| Objective:This study was to develop a scientific and widely applicable costing method of the National Essential Public Health Services Package on tranditional theoretical and methodological basis. This may provide a reference for governments at all levels and relevant departments to develop reasonable subsidy policies of the National Essential Public Health Services.Methods:There were two parts in the methods.The first part is to develop a costing method of the National Essential Public Health Services Package, which includes five steps. First, to classify the primary health care and their subitems; Second, to calculate the equivalent value based on person-time of each service; Third, to collect the expenditure of primary health facilities, including personnel, materials, public expense, except for drug expense; Fourth, to calculate the total equivalent value of all the primary health care and the equivalent value of the National Essential Public Health Services Package; Finally, to calculate the cost of one equivalent value and the cost of per capita of the package. The key step of the costing method is to define the equivalent value based on person-time of each service. 8 primary health care facilities from four provinces (one community health service center and one township hospital each province; Zhejiang province from east China, Hubei province from middle China, Shanxi province and Inner Mongolla from west China) were selected. The equivalent value based on person-time of each service was generated by experts’inquiry and finally defined through field verification.The second part was an empirical study. The costing method was applied in 14 community health service centers in Beijing Xicheng District, and 300 primary health care facilities in 16 provinces all over China. Questionnaires were developed based on the costing method of the National Essential Public Health Services Package, to collect relative data including personnel, demography, financial investment, manpower cost, public expense and service amount or each service from pilot primary health facilities in 2013. Then, the cost of per capita of the package was calculated. The standard costing method was also used to do comparision analysis with the costing method in the study. The consistency and reliability of the costing method was conducted based on the results of correlation coefficient analysis of calculation of 16 provinces, and different areas as well. Besides, to evaluate the stability of the new costing method, the study extracted various numbers from the 300 sample primary healh facilities to different groups, including 10-sample group, 5-sample group, and 3-sample group, to calculate the variable coefficient of each group. A stratified random sampling method was adopted to select two individual samples (five centers and five town hospitals each province) and the correlation coefficient of calculation result of the package between the two samples was analysized.Results:Part 1:Building of the costing method of the National Essential Public Health Services Package. Based the function of the primary health care facilities in China, the primary health care was been devided into five categories, including basical medical services, nursing care, pharmaceutical affairs, medical auxiliary examination and public health services.76 main primary helath service types were listed, among them there were 23 items of basical medical services,9 items of nursing care,5 items of pharmaceutical affairs,15 items of medical auxiliary examination and 24 items of public health services. The field survey found that average person time of one standard equivalent value was 15 minutes. The person time of the 76 types of sevices were also measured, and each equivalent value was also defined based its person time compared with the standard equivalent. The numerical value was lower in rural and west areas of China.Part 2:Empirical study of the costing method. In 2013, the cost of one standard equivalent was 18.7 RMB, and the cost of the package per-person in Xichen distict, Beijing was 87.97 RMB, while it was 102.3 RMB using the standard costing method. In 2013, the the cost of the package per-person in 300 primary health care facilities in 16 provinces was 63.6 RMB, while 77.1 RMB calculated by the standard costing method. The cost per-person was lowest in middle China. The consistency check between the new method and the standard costing method on per-person cost in 16 provinces showed that the correlation coefficient was 0.71, while the correlation coefficient was 0.70 between two methods within various areas. The variable coefficient of the 10-sample group,5-sample group, and 3-sample group went down from 12.5% to 5.4%, and the cost of both the one standard equivalent and the the cost of the package per-person of two individual samples was calculated. The the correlation coefficient was 0.83 for the cost of one standard equivalent and 0.84 for the cost of the package per-person, which indicated the stability of the new costing method.Conclusions:The study developed a new costing method with a concept of equivalent value based on person-time of each service. By this new method, the total cost could be calculated directely in specific work task, which conformed to the classic costing theory. The empirical study shows that the new method and good reliability and stability. The study shows that the national subsidy standard was lower than the actual cost and the investment was insufficient. The causes for the dilemma were government’s underestimation of the manpower cost and public expense. The other reason was that the local governments required more task with extra financial and manpower investment. The costing method could be widely used for its being in line with cuurent reality of primary health care and its clear and simple procedure. The costing method could be used by governments to calculate the cost of the National Essential Public Health Service, newly added service, service package, and also to conduct cost control, performance assessment, and the reference price of service purchase. Special attention should be put on the larger sample size, selection of sample with higher quality of service and quality control of data while costing the National Essential Public Health Service Package in other aears. |
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