| Purpose:Women and children health condition is a core indicator for assessment of resident in any region, the improvement for women and children physical well-being impact national economical and social development positively. while the condition and quality of maternal and child health services serve as a fulcrum for women and children well-being. The financing scenario to relevant departments influence directly rendering of service for maternal and child health, and the accessibility and affordability of service in community. The establishment of full-blown financing mechanism for maternal and child health services is safeguard to adequate ,stable ,efficient and sustainable financing for maternal and child health services. So it is very important to understand financing, allocation, distribution and compensation for maternal and child health services at any given country and region.Methods:This expenditure calculation is steered by SHA of OECD and is based on campaign for maternal and child health services in Tianjin to categorize and adjust to scope for it. Firstly, a facilities investigate was carried out to identify maternal and child health services in medical institution at varying level in Tianjin. Secondly, to combine the functional category of maternal and child health services and SHA for OECD to determine ballpark for expense to this maternal and child health services. at last to ascertain which unit provides service programme measured by expenditure for this women and children health and to design benchmark system and questionarrie according to unit and service programme. After the categorization and adjustment, maternal and child health services provided by medical institutions in Tianjin fall into four types pregnant Prenatal care,children health care,family-planning service and other genital health service.Results:1,maternal and child health services financing in Tianjin Total expenditure on maternal and children health service (MCHS) was 88652.5 thousand yuan account for 10.21% of public health expenditure for entire city. Among which, government investment was 17013.2 thousand yuan,which accounting for 19.19% of total financing, social and out-of-pocket expenditure was 71639.3 thousand yuan taking up 80.81% of MCHS expenditure for entire city. Expenditure on MCHS per capita was 9.5 yuan in 2005.For expenditure on maternal and children health services in Tianjin family-planning service cost was 46257.2 thousand yuan,most of which was used for operation under family–planning programme,accounting for the half of MCHS expenditure for entire city. Expenditure on maternal service was 25017.3 thousand yuan accounting for 28.22% of the whole MCHS expenditure for the entire city. Expenditure on children health services was 9997.3 thousand yuan, accounting for 11.28% of MCHS expenditure for the entire city. Expenditure on other reproductive health service was 8350.6 thousand yuan accounting for 9.42% of the whole MCHS expenditure.In terms of health financing structure, government and individual run parallel in children health care financing, that government financing was 55.54%. However, government financing was weaker in other service.2,allocation of MCHS expenditure across different institutionsFor distribution of MCHS expenditure for maternal and children in Tianjin the following three institutions took biggest chunk of health cost: medical organization in community institution for maternal and children health care and local hospital in township. The percentage of total cost for maternal and children to these three organizations was arranged in order of 25.32%,23.30%,15.47%. This composition implied bigger role in maternal and children health service for three agencies. The rest maternal and children expenditure incured at medical institution above second class,county health institutions and family-planning programme institutionIn terms of specific service programme, popular check-up for women service charge belonged to family-planning programme agency , medical care institution at grassroot level and maternal and children health care institutions. The rest service was mainly provided by medical institution at grassroot level and maternal and children health care institution.3,maternal and child health services compensation3.1,maternal and child health services compensation in TianjinIn 2005 total revenue for health service to maternal and children in Tianjin was 88652.5 thousand yuan, the total cost for health service to maternal and children in same period was 74344.8 thousand yuan. The margin of difference between earning and expenditure was 14307.7 thousand yuan. For different service prenatal care and family-planning service were main sources of revenue, among which the gap for earning and expenditure was 5031.6 thousand yuan to prenatal care and the gap for earning and expenditure was 36761.7 thousand yuan. However, the gap for earning and expenditure to children health care and other genital health service was minus, among which the difference for earning and expenditure to children health care was -22458.6 thousand yuan and the expenditure was 3.25 times earning expenditure was 1.60 times earning in terms of other genital health service(mainly women check-up).In 2005 the government subsidy to maternal and children health care was 17013.2 thousand yuan, meanwhile the total cost for maternal and children health care was 74344.8 thousand yuan. Therefore, the difference between the former and latter was 57331.6 thousand yuan. Even comparing to the cost of medical personnel the gap between government compensation and expenditure on medical personnel for maternal and children service was 11358 thousand yuan. For other maternal and children medical service,government compensation was far behind expenditure for medical service.3.2,Compensation for different maternal and children health serviceIn terms of maternal and children health service in Tianjin,the gap between earning and expenditure for family-planning service and pre-natal check remained positive,and the balance was 36761.7 thousand yuan and 11292.8 thousand yuan respectively; the gap between earning and expenditure for prevention of infectious disease for baby was 247.5 thousand yuan; the cost for marital check-up was 155.6 thousand yuan. The surplus remained for these four kinds of serviceIn terms of compensation for maternal and children health care cost, the total cost for family-planning service was 8525.5 thousand yuan, meanwhile the government compensation was 4475.4 thousand yuan, which accounted for 59.49% of total expenditure. For the cost of pre-natal check, government compensation was 16.76%; the government compensation for prevention of infectious disease for baby and marital check-up were 0.61% and 23.02% of total expense respectively.Besides the afore-mentioned four service, the rest different maternal and children health care was in the black. The gap for children health were(including information collection ,health education and screening) was biggest, amounting to 10959.1 thousand yuan. Comparing to cost for health personnel to maternal and children service , government compensation for other different health service could not meet the cost for health personnel except the family-planning service. The gap for systematic management of children health care was biggest, amounting to 3918.6 thousand yuan, and the government compensation was only 41.16% of the cost for health personnel. The gap for prenatal check and other children health care were 2656.5 thousand yuan and 2670.9 thousand yuan respectively. Government compensation for other service was 40% -60% of the cost for health personnel. The overall government compensation was soft.Discusses:1,Government expenditure only accounted for 19.19% of MCHS in 2005, thus the MCHS financing heavily relied on market. Based on economic development, government at different level increased their input on MCHS. However, the demand of maternal and child health is increasing and the scope of MSHS is enlarging. Financing policy for MCHS should be adjusted according to the changing market demand.2,According to fund allocation, 50% of MCHS expenditure are used for family planning services, and 25.25% are used for pre-natal examination. Expenditure on health data statistics, health education, pregnant physical examination only accounted for 1.6% of MCHS expenditure. There are obvious problem in MCHS expenditure allocation and usage. The lack of finance for pure public health services largely affects the provision of such public services.3,The traditional subsidizing mode is to directly appropriate subsidy to provider, and the relation between input and work performance is weak. Such subsidizing mode is bad for accomplishment of government policy objectives. The new type of subsidizing mode should be developed to improve the efficiency of fund usage, based on identify the public health items and input stand serving as standard for government subsidy. 18 public health services project, which was implemented in 2007 is a good pilot about this issue.4,The findings indicated that the medical institutions also provided plenty of maternal and child health services, especially the health institutes at grassroot level play a vital role in services with strong public feature. The health bureau should accelerate the coordination between medical institution and maternal and child institutions, so as to improve MCHS performance through the establishment of comprehensive services provision system. The rational compensation mechanism of MCHS costs of medical institutions should be set up, otherwise the enthusiasm of medical institution for MCHS will be undermined.
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