| Objective:This study estimates total expenditure on health (TEH) by provider of Shandong province over 1998 to 2009, macroscopically evaluates Shandong's TEH distribution and utilization by different sectors, by different fields and by different providers at different level. Taking health providers in health sector for example, analyze their economic operation, service delivery and utilization, for deeply understanding operational effect and service delivery capacity and utilization efficiency of all kinds of providers, then to analyze and evaluate health resource use efficiency in medical service provides. This study identifies the exiting problems and makes suggestions on policy improvement, provides policy-making and management evidence for related government sector, as well as proposes policy suggestion for deepening health care reform.Method:According to the study objective and technical roadmap, this paper using literarily interviews to overview "Annual Financial Health of Shandong Province" and "Health Statistics Yearbook of Shandong" and "Shandong Statistical Yearbook" and other data to measure Shandong TEH by provider over 1998 to 2009. Also, with the data of "Annual Financial Health of Shandong Province", it collects indicators on facility's operation, service delivery amount, and government input, etc., and uses Excel, SPSS 13.0 software to make estimation.Main Results:1 This paper objectively reflects the distribution of Shandong TEH by provider over 1998 to 2009 and its trend.1.1 During 1998 to 2009, Shandong TEH by provider and per capita TEH increased year by year, their average annual growth rate respectively being 12.39% and14.43%. However, TEH as the share of GDP ranged from 2.79% to 3.44% in Shandong, and there was a big gap compared to the requirement proposed by WHO that TEH as the share of GDP is no more less than 5%.1.2 During 1998 to 2009, about 80% of TEH went to hospitals in Shandong, while only 8% went to public health facilities. Among the total hospital expenditure, 70% went to city hospitals, and the residual 30% to other hospitals. TEH distributing to town-ship hospital showed a decreasing trend, while TEH going to community health facilities reflected a rising trend since establishment. The total public provider expenditure, around 55%, the biggest, went to other public health facilities (including Food and Drug Administration, family planning facility, blood bank and health administration, etc.); 30% went to disease prevention and control facility, and about 15% went to maternal and children care facility.1.3 As drug expenditure-controlling policies issue by health sector, drug expenditure as the share of TEH by provider declined slowly and in fluctuation, from 47.19% in 1998 down to 43.83% in 2009.2 Taking health-sector facilities for example, by comparing structure of income and expenditure and distribution of health enterprise fund of different kinds of providers, to deeply analyze the resource allocation of Shandong TEH by provider.2.1 From 1998 to 2009, in the total revenue of hospitals, finance subsidy amounted to ranging from 6% to 9%; around 97% was about medical expenditure and drug expenditure.2.2 From 2000 to 2009, average annual growth rate of total revenue and expenditure of Shandong Public health facilities was 14.48% and 13.79% specifically. In the total revenue, the growth rate of government budget fund was fastest, average annual growth rate was 19.42%; in the total expenditure,97% was about enterprise expenditure; carry-over capital expenditure and other expenditure took a small proportion and changed in a modest growth rate.2.3 From 1998 to 2009, both health enterprise expenditure (including traditional Chinese medicine enterprise expenditure) and per capita health enterprise expenditure show increasing trend year by year, but health enterprise expenditure as share of GDP, as share of TEH, and as share of fiscal expenditure all keep decreasing trend.3 Taking health-sector facilities for example, by comparing health service delivery, utilization and per capita expenditure of different kinds of providers, to deeply analyze medical seeking distribution and resource utilization efficiency.3.1 According to the order of outpatient service delivery amount by descending for all kinds of health providers of Shandong province, from the top to down, they are township hospital, city hospital, county hospital and community health service facility.3.2 In all types of hospitals of Shandong province, county hospital accounted for the biggest portion in terms of inpatient services delivery, the second was city hospital, and the third went to township hospital, community health service facility was the smallest one.3.3 In all types of hospitals of Shandong province, the biggest per staff outpatient workload went to township hospital, the next went to community health service facility, the third city hospital, and county hospital was the smallest one.3.4 In all types of hospitals of Shandong province, the biggest per staff inpatient service workload went to city hospital, the next went to county hospital, the third township hospital, and community health service facility was the smallest one.3.5 In all types of hospitals of Shandong province, order by bed utilization ratio, from top to down, it was city hospital, county hospital, township hospital and community health service center.3.6 In all types of hospitals of Shandong province, order by expenditure per outpatient visit, from top to down, it was city hospital, county hospital, community health service center and township hospital.3.7 In all types of hospitals of Shandong province, order by expenditure per inpatient, from top to down, it was city hospital, county hospital, community health service center and township hospital.Conclusion:In this study on TEH by provider of Shandong, it finds that TEH as share of GDP was low in Shandong, at the same time, the distribution by provider was unreasonable, and there is a problem about "focusing on treatment, underrating prevention", and public health facility sharing a little proportion of TEH is still unsolved. Drug revenue was still the important revenue source for hospitals, low reimbursement from government lead to public hospitals run for profit; the distribution of patient seeking medical service is unreasonable, inpatient bed per staff and hospital bed occupancy rate is low in grassroots hospitals. To resolve these issues, this paper proposes some improvement advices and feasible suggestions, such as establishing long-term health provider. |
PDF Full Text Request