Study On Public Health System

The ultimate purpose of public health system is to protect people's health, and it is the most important component of preventive health care system. Chinese public health is in a dilemma situation, in which while the measurements aiming at maternal and child health care, immunization and foods sanitation etc are still needed to be improved, the emerging health problems including chronic non-infectious disease, AIDs and birds flu are increasing. How to response to the new problems and strengthen public health functions at the same time is a challenge to public health system.Before SARS outbreak, China's health sector reform had been focusing on medical delivery system, pharmaceutical system, and social health insurance schemes. Since then, the public health care system has been paid more attentions, in order to address the issuses of how an effective public health system can be improved for dealing the common public health problems, how a responsive system can be established for addressing the emerging public health events, and how the current public health system can be operated more effectively for improving health status of the people. The government has made great effort that was not seen before for public health issues.This study aims to assess the sampled public health systems and their operational mechanism, find the weaknesses of these systems, and put forward suggestions to perfect them. The specific objectives of the study include review of public health system in terms of definition, organizational structure, regulation and financing mechanism from a range of countries; analysis of the major health problem on which a package of essential public health services are developed; analysis of various operation of public health systems in both rural and urban areas; analysis of relative efficiency under different institution arrangement for delivering public health service; and exploration of possible mechanisms for a well coordinated system between different level health providers.Data sources in this study include key informant interviews, facility-based questionnaire survey, investigations of health workers, and household survey. According to economic development and operation patterns of public health system, the study sites include three rural counties from Shandong Provinces, Zhangqiu, Changle and Dong'e, and two municipal cities of Yinchuan in Ningxia and Xining in Qinghai. The survey instruments include question sheet for interviewing key informants and questionnaires for health workers and households. The key informants came from different types of health institutions. The questionnaires are used in the investigations for health facilities, health workers, and households. According to the purposes of the study, analyses were carried out in three components. The first component is description of public health care systems in study sites. The second one is analysis of relative efficiency in use of resources using transaction cost method. The third component is the analysis of coordination mechanism between different levels of health institutions, and the distribution of primary facilities and residences' utilization of these facilities.Literature review shows that there is no uniform definition to public health and public health system, neither to public health functions and services. China has no explicit definition of public health and public health functions either.The description and analysis of public health system in study sites indicated that financial investment was not significantly related to economic development, and disparities among different regions were large, government investment to the institutions of disease control, maternal and children health care were insufficient, especially to the primary facilities-village clinics and community health stations, and there was no output assessment mechanism to public health investment. Public health human resources were short; they were in high floating ratio and low quality and aging in primary facilities. Equipments renewal hung behind the development of public health institutions and the disparities in equipment among institutions were large.The output of public health system showed the trend that facilities concentrated on service supply, not on residences' health improvement, and little concern was given to the development of public health functions. Present information systems emphasized information report, this improved information sharing in larger district, but ignoring regional information utilization.The analysis of transaction costs showed input of law and regulation could be helpful for reducing transaction cost and improving public health service supply; management models had different impact on public health input and transaction cost; principle's monitoring methods could stimulate public health service supply, but interview results revealed the agents pay more attention to reward or compensation standard and other treatments, such as endowment insurance of village clinic doctors.The primary purpose to perfect our public health system is to improve equity and efficiency. The construct of public health system should focus on primary facilities, disease prevention and health surveillance institutions. The public health system should be urban-rural integrated model, namely whether country or city should establish public health system based on primary facilities, and it is also the base to cover the whole population for basic health services.The key point of public health decision-making system is to develop regional decision-making system, for example, county or city. Two levels-regional and national decision-making units should be established. The one-way information flow system should be changed; much attention should be paid to regional information collection and analysis, and improve decision-making ability of local government.Public health finance is to study the allocation of funds, and actually that is the problem of politics decision-making and institution design. Government commitment is the base of realization of public health functions; thereby government responsibility should be clarified and be regulated by laws, then transaction cost would decrease. Additionally, transfer-riayment method can be used to poor areas, the principle is that: center government provides national public goods, and local governments provide local public goods according to their financial capacity and benefit scope.The role of health administrative sectors is emphasized in public health system, but to be an efficient responsive system, politics, economic and technological support mechanism are necessary.There are several methods to reduce transaction costs: to improve information management and build information net system; decrease principle-agent layers and township hospitals (community health centers) take all monitoring responsibilities to village clinics (community health stations); develop public health law and regulation, to regulate public health service suppliers with sound measurements and improve professional self-discipline; adopt feasible management models and establish effective incentive mechanism and scientific monitoring technology.To analyze transaction costs, one should notice that: an institution arrangement should not be abandoned only because of high transaction cost, there is trade-off between transaction cost and other costs; transaction costs should be compared in real world not in ideal condition; transaction costs will change during a period, they will decrease with time, so attention should be paid to the continuity of institution arrangementThe innovation of this study is to calculate transaction costs during public health service delivery and compare different institution arrangements of public health system in sites. The shortage of the study is that there maybe incompletion of transaction cost definition, so the calculation may be inadequate. In addition, there is no relativity analysis during the comparison of transaction costs, namely that the causality between output and transaction costs is not sure. And yet there is only descriptive analysis of public health system and no performance analysis. These are emphases to further study.