| BackgroundAs a basic and long-lasting policy of public health,establishing the national basic public health service program is a big decision of the Central Committee and the State Department to care for and benefit people.It's an important part of the new healthcare reform to ensure basic services,and also a key move to strengthen the grass-roots through constructing mechanism.Shandong provincial government has attached great importance to the work to bear its responsibility of ensuring livelihood and promoting fairness after the national basic public health service program was put into practice in 2009,which has been continuously promoting the health level and health literacy status of the urban and rural population.This program also embodied public welfare nature of the medical and health services.Per allowance of the basic public health service program increased from 15 RMB in early 2009 to 50 RMB in 2017,and service contents also expanded from 9 categories 22 items to 12 categories 49 items.The government supported the basic public health service program mainly by financial assistance which largely depended on the workload of the program.Scientific and reasonable estimation on the cost of the program is the basis of performing public health service and perfecting compensation mechanism,it also has great significance for stable development of the program.This research used the survey data of Shandong Health Care Commission in 2017 to estimate cost of basic public health service program in community health center and township health center to provide policy basis for further standardizing fund investment of the program.Furthermore,Shandong province explored country doctor contracting service in rural areas and family doctor contracting service in urban areas.By the end of 2016,contracted physician engaged in basic public health services aggregated more than 40 million,contracted service completely covered all the county(municipal or district)units.Cost estimation of basic public health service will not only promote and implement the program but also lay foundation to fully promote and upgrade cost estimation and standards establishment of family physician contracted servicesObjectTo better promote the implementation of the program.6 administrative cities in Shandong province were investigated for a comprehensive and in-depth understanding of the completion,allocation and usage of fund and cost of basic public health service in 2016.Results of the investigation could provide reasonable subsidy standard for service and family doctor program.In addition,more effective estimation methods for basic public health service cost were explored by comparing results of two different estimation methodsData and MethodsStratified sampling was used to select 6 prefecture-level cities in the eastern,central and western regions,including Qingdao and Weifang from the eastern region.Zibo and Tai'an from the central region,Liaocheng and Heze from the western region.In each prefecture-level city,1 county and 1 municipal district which ranked well on the 2016 basic public health service program list were selected.A total of 72 primary health institutions were collected,including 6 township health centers from each county and 6 community health centers from each municipal district.Basic contents of the public health service program in 2016 was ascertained by referring to the national basic public health service specification(third edition).Data of the 72 selected primary health institutions were collected by questionnaire survey based on interviews.Person hour and equivalent value of the basic public health service program in different regions of Shandong were ascertained on the basis of standard outpatient service(standard service equivalent).Standard cost method and equivalence method which was also adopted by the national basic public health service program were both used to estimate the cost.Besides,correlation of the results were analyzed by Pearson correlation method.Results1.There were 13 categories and 48 items of services involved in this study.The study selected 12 institutions in each city,with a total of 72 primary health institutions in 6 regions investigated,including 32 community health centers and 40 township health centers.The average service area of the institutions was 47.62 square kilometers,with an average construction area of 5598.61 square meters and anaverage house area of 718.63 square meters.There were a total of 3996 enlisted personnel and the actual number of persons on duty was.The total household registered population was 3463232 and resident population was 3722027.In 2016,total expenditure of the 72 health institutions was 507931126 RMB,including 270059224 RMB for public health service.2.Equivalent value of basic public health services of the investigated institutions were ascertained on basis of human hours per standard service equivalent.Results showed that total basic public service equivalent value of the 72 institutions was 16404123.37,including 8869184.53 in the rural regions and 7534938.84 in the urban regions.Average service quantity in urban regions was 235466.84 compared to 221729.61 in rural regions,among the 13 service items,patients with high blood pressure enjoyed the biggest service equivalent values,and patients with tuberculosis enjoyed the smallest service equivalent values.In this study,total standard service equivalent value was 5875210.01 for the eastern regions,2683156.24 for the central regions and 7845757.12 for the western regions of Shandong province.3.Cost for one equivalent value of the basic public health service was 16.46 which was calculated according to expenditure and total equivalent values of the basic public service.Cost of each item was based on equivalent values and cost of one equivalent value.Cost of health education was the highest,while cost of health records management was the lowest.Cost of standard service equivalent in community health centers was higher than township health center,with the highest cost of standard service equivalent in central regions and the lowest in western regions.4.According to the equivalent method,cost of basic public health service per person in Shandong was 72.56 RMB.The number was 72.56 RMB in rural areas and 67.02 RMB in urban areas.Cost of basic public health service per person was 73.92 RMB in the eastern regions,83.74 RMB in the central regions and 65.97 in the western regions.5.Cost evaluation using the standard costing method showed that project cost per person was 66.44 RMB,77.61 RMB in rural areas which was a little higher than the urban areas(57.56 RMB).Project cost per person was 65.67 RMB in eastern regions,67.75 RMB in the central regions and 62.07 RMB in the western regions.6.According to the results,project cost per person of the equivalent method was higher than the result of the standard costing method.Results of equivalent method of the rural areas in the central and eastern part was higher than results of standard costing method,results of equivalent method of urban areas were higher than standard method in all parts.Correlation of the results was analyzed with Pearson correlation analysis,which showed a correlation coefficient of 0.706,indicating good correlation between results of the two methods.SuggestionsOur findings may have translational implication for the following:1.To evaluate the cost scientifically and raise the compensation standard properly.2.To establish an assessment mechanism for basic public health service.3.To strengthen the establishment of information systems for medical and health institutions4.To strengthen the technical ability for basic public health service. |
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