| ObjectiveBy defining the concept and extension of the essential health service, we seek to put forward the main content and some relevant policies of National Essential Healthcare Package (NEHP), analyze the feasibility of implementation of NEHP and its adaptability to the development of economics; On the other hand, we seek to find out the relationship between public finance and NEHP in order to pinpoint the responsibility of the government., provide theoretical, political and evidence-based foundation to the essential medical and health service system.Methods①Literature review: Using Literature review method,we summarized the relevant researches and implementing experiences of NEHP all over the world in recent years and formed a systemic report.②Field research method: Using random sampling method, study objectives were then selected and they were investigated face-to-face using questionnaire.③Delphi Method: In our research, relevant experts were consulted about the content of NEHP, the priority of providing different health services, the applicability of essential examinations and essential drugs, and so on.④Economic evaluation method: Using the principle and methods of economic evaluation, the concept and extension of NEHP was then defined and the costs of different levels of NEHP were calculated.Results(一)Concept system of NEHPWe consider that essential healthcare is not an isolated concept but one part of the whole concept system of health service. 1,The concept system of health service should keep its historical continuity. We must persist what the government has advocated that the health system is made up of health service, health insurance, health law execution and monitoring. Medical services and public health services provided by the community health organizations belong to essential health service.2,The essential healthcare can be divided into two kinds: generalized and narrow essential healthcare. The generalized essential healthcare is mainly based on the equity; all the health services that can satisfy people's health need are essential healthcares; other health services belongs to non-essential healthcare, such as hospitalizing environment, accessorial services, etc.However, the narrow is mainly defined according to the actuality, which can be realized, with high utility, reflect equity, nearly free-fee and can be obtained in community health organizations are categorized into essential healthcare; other healthcares whether they have health need or not are grouped into non-essential healthcare.3,Essential Healthcare Package include National Essential Healthcare Package (NEHP) and Local Essential Healthcare Package (LEHP). The NEHP refers to the health services provided all over the country with identical standard; while the LEHP refers to the essential healthcare package that the local government add some other health services to the NEHP according to their financial status.Essential Healthcare Package of our study is thus defined as the national-level narrow Essential Healthcare Package.(二)The extension of Essential Healthcare PackageIn our study, the NEHP is divided into 5 levels:1,Level-1 package: These services are mainly public health services. These health services are pure public goods that mainly founded by the government and provided by community health organizations, including statistics of community health information, surveillance of key infectious disease, management of epidemic situation of infectious disease, health education, etc. Level-1 package would be come true if the department of finance allocate and sustain 1 preventive health worker per 10,000 persons.2,level-2 package: Based on the level-1 package, some health services are added to the health package such as prevention and treatment of acute infectious disease, management of acute infectious disease, planned immunity injection, emergent and intensifying immunity, management of chronic patients. Level-2 package would be come true if the department of finance allocate and sustain another 1 preventive health worker per 10,000 persons.3,level-3 package: Based on the level-2 package, free-fee of outpatient service (including physical examination, treatment plan and prescription, emergency treatment, general treatment, healing physical therapy) and non-profit drugs provided by the community health organizations are added to the NEHP, this is so-called"double-zero package". ("double-free package"). Levele-3 package can be implemented by making full use of the existing community health organizations and the department of finance provide for the organizations and staffs.4,Level-4 package: Free basic accessorial examination is added to the healthcare package on the basis of level-3 package, therefore we could achieve the goal of"free-fee of outpatient service, non-profit drugs and free basic accessorial examination"(this is called three-zero package). Free basic accessorial examinations include blood, urine and stool routine test, X-ray examination, electrocardiogram examination, B-ultrasound examination and plasma biochemical test. If the department of finance allocate relevant machine and running expenses to community health organizations, the level-4 healthcare package would be come true.5,Level-5 package: On the basis of level-4 healthcare package, the essential drugs are charged no money (it is called new three-zero package). If the government of finance again pays for the costs of essential drugs, the level-5 healthcare package would be realized.(三) Calculating of the costs of NEHPAfter comparing to need analysis, provision analysis and demand analysis method, we adopt need-demand-cost method to calculate the cost of NEHP. The advantages of the method include: (1) fully taking the demand releasing after cost-free into account; (2) simple and convenient to be done; (3) the results are exact. The results of the costs of NEHP are followed: Level of NEHP Total cost of NEHP (billion Yuan) Cost per capita (Yuan) Level-1 10.045 7.6 Level-2 223.000 16.84 Level-3 116.529 88.01 Level-4 146.070 110.32 Level-5 Level-5.1 153.533 115.96 Level-5.2 173.285 130.88 Level-5.3 274.808 207.56Because the definition of NEHP is defined as the public health services, diagnosis and treatment received in community health organizations, the result of need-demand-cost method is much realistic and exact.(1)As to level-3 healthcare package, our study calculated the quantity of doctors and nurses and operating cost according to the health need. If only the government provide for these health staffs, the residents could receive free outpatient service and non-profit drugs.(2) As to level-4 healthcare package, the study also calculated the operating costs of equipments. If the government allocate and maintain relative equipments, the residents can receive cost-free basic examination services.(3)As to level-5 healthcare package, familiar disease in community health organizations is divided in to 3 kinds as acute syndrome, emergent disease and chronic disease. 83 kinds of these disease and 121 kinds of drugs are selected. If the government provides these 121 kinds of drugs, the residents could receive free drugs in community health organizations.(四) Implementing of NEHP1,Feasibility analysisOur study also demonstrated the feasibility of NEHP especially its economic feasibility. By analyzing the relationship between NEHP, GDP and financial expenditure, we deem that our country can carry out five-level NEHP at present. In order to explain the relationships, some graphs on cost of NEHP, GDP and financial expenditure are provided.2,Approach of implementing NEHPWe suggest that the implementing of NEHP should adopt a method of"strengthening the network, providing the health staff to fulfill their work, perfecting the health management mechanism". (1)Strengthening the network. First, this method can make full use of existing health resources; secondly, this can solve the problem of access. (2)Providing the health staff to fulfill their work. This is much practical and realistic than purchasing services as long as the health management mechanism is perfect. (3)Perfecting the health management mechanism. Some management mechanism must be made to avoid the problem of low efficiency.
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