Design For Essential Health Care Package For Three Chronic Diseases Of Diabetes, Hypertension, And Coronary Disease

Objective:This paper attempts to develop an essential health care package for diabetes, hypertension, and coronary disease based on the situation of China, to explore the methodology approaches of priority setting in designing the package and identify the criteria for it, and to provide the evidence on theory, policy and demonstration for the establishment of essential health care system.Methods:Literature study is applied to summarize the preventive interventions with cost-effectiveness of diabetes, hypertension, and coronary disease; questionnaire survey combined with literature study is used to identify the criteria for priority setting; each service receives 1 to 10 points on each of the identified criterion through questionnaire; priorities of delivery are establish by comparing the ranking of each services.Results:â‘ The theories for establishment of the essential health care package include health equity, efficiency, principle of the lowest efficient level of care, the role of government in health and so on.â‘¡The analysis of the changes in prevalence of diabetes, hypertension and coronary disease from 1993 to 2008 indicates that they have increased by 1.3 to 4 times during the past 20 years, which shows the necessity to provide the essential health care package.â‘¢A multi-criteria system is employed in this paper including 3 sets of 8 criteria. The first set of the criteria relates to epidemiology and burden of disease analysis, including prevalence of disease, effect on the risk factors; a second set is about economic analysis, which is cost of the service, the percent of the out-of-pocket and health insurance coverage; a third set responds to feasibility analysis, including the acceptance of target population, technical difficulty and political views.â‘£A priority list of 18 services is obtained by comparing the final score of each service. The package will be defined on the basis of the list, going as far down the priority list as resources would allow.Conclusion:There is an increasing trend in the prevalence of diabetes, hypertension, and coronary disease. It is necessary to define the package for these chronic diseases which consists of preventive interventions. A multi-criteria priority setting should be employed to design the essential health care package, which is necessary to improve access of health care and the efficiency in health resources allocation.