Research On Estimating The Costs Of National Basic Public Health Services And Compensation Policy In Zhuhai

Objective: Since 2009,Chinese central government launched national basic public health service(BPHS).The development of various services has promoted the equalization of basic public services in China.However,there is no scientific compensation standard for service items in different regions.This study investigated the implementation of 13 items of BPHS and estimated the cost of BPHS in Zhuhai with standardized service processes referring to National Standard of BPHS Third Edition.We estimated the cost of BPHS carried out in Zhuhai and defined the compensation standard to provide reference for government to formulate relevant investment policies and determine the fund allocation criteria.Methods: A total of nineteen primary healthcare facilities(PHF)in Zhuhai were selected by multi-stage stratified sampling method.We conducted a questionnaire on 114 staffs working in BPHS and 19 financial personnel,and conducted semi-structured interviews with heads of PHF,public health departments and financial personnel.We used the method of literature research and expert interviews to determine the difficulty dimension,the analytic hierarchy process(AHP)to determine the weight of the difficulty dimension,the difficulty coefficient to adjust the annual working time of each sub-items,and the activity-based costing(ABC)to calculate the cost of BPHS.Yaahp 5.0 software was used to calculate the weight of difficulty dimension.SPSS 22.0 and Excel 2013 software were used to carry out descriptive statistical analysis of arithmetic mean and constituent ratio.Results:(1)In Zhuhai,19 primary healthcare facilities(PHF)cover 924,987 residents.A total of 1701 and 263 employees are engaged in BPHS,accounting for 15.46%.13 public PHF account for 68.43%,and 6 private PHF account for 31.57%.(2)The weights of the difficulty dimensions of BPHS in Zhuhai are follows: 35.04%(coordination of residents),24.03%(staff workload),21.36%(complexity of work-related skills)and 19.59%(basic qualities of staff).(3)Among the 13 BPHS in Zhuhai,Immunization(18.87%)and Management of hypertension(15.57%)accounted for the largest proportion of total working hours.However,Management of tuberculosis(0.57%),Reporting of infectious diseases and public health emergencies(0.9%)accounted for the smallest proportion of total working hours.(4)Handing out health educational materials has the minimum difficulty coefficient(1.00),and immunologic surveillance has the maximum difficulty coefficient(7.25)in 95 secondary sub-items.The average difficulty coefficient of sub-items is 5.28.(5)The per capita actual cost of BPHS in Zhuhai was 97.48 RMB of which the per capita human cost was 83.83 RMB per person,the per capita cost of consumables was 4.77 RMB per person,and the per capita operating cost was 8.89 RMB per person.(6)The service items with higher per capita cost include Immunization(18.39 RMB),Management of hypertension(15.18 RMB),Healthcare for children(<6 years old)(14.25 RMB),and Creation of health records(13.38 RMB).The items with lower per capita cost include Management of tuberculosis(0.56 RMB)and Reporting of infectious diseases and public health emergencies(0.88 RMB).(7)After deducting human cost of BPHS subsidized by Zhuhai government,the per capita cost was 71.02 RMB.(8)The results of semi-structured interviews show that: some service items need to go out.At present,there is a lack of incentives.The current funds of BPHS are difficult to meet the needs of high-quality services.Conclusions: BPHS in Zhuhai receives inadequate financial subsidy.After deducting human cost of BPHS subsidized by Zhuhai government,the per capita cost was 71.02 RMB and the government needs to increase by 16.02 RMB.The government lacks scientific standard for the use and allocation of funds,which makes it difficult to exert the value of capital investment and reduce the quality of services.Existing compensation policies did not take into account the "additional consume" in the human cost of BPHS.BPHS Lacks financing channels and personnel lack enthusiasm to carry out work.Innovation: In this study,the cost allocation of BPHS is refined into each process by ABC,which improves the accuracy of cost estimation.On the basis of ABC,the "difficulty coefficient" is introduced.We translated the factors such as "Coordination of Residents" and "Workload of staff" into quantitative data through difficulty coefficient,so that the cost of each items is more related to actual situation.