Research On Financing Of Public Health Services In Three Counties' Rural Areas

1. Background and Significances(1) To fasten health system reform and mitigating overly expensive health careOver past ten years, "overly expensive health care" has gradually become a topic of concern to people, especially more serious in rural areas. The increasing rate of health care expenditures has exceeded per capita household income growth, and become the third-largest expenditure after the family food and education. The cause of health care is an important guarantee of social stability and economic development in rural areas. "Three rural" concerns the long-term stability of the country. To improve the fairness of health financing and ensure fair access to health resources and health services, the government has issued a series of policies and documents. In particular, the new policy about health system reform in March 2009 pointed out that health care in rural areas was relatively weak, and health financing from the government was inadequate. So the reform emphasized the scope of public health services to identify clearly basic public health care in rural areas, and gradually increasing public health financing per capita from the government. Thus, it is particularly important to deepen the research of government finance based on the clear public health care in rural areas.(2) To narrow and eliminating the difference between urban and rural areas in health careFor a long time, 2/3 of rural population has only shared less than 1/4 of health resources. As we all know, health resources in rural areas are weak. Health care financing in rural areas has been declining gradually. In 1998, total health expenditure reached 377.6 billion, the government financed 58.72 billion and 9.25 billion for rural areas, accounting for only 15.9% invested by the Government. In 2000, the government's finances for rural public health were not amount to 20 billion, 2.5 Yuan per capital per year on average. It was statistic by the Ministry of Health in 2004, China's health expenditure accounted for 1.6% ~ 1.7% of financial expenditure by the government, of which only 30.0% allocated to Chinese rural areas. This shows that the research on financing of public health services in rural areas will help to narrow and eliminating the difference between urban and rural areas in health care.(3) To improve public health investment mechanisms to public health institutionsBefore the 80s, public health institutions at all levels had been full funded by the government. Since the 80's, the policy of self-financing has allowed public health institutions to carry out un-public and profitable health care. In recent years, the proportion that financing by the government accounted for public health institutions' expenditure have been getting smaller and smaller. To resolve this problem and improve the public health institutions funding mechanism, the following questions needed to be clear: a. which public health care should be carried out in rural areas? b. what was the cost to carry out these public health services? c. how much the government should financed according to these health care? As a result, it is necessary to carry out cost accounting and improve the level of financing, which will play a guide role in improving the public health service financing and investment mechanisms in rural areas.2. Study Objectives and ContentsThe study defined public health services by literature analysis and expert consultation, obtaining data by sampling survey, and accounting the financing by the method of cost accounting. The result will provide reference for improving the public health financing in rural areas.The research contents as follows:a. To introduce the concept of cost accounting to explore a set of strategies and methods for accounting the financing of public health services in Chinese rural areas;b. To account the cost and the financing by the method of cost accounting, the result of which might provide reference for improving public health financing in rural areas.3. Research Methods(1) Ideas and methods of Cost AccountingCost accounting is the process of tracking and aggregation in a project related to the consumption of resources, as long as all of the project should be spent on the costs, including direct and indirect costs. The study will account the cost and the financing of public health services in rural areas by the method of cost accounting.(2) Literature analysisIn this study, the specific application is divided into two levels: First, to form a smooth guiding principles and methods by collecting and estimating methods, ideas, principles of economics-related data and information; Second, to define the public health services in rural areas by collecting the content of rural health services, assessment indicators and other relevant documents, literature, law, etc.(3) Expert consultation and argumentationThe study invited practice and management experts to define the public health services for rural projects. After 117 person times of consultation and argumentation of experts in 11 rounds, public health services in rural areas and examination requirements are formed eventually to lay the foundation for financing accounting of public health services in rural areas.(4) Utilization of conventional materialsSearch "China Statistical Yearbook", "Chinese Health Statistics Yearbook" and other statements of conventional data, and access to information relevant to the study, such as the population of samples areas, work situation in sample areas, etc.(5) Survey in agentsTo measure and analyze the costs of public health services in sample rural areas by carrying out the survey of costs in 93 county, townships, and village health institutions, which includes 3 health bureaus, 2 centers for disease control and prevention , 2 health authorities, 1 health and epidemic prevention stations, 8 medical institutions at the county level, 3 maternal and child health hospitals, 1 medical first-aid center at the county level, 39 township hospitals and 34 village health institutions.4. Main study results(1) Form a measuring method and step on financing of public health services in rural areasThe study developed a set of ideas and methods of measurement in the financing of public health services in rural areas, which determined the information sources needed by such measurements. The ideas of measurement in the financing of public health services in rural areas included 6 parts, namely, defining the "rural" areas according to the public health services, defining the public health services in rural areas, measurement of the actual cost of the services in the sample areas, measurement of the actual cost of per unit of services in the sample areas, measurement of ideal cost of completing all projects in sample areas and the measurement of the financing of public health services in rural areas throughout the country.(2) Define a unified public health functions and items in rural areasThe results showed that public health in Chinese rural areas could consist of 8 functions including monitoring and reporting of disease, prevention and control of disease, maternal and child health, public health emergencies, health supervision, basic health care, the patriotic health as well as newly-type cooperative medical management, 23 categories and 59 items. After 117 person times of consultation and argumentation of experts in 11 rounds, the overall recognition of the functions, categories and items reached 94.1%, 96.1% and 97.1%, respectively with a certain acceptability, which laid the foundation for further measurement of financing of the projects. (3)The financing of public health services in three counties' rural areasTaking into account China's national conditions, in particular the financial and economic conditions, funding still needed to implement step by step. Therefore, this result was calculated after deducting the cost of "primary health care", which was the level of funding in line with the actual situation in rural areas and facilitating the operation of public health services in rural areas.The result showed that the financing of sample county in Jiangsu should be increased by 15.40 Yuan per person, reaching 58.45 Yuan per person; the financing of sample county in Shanghai should be increased by 15.85 Yuan per person, reaching 97.64 Yuan per person; the financing of sample county in Qinghai should be increased by 22.03 Yuan per person, reaching 50.47 Yuan per person.The financing in Shanghai sample areas was higher than that in Jiangsu and Qinghai, which might relate to target groups, the level of local economy and the accomplishment degree of public health services. So those factors should be taking into account, when adjusting the level of financing of public health services in future.5. Exploration and innovation(1) To explore ideas and methods of financing of public health care. At present, the study introduced the concept of cost accounting to account the cost and financing of public health services was still few, and which was largely at the exploratory stage, particularly for public health care in rural areas. Although this study is still an exploratory stage, but the course of the study summarized in a comprehensive analysis of the literature, institutional surveys, as well as expert interview and demonstration, and developed a method of financing accounting used in the field of public health, from institutions to the region in accordance with the actual situation of China's rural .The method has developed in order to provide reference for improving public health care financing and investment mechanisms in rural areas.(2) To account the cost and financing of public health services in rural areas on the basis of defining public health services in order to play a directing role in financing. Based on the cost per unit of public health services, the number and the accomplished degree of serviced groups, the study accounted the financing of public health services in sample rural areas. Taking into account China's conditions, particularly the financial and economic conditions, this result has been calculated after deducting the cost of "primary health care", which was the level of financing in line with the actual situation in rural areas and keeping operation of public health institutions in rural areas. Along with economic development and the project's requirements change, the level of financing should still be adjusted and measured again. Then, the cost of "primary health care" will be taken into account, and the total financing would provide reference for improving the public health service financing and investment mechanisms in rural areas.