The Study On Economic Evaluation Of Essential Public Health Services In Ningxia

Background: In recent years, our government investment lack of based budget for a long time in essential public health service. Compensation is not reasonable and there is no guarantee, so that the essential public health function is difficult to give full play.Unreasonable allocation of health resources and applications led to excessive growth of medical costs to a certain extent, how should we measure the cost of essential public health services in a reasonable manner, how to analyze the various services for input and output by the economic approach. It plays an important role that from the perspective of economics analysis services at the lowest cost to achieve the best effect on the current.Objectives: This study chooses the representative essential medical and health service institutions in Ningxia rural areas. On the basis of cost accounting of health economic theory and in combination with the practical situation of essential medical and health service institutions in Ningxia, measure the essential public health service costs that are promoted in sample institutions and according to the different characteristics of the project, cost- effect analysis method is used to analyse and evaluate economics, provide economic basis for the government to establish a scientific and reasonable investment and compensation mechanism.Methods: The study adopts the typical sampling method to select Ningxia in theMidwest of China as the sample, and then adopts the stratified sampling method bothaccording to the level of economic development of high, medium and low to chooseQingtongxia city, Tongxin county and Pengyang county as three sample counties, thenextract three village clinics in each county, sum to nine village clinics as the samples.Qualitative analysis: Adopt literature review analysis and descriptive analysis, analyse the practical situation of essential medical and health service institutions in Ningxia. Depth interviews and descriptive analysis methods are used to clear up the related data statistics that contained the cost and the effect of essential public health service in the sample area. Descriptive analysis is used to find the more reasonable and effective compensation policy of funding. Quantitative analysis: Field investigations, economics principle and method are used to measure the cost of the essential public health services project. Cost-effectiveness analysis method is used to the evaluation and analysis of health economic.Results:1. Basic conditions of institutions: The institutions' service population and service area coverage have a little change; the sources of funds in village clinics are given priority to the government investment in combination with the paid services.The gap of the medical proportion between the sample institutions is larger, staff education is given priority to the college degree and the following degrees, college education accounted for the highest, the title is given priority to the primary, staff is given priority to the permanent staffs, the annual average wage gap between the permanent staffs and unauthorized personnels is 1.95 times. There existed differences on the level of income between the permanent staffs and unauthorized personnels in different institutions.2. Finance conditions of institutions: the average year-on-year growth speed is 9.74% in 2012-2013, and the average year-on-year growth speed is 11.17% in 2013-2014. The overall growth speed fluctuation is hardly. In 2012-2014, nine samples of institutions except one institution are based on the business income as the main source; the remaining eight institutions are based on the fiscal and superior benefits income as the main source, the average proportion is more than 60%. In 2012-2013, the total year-on-year growth of 9.97% on average, in 2013-2014, the total average year-on-year growth is 8.75%, the overall growth speed slowed. Growth trend of the total revenue and expenditure is almost the same and total expenditure growth speed slightly higher than the income growth speed. It kept balance basically. The sample institutions are based on the health care expenditure as the main expenditure, more than 85% of the average accounted, followed by the fiscal subsidy spending infrastructure equipment. 78% of the sample institutions can achieve basic balance of payments or a slight surplus on average.3.The cost of essential public health services project: The actual cost of essential public health services is 35.72 yuan per capita in2012, the standard cost of essential public health services is 31.22 yuan per capita. The actual cost of essential public health services is 42.38 yuan per capita in 2013, the standard cost of the basic public health services is 37.82 yuan per capita.The actual cost of essential public health services is 48.58 yuan per capita in 2014, the standard cost of essential public health services is 45.06 yuan per capita. Labor expenditure is the main cost of the consumption, accounted for more than 60% on average. The second main cost is the depreciation of fixed assets repair rental expenditure, accounted for more than 14% on average. The third main cost is business expenditure, accounted for about 8% on average.4. Implementation effectiveness: There are seven projects contain the residents health records management, vaccination, immunization, maternal health management,the elderly health management, and infectious diseases and public health emergency report and processing, assistance service health supervision and the traditional Chinese and Hui medicine services intervention effect showed a trend of increasing year by year and the effectiveness is better. There are five projects contain the 0 to 6 years old children health management, high blood pressure patients health management, type?diabetes patients health management and health management for patients with severe mental illness intervention effect is increasing year by year, but the increasing range is not obviously, the effectiveness changed better but not clearly.5. Cost-effectiveness: There are three projects contain the vaccination, infectious diseases and public health emergency report and treatment and health supervision and management assistance services cost effectiveness each get one unit effectiveness need to input cost in reducing year by year, per capita cost effectiveness is better. There are four projects contain the health education, maternal health management, health management for patients with high blood pressure, type ?diabetes health management and so on cost effectiveness each get 1 unit effectiveness need to input per capita cost to increase, but of a smaller cost increase cost not achieve ideal effect. There are five projects contain the residents health records management, 0 to 6 years old children health management, the elderly health management, the traditional Chinese and Hui medicine services and the health management for patients with severe mental illness and so on, effectiveness each get 1 unit effectiveness need to input per capita cost to increase year by year, the cost increase larger, the cost effective is poorer.Suggestions:1. The government should be appropriate to increase the compensation standard of basic public health services and control the actual costs strictly. The projects of low-input high-effectiveness in infectious diseases and public health emergency report and treatment and health supervision and management assistance services should be given preferential policies. However, the projects of the high-input low-effectiveness in resident health records management, 0 to 6 years old children health management, the elderly health management should be adjusted appropriately.2. The government plays a leading role, setting clear and feasible investment spending plan, supervises and manages the essential public health funds compensation transfer strictly, improve the internal financial management system, controls the agency cost expenditure budget strictly, make the special fund is special. Government should configurate limited health resources efficiently in the most rational.3. Broaden the channels of the essential public health funds, establish diversified financing mechanism.4. Strengthen basic information management, establish a unified basic public health services management information platform, promote resource sharing, and avoid the waste of resources.5. Improve the service quality evaluation and management system of the project, improve the quality of service.