A model to estimate the cost of the National Essential Public Health Services Package in Beijing, China

Yin, Delu; Wong, Sabrina T.; Chen, Wei; Xin, Qianqian; Wang, Lihong; Cui, Mingming; Yin, Tao; Li, Ruili; Zheng, Xiaoguo; Yang, Huiming; Yu, Juanjuan; Chen, Bowen; Yang, Weizhong

doi:10.1186/s12913-015-0902-4

Cited by 25 publications

(34 citation statements)

References 2 publications

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“…The activity-based component was paid by the RBRVS. RV was used to quantify the NEPHSP, outpatient visits, and hospitalization bed days by comparing their workload with a standard clinic visit (Yin et al, 2015;Pu et al, 2019). To prevent over-consumption on the part of providers, as RBRVS is an activity-based payment, volume thresholds were introduced to limit spending increases according to service standards (OECD, 2016).…”

Section: Input-based Payments To Thcsmentioning

confidence: 99%

Realigning the provider payment system for primary health care: a pilot study in a rural county of Zhejiang Province, China

Huang²,

Wang

et al. 2020

Prim Health Care Res Dev

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Aim: This work aimed to evaluate a pre/post-reform pilot study from 2015 to 2018 in a rural county of Zhejiang Province, China to realign the provider payment system for primary health care (PHC). Methods: Data were extracted from the National Health Financial Annual Reports for the 21 township health centers (THCs) in Shengzhou County. An information system was designed for the reform. Differences among independent groups were assessed using Kruskal–Wallis H-test. Dunn’s post hoc test was used for multiple comparisons. Differences between paired groups were tested by Wilcoxon signed-rank test. Two-tailed P < 0.05 indicated statistical significance. Data were processed and analyzed using R 3.6.1 for Windows. Findings: First, payments to THCs shifted from a “soft budget” to a mixed system of line-item input-based and categorized output-based payments, accounting for 17.54% and 82.46%, respectively, of total revenue in 2017. Second, providers were more motivated to deliver services after the reform; total volumes increased by 27.80%, 19.22%, and 30.31% for inpatient visits, outpatient visits, and the National Essential Public Health Services Package (NEPHSP), respectively. Third, NEPHSP payments were shifted from capitation to resource-based relative value scale (RBRVS) payments, resulting in a change in the NEPHSP subsidy from 36.41 to 67.35 per capita among the 21 THCs in 2017. Fourth, incentive merit pay to primary health physicians accounted for 38.40% of total salary, and the average salary increased by 32.74%, with a 32.45% increase in working intensity. A small proportion of penalties for unqualified products and pay-for-performance rewards were blended with the payments. The reform should be modified to motivate providers in remote areas. Conclusion: In the context of a profit-driven, hospital-centered system, add-on payments – including categorized output-based payments to THCs and incentive merit pay to primary care physicians (PCPs) – are probably worth pursuing to achieve more active and output/outcome-based PHC in China.

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Section: Input-based Payments To Thcsmentioning

confidence: 99%

Realigning the provider payment system for primary health care: a pilot study in a rural county of Zhejiang Province, China

Huang²,

Wang

et al. 2020

Prim Health Care Res Dev

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“…Province and municipality level governments can further supplement the funding level according to the content of their local basic public health service packages, cost of services and local financial capacity, which has helped to expand services in the package for many areas. For example, a study suggested that the cost of the package in Beijing was 50 RMB (7.95 USD) per capita in 2010 based on survey in 17 sample centers and model estimation [31].…”

Section: Establishment Of Minimum Funding Level With Progressive Gradmentioning

confidence: 99%

Financing strategies to improve essential public health equalization and its effects in China

Sun

Wen

et al. 2016

Int J Equity Health

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BackgroundIn 2009, China launched a health reform to promote the equalization of national essential public health services package (NEPHSP). The present study aimed to describe the financing strategies and mechanisms to improve access to public health for all, identify the strengths and weaknesses of the different approaches, and showed evidence on equity improvement among different regions.MethodsWe reviewed the relevant literatures and identified 208 articles after screening and quality assessment and conducted six key informants’ interviews. Secondary data on national and local government health expenditures, NEPHSP coverage and health indicators in 2003–2014 were collected, descriptive and equity analyses were used.ResultsBefore 2009, the government subsidy to primary care institutions (PCIs) were mainly used for basic construction and a small part of personnel expenses. Since 2009, the new funds for NEPHSP have significantly expanded service coverage and population coverage. These funds have been allocated by central, provincial, municipal and county governments at different proportions in China’s tax distribution system. Due to the fiscal transfer payment, the Central Government allocated more subsides to less-developed western regions and all the funds were managed in a specific account. Several types of payment methods have been adopted including capitation, pay for performance (P4P), pay for service items, global budget and public health voucher, to address issues from both the supply and demand sides. The equalization of NEPHSP did well through the establishment of health records, systematic care of children and maternal women, etc. Our data showed that the gap between the eastern, central and western regions narrowed. However the coverage for migrants was still low and performance was needed improving in effectiveness of managing patients with chronic diseases.ConclusionsThe delivery of essential public health services was highly influenced by public fiscal policy, and the implementation of health reform since 2009 has led the public health development towards the right direction. However China still needs to increase the fiscal investments to expand service coverage as well as promote the quality of public health services and equality among regions. Independent scientific monitoring and evaluation are also needed.

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“…This method has been used to estimate the cost of the National Essential Public Health Services Package in Beijing, China [30]. …”

Section: Methodsmentioning

confidence: 99%

An economic-research-based approach to calculate community health-staffing requirements in Xicheng District, Beijing

Yin

Yang

et al. 2016

Hum Resour Health

Self Cite

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BackgroundA shortage of community health professionals has been a crucial issue hindering the development of CHS. Various methods have been established to calculate health workforce requirements. This study aimed to use an economic-research-based approach to calculate the number of community health professionals required to provide community health services in the Xicheng District of Beijing and then assess current staffing levels against this ideal.MethodsUsing questionnaires, we collected relevant data from 14 community health centers in the Xicheng District, including resident population, number of different health services provided, and service volumes. Through 36 interviews with family doctors, nurses, and public health workers, and six focus groups, we were able to calculate the person-time (equivalent value) required for each community health service. Field observations were conducted to verify the duration.ResultsIn the 14 community health centers in Xicheng District, 1752 health workers were found in our four categories, serving a population of 1.278 million. Total demand for the community health service outstripped supply for doctors, nurses, and public health workers, but not other professionals. The method suggested that to properly serve the study population an additional 64 family doctors, 40 nurses, and 753 public health workers would be required.ConclusionsOur calculations indicate that significant numbers of new health professionals are required to deliver community health services. We established time standards in minutes (equivalent value) for each community health service activity, which could be applied elsewhere in China by government planners and civil society advocates.

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A model to estimate the cost of the National Essential Public Health Services Package in Beijing, China

Cited by 25 publications

References 2 publications

Realigning the provider payment system for primary health care: a pilot study in a rural county of Zhejiang Province, China

Realigning the provider payment system for primary health care: a pilot study in a rural county of Zhejiang Province, China

Financing strategies to improve essential public health equalization and its effects in China

An economic-research-based approach to calculate community health-staffing requirements in Xicheng District, Beijing

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