Study On Performance Indicators Of The Public Health System In China

Aim:The study is aimed to illustrate the infrastructure of the delivery system of public health services with Chinese characteristics, to highlight the potential approach for evaluating the effectiveness and efficiency of the delivery system, and to establish a performance indicator system in accordance with the present situation in China and oriented to the future development.Content and methods:Literature review was conducted to define basic concepts such as performance, performance evaluation, to compare different approaches of performance evaluation, to select performance indicators, and to examine the relevant studies conducted both in China and abroad. Delphi method and analytical hierarchy process were adopted to establish the performance indicator system for the delivery system of public health services. Data from 26 provinces were used to assess validity and reliability of the performance indicators and results were discussed afterwards. The expected application of the performance indicator system for the delivery system of public health services was discussed as well.Results:The infrastructure of the delivery system of public health services with Chinese characteristics was illustrated. The framework of performance evaluation for health system adopted by the World Health Organization and the Donabedian’s "structure, process, and output" logic model were used for reference to establish the 3-level performance indicator system. The logic model established in the study is called "input, output, and outcome model". The performance indicator system is consisted with 3 indicators at 1st level,12 indicators at 2nd level, and 25 indicators at 3rd level. Data from 26 provinces in 2008 were used to assess validity and reliability of the performance indicators and results were discussed. The performance of the delivery system for public health services in 26 provinces was ranked by the scores calculated from the performance indicator system established under the study. The expected application of the performance indicator system for the delivery system of public health services and the key control knobs was discussed as well.Conclusion:The research method used to establish the performance indicator system for the delivery system of public health services in the study is reasonable. The coverage of the performance indicator system is broad, systematic and with appropriate priorities. As a whole, the performance indicator system is valid and reliable. With the current framework for performance evaluation, the most important influencing factor for the performance of the public health services provision is input. The study is valuable and informative in the following two aspects. One aspect is to highlight the potential approach for evaluating effectiveness and efficiency of the deliveri system. The other is to establish a performance indicator system in accordance with the present situation in China and oriented to the future development.Innovation:(1) It is argued in the study that the professional public health institutions are the predominant providers for public health services and the medical facilities at township and village levels work as the basis for the delivery of public health services. The medical facilities at county and above administrative level providing public health services are important as well. Based on the reality of the provision of public health services in the country, the author argued that the delivery system of public health services with Chinese characteristics was consisted of disease prevention and control system, maternal and child health system, rural and community health system. (2) In recognition of the economic and social development of the country and the current financial status, capability, and the service quality of the professional public health institutions, the input was given the highest priority for its impact on the performance of the delivery system of the public health services in the study. Furthermore, the financial resource allocated annually to the public health by provincial and lower administrative level was selected as an indicator. The logic model of "input, output, and outcome" was established in the study to set up the performance indicator system. (3) Based on the critical review of traditional public health services both in China and abroad, the author established a practical performance indicator system for the delivery of public health services by integrating the current public health practice and policies into the study. More importantly, data from 26 provinces in 2008 were used to assess validity and reliability of the performance indicators.