| Background:Primary healthcare has been considered as an efficient, fair, and cost-effective way to organize a health system. The issuing of State No.10 Document in 2006 unveils China’s new healthcare plan, with focus on increasing primary healthcare investment and achieving universal healthcare by 2020.In 2009, the Chinese government launched a three-year health reform program to achieve equity of access. Promoting the development of community health organizations (CHOs) and establishing a stronger public health and primary care system are the key features of the new reform. However, reports about the outcome and the improvement of the health performance have not been presented yet.Methods:The thesis collected Chinese national data on health performance, health expenditure and GDP per capita from 1993-2011 and the CHO coverage rate and CHO number from 2002-2013. The secondary data are collected from China National Bureau of Statistics, World Health Organization, China Health Statistical Yearbook,World Bank, Center for Disease Control and Prevention and UN databases, mainly UNICEF. This thesis uses Eviews as the analytical tool to examine the correlation between investment on primary healthcare and heath performance. Primary healthcare investment is the explanatory variable and health performance is the variable being explained. Government health expenditure as percent to total health expenditure, CHO number and coverage rate are indicators of primary healthcare investment. Life expectancy at birth and tuberculosis detection rate as representations for health performance. The primary data are collected from the field research in Zhengzhou, one of the a pioneering city for the new medical reform. The field research includes questionnaires and personal interviews with 70 respondents in six different districts. 55 survey results are applicable. To examine people’s demand and satisfaction situation of primary healthcare, the survey includes three major indicators:awareness situation, satisfaction rating and awareness of the CHOs’ service functions and preference over hospital services.Objective:The thesis sets two objectives:first, do consumers want primary health care? Second, whether the investment on primary health care will effectively improve the heath performance? To answer the two objectives, the thesis sets two hypotheses: first hypothesis is that there exists positive correlation between the investment on primary healthcare and improvement of the heath performance and the effects will not be hindered by waste, inefficiencies and poor quality of services. Second hypothesis is that whether there is positive correlation between the primary healthcare institution coverage rate and people’s demand for primary healthcare, and that local institutions are capable of taking on the challenge and producing services for the population.Results:The result shows that one percent increase in CHO coverage rate correlates with 0.7905 percent increase in TB detection rate. The result further reveals that one percent increase in CHO coverage rate correlates with 0.031132 increase in life expectancy (years).The result means that with 10,000 more CHOs, there will be one 1.696052 percent increase in people’s demand for PHC. The result is consistent with the hypotheses that there exists positive correlation between the CHO coverage rate and life expectancy. There exists positive correlation between the CHO coverage rate and TB detection rate. People’s demand for PHC correlates with easier access to CHOs and lower expenditure at CHOs.Several limitations exits for this thesis including the relative shortage of control group comparison in Chinese data base, the inclusion of multiple components in the primary care programs and the asymmetric data source. Firstly, very few programs carried out by CHOs included control groups, thus made it difficult to rule out alternative (non-intervention related) explanations for results observed. Secondly, the inclusion of multiple components in the primary care programs reviewed, leading to difficulties in attribution of effects specifically to the primary care component. Thirdly, different data bases have data ranged from different years. For example, China National Bureau of Statistics has available data till 2013 while China Health Statistical Yearbook only provides data till 2012. There also exists slight difference between WHO database, UN databases and Chinese databases.The thesis acknowledges the limitations on the time length and comprehensiveness of data, yet believes that a cost-effectiveness analysis on the primary healthcare performance will provide timely advices for healthcare reform and reform adjustments. Limitations considered, this thesis hopes to provide solid testing results as well as some valuable policy recommendations in the final chapter for primary healthcare’s future development in China. |
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