Study On The Financing And Cost Accounting Of Community Prevention And Control Of Noncommunicable Chronic Disease

[Background]In recent years,prevention and control of noncommunicable chronic diseases(NCDs) has developed substantially in order to impair the prevalence of NCDs.Health Bureau of Shanghai set down a middle-long term strategic framework of preventing and controling of NCDs(2001-2015) in 2000,and then required Community Health care service(CHS)joined in action on preventing and controling of NCDs.Through five years hard working,a integrated systerm and service standards have been established.In 2005,the Songjiang District started "three prong approach" reform,government increased investment for public health care service which promoted the development of community prevention and control of NCDs(CPCNCDs).However,reimbursement evidence is not explicit enough and necessary information is deficient to assess input-output and efficiency of financial investment.It is these problems that are key factors which limiting the sustaining development of community prevention and control of NCDs.[Objectives]This paper estimates expenditure of CPCNCDs in 2008-2012 in the basis of cost accounting research on all the services it provides,then gives suggestion on financing and reimbursement policy as well as provides scientific evidence for establishing a sustaining financing systerm and make specific reimbursement policy.[Methods]This research selected four CHSs by economic condition as investigation fields in Songjiang District,Shanghai City.We interviewed experts to find out content of CPCNCD,reviewed financial statements and other relevant records to gain operation cost and service provision in 2006,then calculated average cost of each item and predicted future financing grasswith estimation of population trend and human resource cost in 2008-2012.Cost accounting method used in this paper is a little different from previous researches.Traditional method follows the way of medical service cost accounting,it compute service cost under the frme of medical section providing service directly. Howerer,the services of CPCNCDs are provided by more than one medical section. This paper has considered this condition,and used section contributing rate method to calculate service cost.[Results]1.Provision of community public health care services of NCDsPublic health care services provied by CHS in Songjiang District accord with local prevlence of NCDs.At present,eight diseases have priority,these are hypertension,diabetes,colorectal Cancer,chronic bronchitis,chronic obstructive pulmonary deseases and breast cancer.Moreover,some CHS may provide special programmes in terms of their function.There is little difference among CHS in provision efficency,but provision volume is not consistent with population size.In 2006,population of Yueyang Community,Jiuting Town,Sheshan Town and Maogang Town were 83,000,24,8000, 34,100 and 39,400 respectivly.Toal time occupied by per 10000 residents were 692days,776days,715days and 1217days respectivly.Research indicates that large population size didn't bring more provision in investigated CHS.2.Cost of community public health care services of NCDsCost accounting shows that most of services costs less than 20 yuan,different CHS has little difference on each service cost.By proportion,human resources cost most while materials cost lowest.Fifty-four percents out of twenty-six services cost less than 10yuan,and near eighty percents services cost less than 20 yuan.By service, health education service of NCDs cost lowest while doctor training service cost most. Among eighteen items of disease management,self examination of Cardio-Cerebral-Vascular Disease and high risk population screen of liver cancer cost much more than oter items,while information management cost lower.3.Financing of community public health care services of NCDs Financing research shows that actual expenditure of community public health care services of NCDs in Songjiang District is less than financial investment in 2006. Accounding to estimation,financial investment on communicy public health care services of NCDs was 84,000 yuan per 10,000 population in 2006,which is 12000 yuan more than requirement per 10,000 population caculated by actual provision, 4,000 yuan more than requirement per 10,000 population caculated by standard provision and 2,000 yuan more than requirenment per 10,000 population caculated by optimized provision.This estimation would be lower than actual requirement for the needs of community public health care service of NCDs increase as a result of improvement on community public health care service provision.[Suggestion]As to finance level,Songjiang District is absolutely capable of affording expendicture for community public health care service of NCDs.Therefor,optimize resource allocation and improve expenditure management to advance effiency of financing investment are key points at present.1.Improve public health care service of NCDs and increase financial investment efficiency.This research advises that six measures should be taken to improve public health care service of NCDs and increase financing investment effiency.Firstly,ameliorate assessment on financing investment performance.Quantity,quanlity,human resource, and suffer's satisfaction shoud be covered in the assessing system in order to reflect service provision completely.Secondly,develop new interventions to contral high risk factors such as smoking control,drinking limit,hepititis B prevention,taking exercise, psychological health,proper nutrition and so on.Thirdly,set up a dynamic evaluating systerm to assess cost-effective of service provision and renew effective information timely to reflect the change of population health conditon.Fourthly,encourage CHS to undertake research to improve innovation on public health care service of NCDs. Fifthly,enhance cost control to avoid resource waste.Lastly,motivation mechanism needs to be improved to promote provision effiency.2.Improve supervision of public health care service fund and use financing investment reasonably.This research advises to implement whole range budget management to use financial investment reasonably,legally and effectively.Firstly,health administration should set down financial criterion to avoid capital abusing.Secondly,CHS should make budget more detailed and list working objective.Thirdly,financial department should enforce supervision and react quickly once illegal action happens.Lastly, post-assessment should be carried out to examine whether aims are achieved or not. Assessment report would be used as reference for the next year financial investment.3.Improve service provision for floating population on NCDs prevenion to increase equity of publich health care service.Although floating population are younger than local residents,they are also the target of risk factors.This research advises to increase financing investment on NCDs prevention for floating population,develop workshop health education and screening on NCDs.Three measures should be taken as following.Firstly,set up data base on floating population to gain their condition.Secondly,improve working method to fit the characteristic of floating population.Health workers could go to factories, building sites and other places floating population settlement to provide preventive services.Thirdly,sign health care service contract with employers who hire floating people.Employers pay a certain amount of money to CHS,then their employees can accept public health care service.4.Solve financing problem of community public health care service on NCDs for floating population.At present,Financial investment for public healh care service in Shanghai are caculated according to the number of local residents,which exclude floating population.However,sufficient investmen bring to sufficient provision.Financial investment should cover public health service expenditure on NCDs for floating population to improve provision and equity.