The Research On Cost Of Community Basic Public Health Services In Guangzhou And Shenzhen

ObjectivesThe purpose of this study was to understand the financial status of community healthservice（CHS）centers and the costs of basic public health services through the investigationof CHS centers in Guangzhou and Shenzhen city, discuss the problems and shortcomingsexisting in compensation for CHS, and to provide reference for developing reasonablecompensation policy to enhance the community health services.MethodsTypical sampling was performed to select11CHS centers in Guangzhou and Shenzhen.We collected the situation of the CHS centers, which mainly including the general status,financial status in years of2010to2012and the development situation of basic publichealth services. Statistical methods included descriptive statistical analysis, such assampling average, proportion, growth rate, and so on.Results1. The average population served by each center was61300.7, service covered areadistributed between1.5to12.5square kilometers, the business occupancy area between565to3502square meters. The source of finance was mainly from fee-based service andgovernment investment.54.54%of CHS centers’ business premises were rented, which cost10%of their total expenditure. All CHS centers had insurance courage.2. There were470staffs in all investigated CHS centers, which contained136doctors and144nurses,1.99general practitioners and0.48public health doctors per million population.The proportion of doctors and nurses was94.34%.72.13%of staff was below the bachelordegree,57.87%was with primary titles, and74.89%of unauthorized personnel, whoseannual income was57700yuan, only50%of the income of establishment strength.3. The average increasing of all CHS centers was11.80%, and13.75%for expenditure. Thebusiness income was more than70%of total incomes, which had a downside. The financialinvestment and the grant from the higher authority distributed between11.32%to47.32%. More than50%of business income was from medicine, which decreased each year. Themedicine income of Shenzhen in2012had14.04%decreased than2010, and the absoluteincome had4.78million decreased. Almost50%of CHS centers had negative businessincome when the based public health investment increased annually.4. The total expenditure on CHS centers grew faster than revenue growth.54.54%of CHScenters could keep their balance of payments or a slight surplus from year of2010to2012.Three of the eight CHS centers in Shenzhen had a balance of payment deficit for threeconsecutive years, one of CHS centers loss was higher than1million yuan per year, wherethe average loss of96100yuan in one of centers of Guangzhou.5. Per capita income of each center had a stable level with average income of179100yuanfrom year of2010to2012. The total amount of financial assistance had positive correlationwith total operation and service population, the correlation coefficients were rs1=0.836(P=0.001)、 rs2=0.627(P=0.039), per capita subvention and outpatient had positivecorrelation with rs3=0.827(P=0.002).The per capita wage showed no correlation withbusiness revenue and per capita services.6. Total basic public health services providing by investigated centers were51, of which aminimum of34, up to51. The total cost of CHS centers in2012was71.21million, whichincluding63.54%of professional service fees,11.17%of depreciation of fixed assets,10.32%of sanitary materials, and so on. According to standard costing, the average humanjob cost could be calculated to1.35yuan per minute. The total cost of public health serviceswas44.16million, which accounting62.03%of total cost of agency. In total cost of basicpublic health services constituted, the top of three were health education, vaccination andresidents’ health records management, which accounting for13.88%,11.43%,10.18%ofthe total cost of agencies. The per capita basic public health services item cost was64.67yuan.Conclusion1. Number of general practitioner and public health physicians was insufficient. Some ofcenters had inverse ratio of physicians and nurses, which meant nurses need to strengthen.There was a low proportion of senior officers, and the professional quality should beimproved.2. The problem of business houses was still a barrier to CHS development, theimplementation of business houses policy should supervise in order to reduce the financialburden on institutions. 3. The centers had unstable financial situation with business income inducing annually.Some of centers appeared financial deficit when self-compensating weaken because of drugincome dipping.4. The financial performance mechanism for CHS centers was not well developed. Thefinancial assistance had no correlation with the amount of public health services, and theinvestment criteria for realistic was deficiency. In aspect of staff performance, there was nocorrelation between per capita wages and per capita level of business and business volume，which meant an appropriate mechanism of performance incentive should establish in orderto stimulate the enthusiasm of staff work.5. Most basic public health services projects had been carried out standardized. The maincost of CHS centers was the cost of basic public health services, which had62.03%.Publichealth services compensation gap was large, and the government should insist on a leadingrole in business development, making compensation according to number of programs andproject quality gradually, while encouraging more business.Suggestions1. Give full play to government-led to develop investment plan.2. Establish a diversified financing system by expanding financing channels.3. Improve employment mechanism to establish long-term personnel system.4. Improve the level of hardware and software in public health services, to enhance thedevelopment and management of information systems and information platform.5. Improve services quality assessment and management mechanism.6. Transform the Public Health Service project from "supply-side up" to "fill the demandside" gradually.