Study On The Financing Of Public Health Care Services In Community Of Shanghai

[Background]Governments at all levels of Shanghai always attach great importance to the development of community health service(CHS).They take the work of CHS as one of the 'Practical Projects' to serve the public as well as an important part of the construction of Shanghai's public health system.Correspondingly.the fund of the governments for the development of community public health service(CPHS) is growing from year to year. The increasing funding level is the evidence of the governments" confidence and determination to serve the public.But.the scientific and rational application of the growing fund calls for proper policies.or there might be the problems of waste and abuse of the fund which is used for the maintenance of the public health.To decide the programs which should be provided on the community level and the proper amount of the fund as well as the plans to use them could be taken as the base of the community health service.The study of these problems will serve the practice of CPHS and the theory of using the fund.[Objectives]Through the study of the definition and classification of the community public health service,the amount and structure of the costs of CPHS,and probe into the financing investment amount as well as the investment mechanism of CPHS,the results of this study will be used to serve the improvement of the related policies of the financing investment for the CPHS.[Contents]1,To define and classify the community public health services2,The current situation of the community public health service of Shanghai3,The amount and structure of the costs of CPHS of Shanghai4,The financing investment amount and mechanism of CPHS of Shanghai5,Policy recommendations |Methodology]Data sources1.Study site.According to geographic and economic situation,three districts (counties) Changning,Xuhui and Songjiang were chosen.Detailed,all the eight community health centers(CHC) of Changning and 10 CHCs of Xuhui were selected, in Songjiang.three were chosen as the study sites.2.Data collection.2.1 Institution investigation.Through questionnaires to collect the following data: the basic condition of the studied institution.the volume of each kind of the services of the surveyed CHCs.the time and the number of person needed for each kind of the services and the consumption of materials human resources of these CHCs.2.2 Second-hand materials collection:Shanghai Statistical Yearbook2004-2008, Shanghai Statistical Bulletin2008,related research results,academic references, policy documents about CHS.2.3 Qualitative interviews.To know the problems of the fund use and supervision as well as related suggestions and issues through interviewing with the administrative officials and health workers of the CHCs.Analysis Methods1.Reference reviews.Summarize the collected second-hand materials to know the following aspects:firstly,theories,rules,methods and results of existed research on the definition and classification of community health services;secondly,the modes and funding resources of community health services at home and abroad;thirdly,the related policies,laws and documents of the country and Shanghai.2.Based on the public goods theory and existed research results,to define and classify the community public health services items through expert advice and focus group interviews.3.Utilize the cost accounting method to calculate the cost of community health service items,and estimate the financing investment amount of community public health services that the government should undertake.Based on these calculations, forecast the financing investment level of Shanghai in future 4 years.4.The health policy analysis methods and statistical analysis methods were applied to study the current problems of the fund use of CPHS and present the corresponding suggestions.5.Analysis tools.Data were input and analyzed by Excel 2003 and SPSS 11.5. [Results]The results of this study contain the following aspects:1.Based on existed studies,and through the methods of expert advice,78 community public health service items were classified as the basic items on the level of community which means the most important items of CPHS and should be finished completely and perfectly.2.Just a few community public health service items were carried out in the surveyed CHCs.not only less than the amount of CPHS suggested in the Guide of The CPHS Items on Which The Shanghai Finacing Investment Should Be Spent,but also less than the 78 items defined in first chapter of this study.3.The cost of staffing was the biggest part of the whole cost of CHCs.Generally, it took more than half of the whole cost,this told us the main cost of CHCs.4.The funding level of different kinds of CPHS of each CHC was of clear difference.But,the service of Prevention Epidemics,Chronic Disease Control, Women and Infants,Family Planning Advice,Community Health Education and Eye Disease's and Dental Disease's Prevention and Treatment was the main direct of funding use.5.The standard cost per person of the surveyed three districts was different,in Songjiang is about 39.99 yuan per person,Xuhui 42.53 yuan per person and Changning 27.17 yuan per person,there was apparent difference of each kind of service among those three districts.6.If 0.2%-0.3%of the local fiscal expenditure were spent as the fund for CPHS, it would be enough and it would not give the local fiscal much more burden.It would be helpful to keep the continuity of funding for the CPHS.7.The study result showed that it is necessary to achieve the equalization of finacing investment for per person in all counties/districts.In order to achieve this aim, the municipal finance should support those counties/districts based on their actual situation.8.Besed on existed study,define the three methods to reimburse these CPHS items through expert advice:according to workload;according to pay package; special funds.[Suggestion]1.The item cost accounting showed clear difference of each CHC which testified the possibility to control the cost.The method of cost accounting should be used to control the cost and avoid the funding waste.2.The special account of fund for CPHS should be set up,and the whole range fund management was needed for the use of financing investment.Those methods would strengthen the supervision of CPHS fund and guarantee its rational use.3.Change the current policy that each county should funding the CPHS according to fixed amount to the one funding the CPHS according to a proper proportion of one county's last year's fiscal expenditure,such as 0.3%.The municipal finance should help those under-average-level counties to achieve the equalization.4.On one hand,plans should be set up to achieve equalization of the fund for every resident population,on the other hand,there need regular CPHS budget for the floating population from the governments at all levels of Shanghai.