The Systematic Review On Financing Mechanism And Analysis On The Space Equality Of Community Health Services

BackgroundOur community health services system has made great development since 1997, and shows broad prospects as the new thing of health reforms.But there are also some deep-seated problems among community health services:because of the relevant economic policies not perfect,community health institutions are lack of funds and insufficient compensations,resulting in a considerable number of problems.These seriously impact the sustainable development of community health services.At the same time,because our community health services are at early stages,an important issue has not been attracted:whether community health services can maximize the allocation and the use of health resources,it has not been effectively evaluated. Aiming at above,this study makes the systematic review on the financing mechanism of community health services at home and abroad.We focus on the successful community-based financing of health services;According to the relevant experiences and lessons,we wish to set up a full range of community health services financing system.We also choose Jinan City to analyze the equity of the allocation of community health resources.Community health services runs in a good condition in Jinan City,and it can represent the most cities in China.We hope the space equity analysis can afford scientific evidence on how to effectively provide community health services for decision-makers.Objective1.To collect the evidence on financing mechanisms of community health services at home and abroad,establish database,and conduct SR; 2.To explore the evidences,effects,regional adaptations and feasibilities;to compare financing mechanisms of different counties,combined with the actual situation of our country to explore the suitable mechanism.3.To learn the geographical distributions of community health institutions in Jinan City,and identify the space equity on the allocation of Community health services;4.To assist policy makers in formulating the relevant decision-making combined with the evaluation results on equity,in order to help residents receive equal and reasonable community health services.Methods1.SR on financing mechanism of community health servicesIn this study,we perform the SR according to Cochrane's criteria,and absorb the specific criteria and methods of "Evidence-based decision-making networks in Asia" Task Force on SR of Evidence-Based decision-making,which is launched by WHO Western Pacific Office.We checked various databases,such as Medline,Pub med, Elsevier Science,CNKI,Baidu,Google etc,and the online resources of relevant international organizations,Relevant websites,consultancy firms and academic centers were also searched.Quality assessment:The conclusions of a systematic review depend primarily on the quality of the studies included.Therefore,an assessment of such quality is an integral part of the analytical process.Each study was independently assessed by two reviewers,who would mark the selected literatures. Synthesis:All studies included in this report were categorized into three groups according to their scores:high quality,moderate quality and low quality.2.The research of space analysis on community health servicesIn this study,the community health institutions of Jinan City were selected as research fields.On the premise of collecting health system statistics and relevant map information,we use Gini coefficient,Lorenze curve,and IDW of space statistical analysis,to analyze the population,geography and space equities of community health services in Jinan City,including health manpower,health institutions and health beds.Results1.SR on financing mechanism of community health servicesWe have checked 5921 literatures,including 1535 Chinese literatures and 4386 English literatures.Finally we selected 45 English literatures and 36 Chinese literatures at the range of 1996-2008.The database included different financing mechanisms of community health services in many countries,such as America,England,Thailand,China etc.User fees:Including 19 literatures; Community financing:Including 5 literatures;Social insure:Including 15 literatures;18 literatures specifically discussed the Government's relevant policies; 3 literatures focused on the project funds and donations.Based on these studies, we discussed the effects of different financing mechanisms,the impact on the poor,and the regional adaptability and equity.We wish to absorb the different financing mechanisms in different countries for our community health services.2.The research of space analysis on community health servicesThe allocation of community health source in Jinan City is unfair.Community health institutions mainly concentrated in the more developed regions at the center of Jinan City,and Lixia Section ranks the first.A statistical significant difference (x~2=46.738,P＜0.01) has been found among social health insurance bringing into community health institutions at various sections.It indicates community health institutions at the center of Jinan City developed preferably.The health resources was reasonable equity according to the distribution of population,but inequity according to geography:the Gini coefficients of community health technical personnel,health beds and health institutions determined by the population distribution were under 0.30, but that of geography were not optimistic;for example,the Gini coefficient of health institutions was above 0.40.The space distributions of community health personnel and health beds per capita/km~2 were also not optimistic:the community health resources of the sub district offices which are nearer the developed districts at the center of Jinan City are better than the undeveloped.Conclusion1.SR on financing mechanism of community health services1.1 User fees of community health services still account for a large proportion in our country.According to the current situations,it is particularly urgent to set criteria of user fees for the community health services,and meanwhile administer incomes and expenditures of the community health services in two lines.1.2 Government financing proportion in the total income of the community health services is too small.Govemment is very important in the development of community health services.The government should invest variable funds for community health services,such as to set up special funds,to insist on the community health services of fixed allowances and so on.1.3 Government should put social health insurance into community health institutions,and increase the distance of individual self-paid between community health institutions and secondary and tertiary medical institutions.1.4 In addition,the Government should adapt policies,regulations and other methods to encourage the community funds,donations,international bank loans and other financing sustains.2.The research of space analysis on community heath servicesThe rational allocation of health resources is related to whether the government grants equal access to medical benefits and public welfares,and also affect the ability to achieve reasonable medical charges.Government should coordinate planning to dispose health resources,and implement the unified management.The allocation of community health resources should be increased,and combine the allocation of resources with medical insurance system and health service system reform.We also merge the cross,close and unequal community health institutions,and optimize the combination of implementation,so as to solve the waste and shortage of resources.