted the salary system and performance pay by a combination of: the structure of wage system on the basis of the ratio of wages to improve performance, and performance pay for a detailed examination of the grade, according to the amount of wages multiplied by the performance of the score right heavy release.3. Current domestic urban community health service institutions payment of the related research, and more concentrated in the urban community health services across the compensation mechanism. Financial status of payments to cover them, but no specific qualitative and quantitative analysis, contains no specific mode of payment. In the urban community health services around the reform of institutions, made applicable to specific business payments programs, such as right-to-work budget allocations, the special funding to the government to "buy services" manner, in accordance with the completion of quantity and the quality of service to be paid, but no payment is given the choice of using the theoretical support and with other forms of comparative analysis. Right around the city for community health service institutions supporting policies related payments, payments for the two pilot areas of management and the comprehensive reform of the community health study to explore more of the specific practices of experience, in the case of a lack of policy and reflects the problems faced and supporting reform research.Operating income is the medical community health services the main channel for other prevention, care, rehabilitation, family planning guidance, health education, and other social public health services in order to avoid more fees, unable to receive reasonable compensation. Staff salaries, bonuses earned entirely, making them re-medical, health light. These are not only affects the enthusiasm of the staff, and community health services to reduce the social image. Community Health Center of basic pay staff salaries are taken in the structure of wages, wage jobs that wage increases performance mode; The community health service stations due to the lower, generally only the salary system - the average distribution methods.4. Major policy recommendations:(1) adjust and clear at all levels of government financial support for basic health services to the responsibilitiesFrom the longitudinal view, must be based on the government's public health services at all levels of economic attributes determine the duty of the government. Which is a national public goods, more should be provided by the central finance to support; The local public goods, mainly by the local government responsibility. China's existing health policies and regulations at all levels of government to assume the duties of public health provisions are too general, the main public health expenditure commitment not clear, and the central and local governments lack of investment in public health in rural areas, and a major reason for this is that there are no corresponding laws related to mandatory subjects of the right Murray and obligations(2) for grass-roots health services provided by public health services to the government-led investmentThe fixed subsidy of basic health services and public health funding for the two to prevent the funding of the tilt. In providing different products for different public financial support. Because of the different nature of public goods, the provision of public goods in different ways. Its basic principle is: Pure public goods provided by the government, quasi-public goods should also help the government and market forces provide. The township hospital for prevention and public health management of pure public health services, the government should be through the establishment of an effective financial system to bear the responsibility; As for the basic medical service should be taken jointly by the government and the market to provide financing for multi-channel approach.(3) for grass-roots organizations to provide health services to provide basic medical services, funding, the recommendations made in the literature were concentrated in: in cities, towns use of the basic medical insurance fund; In rural areas, the use of new rural cooperative medical fund payments. The specific mode of payment options, in the literature did not give a clear options. Literature on reform of the medical insurance payment to the impact of cost control from the pilot study of quantitative data, as payment for medical insurance reform is part of the role of cost control, it is difficult to determine payment cost control results. At the same time, no specific evaluation of the pilot comprehensive medical insurance payments in the pros, payment options provide a clear policy recommendations.The grass-roots health services research payments, and more financial compensation from the perspective of the effort, demonstrating to the grass-roots investment is insufficient and some of the specific services to a particular mode of payment. There is no payment from the literature theory, basic health services and the supporting policies of payment systems research. In the literature of policy recommendations to the government stressed that the main responsibilities, few options for the payment of the recommended policies and supporting research.