Comparative Study On The Health System Between Yunnan Province And Cambodia

Objectives By comparing the health systems of Yunnan Province,China and Cambodia,this paper identifies the similarities and differences,and finds out the strengths and weaknesses of the two health systems,so as to provides the basis for the two to learn from each other,and to put forward suggestions for improving the two health systems aiming at promoting population health and the development of health systems at the two settings.Method Based on the conceptual framework of health system defined the World Health Organization(WHO),we conducted existing data collection and analysis and informant interviews to study and compare the four components of the two health systems,namely leadership/organization and governance.balth financing,health human resources,health service provision as well as health outcomes.we also used trend extrapolation prediction method and One Health Tool to predict whether Yunnan Province and Cambodia can achieve health targets listed in Sustainable Development Goals(SDGs)and to estimate the cost of health system operation needed to achieve those health targets.Results In general,the social and economic conditions of Yunnan Province are better than that of Cambodia.In terms of leadership/organization and governance of the health system,the Ministry of Health(MOH)of Cambodia is authorized by the Royal Government of Cambodia(RGC)to take full charge of and manage the health affairs of the whole country whereas the provincial,municipal and county health committees of Yunnan Province are responsible for the health administration within their respective administrative areas under the leadership of the people's governments at the same level.In terms of health financing,Yunnan's government health expenditure accounts for the largest proportion of total health expenditure while Cambodia's out of pocket(OOP)accounts for the largest proportion,reaching more than 60%of the total;in 2015,Yunnan's per capita health expenditure was 2396 Yuan,which is much greater than 69 US dollars(about 483 yuan)of Cambodia;the per capita health expenditure in urban areas is higher than that in rural areas in both Yunnan and Cambodia;the social health security system in Yunnan Province has been well established with the basic medical insurance covering over 95%of the population in 2015,however,the social health security system in Cambodia is in its infancy.Health insurance plans such as Health Equity Funds(HEF),Community-based Health Insurance(CBHI)and Reproductive Health Voucher Plan in Cambodia,which mainly rely on the cooperation of the government,donors and non-go vermental organizations,provide health care service and financial risk protection to limited population.The coverage rate of all the above-mentioned health insurance plans in 2016 was only 23%.Regarding health human resources,the number of beds,health care professionals,registered nurses,practicing(assistant)doctors;,practicing doctors and general practitioners per 1,000 people in Yunnan in 2017 was 5.72,5.91,2.7,2,1.6 and 1.09,respectively and the ratio of doctors to nurses was 1:0.8.In Cambodia,the only data available on the number of health care workers working in public health sector was published in 2011:0.72 beds per 1,000,0.383 registered/professional nurses per 1,000,0.057 physician assistants/Health officers per 1,000,0.025 specialist medical practitioners per 1,000,and 0.152 general medical practitioners per 1,000 population and the ratio of doctors to nurses was 1:3.47.In Cambodia,at least 56%of health workers working in public health sector also work part-timely in private sector.the density of health workers in urban areas is much higher than that in rural areas and the proportion of women is higher than that of men in both Yunnan and Cambodia.Regarding health service provision,both Yunnan and Cambodia have a mixed health care service system of public and private institutions.Yunnan Province is superior to Cambodia in preventive service,curative service and drug supply.In 2014,the antenatal care coverage rate,institutional delivery rate and postnatal visit coverage rate in Yunnan Province reached 98.5%,98.9%and 97.8%respectively,while the same indicators in Cambodia were 95%.83.2%and 90.3%respectively in the same year;in 2013,the immunization rate of children in Yunnan Province was 94%,and that in Cambodia in 2014 was 73.4%.In 2013,the proportion of the patients who should have seen a doctor but not in Yunnan Province was 51.2%while the same indicator in Cambodia was 92.9%in 2014and 14.7%of the patients who could not see a doctor were due to economic difficulties,which is twice as many as in Yunnan Province.Yunnan Province has medicines covered by medical insurance and increasingly expanded the coverage scope of drug reimbursement catalogue while Cambodia's drug supply is concerned with fake or unqualified drugs.The health outcomes affected by the two different health systems are also very different in Yunnan and Cambodia.The average life expectancy,maternal and child health,infectious diseases and other health indicators in Yunnan Province are better than those in Cambodia,but the obesity of children and adults and the smoking rate of minors are higher than that in Cambodia.The projection shows that Yunnan Province can achieve the SDGs target of maternal mortality ratio,but has difficulties to achieve other targets including infant mortality ratio,under-five children mortality ratio,premature mortality due to non-communicable diseases,and the number of deaths and injuries caused by traffic accidents.It has been projected that Cambodia would not be able to achieve most SDGs health targets except for neonatal mortality ratio.The cost calculation by using One Health Tool shows that the actual health expenditure in Yunnan and Cambodia are less than the cost projected for achieving the health targets in SDGs.It is predicted that in 2020,both of Yunnan and Cambodia will focus on the prevention and treatment of chronic diseases,so the both can learn from each other on measures and experience.Conclusion Both Yunnan province and Cambodia have problems in health system such as insufficient medical and health investment,emphasis on treatment rather than prevention,lacking of health human resources in remote rural areas and weak development.In addition,Cambodia's health system has additional weakness including insufficient coverage of social health security system and inadequate drug supply and administration.Yunnan and Cambodia can cooperate with each other in the prevention and control of infectious diseases,health workers' education and training,and the trade of medical suppliers.Yunnan Province has successful experience in the establishment and improvement of social health security system,health poverty alleviation,prevention and control of infectious diseases,which Cambodia may learn from.