Development Of The Provider Payment Systems Under A National Essential Health Care System

Payment method influences the behavior of health service providers, and has the apparent effect on the control of expenditure, distribution of health resources, the quality of health service, the efficiency of health service, and the equity of health service. So it should be researched primarily for the built of National Essential Health Care System.This study aims to describe the characteristics, the performance, the supported policy and measurement of some payment methods which are developed and applied in order to improve the performance of basic health services, and to propose some payment methods, corresponding supported policy and measurement, which are designed for development of National Essential Health Care System.The methods used in this study include: survey and literature review, in which literature searching, in-depth interview, group discussion, letter investigation are used for collecting data. We mainly apply qualitative method to sort out, categorize, and analyze collected data.Objectives of research comprise Center of Disease Control (CDC), township hospitals, village clinics, community health center, and the services provided by them. The payment methods we research include payment of institutions, payment ofservices, and payment of staff.Result1,Payment methods used in China: Line budget, Number of staff based global budget, Activity-based global budget, Fee for service, Capitation, Salary combined with performance-related pay. The case study of every payment method will present the performance and questions of these payment methods. Line budget and Global budget involve low administrative cost and are in favor of cost control; Fee for service and performance-related pay can encourage supply of public health service; the effectiveness of capitation is dependent on payment level of per capital and inspection system.2,Payment methods of government funds to primary health service institution: salary combined with line budget for provide side subsidy, fee for service, capitation, and performance-related pay for service purchasing. Payment reform in different countries tried the mixed payment of the above methods. All the payment methods of purchasing have facilitated the supply of basic health service.Policy implications:1,For Centers of Disease Control (CDC) in counties or upper levels, it is suggested that salary is used for paying health workers, global budget for expenditure in maintaining the institutions.2,Different payment methods are used for different services provided by CDC: for the public health services which have standard contents and procedure, line budge is recommended; for the public health services whose demand are irregular, capitation is the best; for the community-based public health services, for example health education, controlling communicable disease etc. combination capitation with performance-related pay should be used; for the individual-based public health services which need be advocated, for example immunization, delivery in hospital, prenatal and postnatal check-up etc. payment method should be combination FFS and performance-related pay; for the individual-based public health services which maybe have the problem of over-utilization, for example, the cure of TB, we should apply the combination of performance-related pay and globe budget; for paying the staff, the choices are combination of salary and performance-related pay, post wage system,and performance-related pay.3,Payment method for health service provided by primary health institution:Capitation can be used for basic medical service; Fee for service, capitation and line budget all are recommended for public health service; for the poor, primary health services bond can be used.4,Capitation under global budget and salary are both recommended for primary health workers.