| Objective : The study aimed to measure the cost of the community noncommunicable chronic disease(NCD)which manily included hypertension and type 2 diabetes management services based on the actual situation of Zhuhai,and further to provide base and reference for the fund input policy of the community NCD management services.Methods: A total of 19 community health service centers / township hospitals in Zhuhai were selected.The design of the survey scale is based on activity-based costing(ABC),referring to the national basic public health service specification(2016 Edition)as the standardized operation process.The survey included the average working time,the average implementation staff,the difficulty of the operation,the total service volume of each project in 2016,and the financial revenue & expenditure and the staffing status of all the primary health institutions in 2016.And on-site interviews were conducted for medical staffs who engaged in hypertension and type 2 diabetes management services and the managers of the national basic public health service project.The data was recorded by Epidata3.0 software and EXCEL2013.The difficulty coefficient of each service project were obtained by Analytic hierarchy process(AHP).SPSS23.0 and EXCEL2013 were used for statistical analysis and calculating the service cost.Results:(1)The total cost of the NCD management service of 19 primary health institutions in Zhuhai was estimated to be about 19.29 million RMB,among which the labor cost was 16.58 million RMB which was the maximum ratio 85.96%,the cost of the reagent consumption was 0.95 million RMB which accounting for 4.91%,the operation and management cost was 1.76 million RMB which accounting for 9.13%.(2)The cost of hypertension management service was about 14.00 million RMB,labor cost was about 12.24 million RMB,the cost of reagents consumables was about 0.69 million RMB,operation management cost was about 1.28 million RMB.The cost of management service of type 2 diabetes was about 5.30 million RMB,labor cost was about 4.56 million RMB,the cost of reagent consumption was about 0.26 million RMB,operation management was about 0.49 million RMB.(3)The per capita cost of whole population for NCD management was about 20.93 RMB per person,for hypertension management was about 15.18 RMB per person,for type 2 diabetes management was about 5.75 RMB per person.The management cost of hypertension patient was about 134.46 RMB per year,and the management cost of type 2 diabetes patient was about 162.12 RMB per year.(4)The total cost of the NCD management service accounted for 21.47% of the basic public health service projects,which was very close to the other research results.The cost of hypertension management accounted for 15.57%,and the management cost of type 2 diabetes accounted for 5.90%.(5)The staffs of primary health institutions generally believed that the management of NCD service has not been paied enough attention.The current compensation standards couldn't accurately reflect the cost consumption of NCD management,and the performance assessment was not conducive to the effectively development of chronic disease management services.Conclusions:(1)The financial compensation for chronic disease management services in Zhuhai city was low,and the total cost of labor was the highest in all costs.(2)The existing compensation policy didn't take into account the additional consumption of NCD management services,and there was a certain gap with the actual cost;the financing channels for the chronic disease management services were single and the financing sources were few,which aggravated the shortage of funds.(3)Due to the lack of funds and performance assessment,the actual cost of NCD management couldn't be reflected in an actual way,and the importance of the organizations to the management of NCD management need to be improved,and the concept of prevention should not be truly implemented.(4)There were no scientific standard for the allocation of funds for the management of NCD,which reduces the quality of chronic disease management.Suggestions: First,the government should take the main responsibility for improving the management of NCD,improving the financial compensation standard and increasing the sources of financing.Second,to support the cost calculation of NCD management services which should highlight the characteristics of non-clinical cost consumption in all areas,to ensure that the cost input is evidence-based.Third lay down a system of the use of NCD management service funds,and optimize the performance evaluation of funds and improve the economic and social benefits of cost input.Last,enhance the quality of staffs,and implement the concept of prevention and promote the quality development of NCD management services.Innovation: The activity-based costing method refines the cost allocation to each operation process,which was especially suitable for measuring the cost of NCD.The traditional cost estimates neglect the unnecessary consumption of non clinical aspects in the management of chronic diseases.Based on the activity-based costing method,introducing difficulty coefficient which not only takes into account the regular work time,the cost consumption of the staff members,but also the service object,can fully reflect the extra consumption of NCD management in non-clinical aspects. |
PDF Full Text Request