Evaluation of health resource utilization efficiency in community health centers of Jiangsu Province, China

Zhou

et al. 2020

Preprint

Self Cite

Background Despite the overwhelming feeling of great happiness, joyful excitement and rituals that heralds the arrival of a child, for too many women (especially in developing countries), child bearing is associated with suffering, ill health and even death. The need to consolidate and support women to procreate in tranquillity has inspired international and domestic agencies to harness the resources at their disposal to protect the health of women especially during pregnancy, child birth and the post-partum period. Methods The study applied a systems dynamic model to selected data to establish the influence of the universal two-child policy in China on maternity insurance fund income. The study also established sensitivity analysis of the appropriate rate of contribution to keep the fund active. Results The study revealed that increases in utilisation rate as results of increase in number of births under the universal two-child policy increased the accumulated deficit of the maternity insurance fund income in the Ningxia-Hui Autonomous Region. At the current rate, the entire fund will be depleted by the end of 2021 unless the contribution rate is increased from 0.5% to 0.75%. Conclusions Maternal health is a “sentinel event” requiring an unprecedented global resource mobilisation to safeguard the future of humanity. Thus maternity insurance schemes in China require new methods of fund raising to keep a sustainable maternity insurance fund in the region. Study also reveals that population reform is not done in isolation but require changes in the fundamental social structures to ensure its sustainability.

Section: Discussionsupporting

confidence: 91%

Bolstering Maternity Insurance to Support Family Health of Ethnic-Minority Women under Universal Two-Child Policy: Empirical Evidence from China’s Ningxia-Hui Autonomous Region

Zhou

et al. 2020

Preprint

Self Cite

“…In Shanghai and other regions in China, CHC revenue and expenditure are separate, meaning that CHCs obtain all their subsidies from financial investment. The amount of governmental investment is set by the amount of service provided by the CHC in the previous year [31]. As such, CHC development is largely dependent on regional subsidies and the state of surrounding competitive health institutions.…”

Section: Discussionmentioning

confidence: 99%

The quality of primary care in community health centers: comparison among urban, suburban and rural users in Shanghai, China

et al. 2020

Objective: Following World Health Organization's initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions. Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience. Findings: A total of 2404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß = 1.57, P < 0.001) compared with those from urban CHCs. Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).

“…A correlation matrix was then extracted to identify and eliminate multicollinearity amongst the variables to help us construct a shortlist of the essential and representative variables. Finally, regression analysis was conducted to identify those inputs with high capability in explaining the variations in the selected outputs [30]. A coefficient of determination value of over 0.5 was considered a benchmark to select the final input and output variables.…”

Section: Input and Output Variablesmentioning

confidence: 99%

Efficiency of health resource utilisation in primary-level maternal and child health hospitals in Shanxi Province, China: a bootstrapping data envelopment analysis and truncated regression approach

Zhang

Lü

Tao

2020

BMC Health Serv Res

Background: District-and county-level maternal and child health hospitals (MCHHs) are positioned to provide primary maternal and child healthcare in rural and urban areas of China. Their efficiencies and productivity largely affect the equity and accessibility of maternal and child health care. This study aimed to assess the efficiency of district-and county-level MCHHs in China and identify their associated factors. Methods: Thirty-three district-and 84 county-level MCHHs were selected from Shanxi Province in 2017. At the first stage, bootstrapping data envelopment analysis (DEA) models were established to calculate the technical efficiency (TE), pure technical efficiency (PTE) and scale efficiency (SE) of district-and county-level hospitals. At the second stage, the estimated efficiency scores were regressed against external and internal hospital environmental factors by using bootstrap truncated regression to identify their determinants. Results: The average TE, PTE and SE scores for district-level MCHHs were 0.7433, 0.8633 and 0.9335, respectively. All hospitals were found to be weakly efficient, although more than 50% of the hospitals performed with efficient SE (SE scores≥100%). As for county-level MCHHs, their average TE, PTE and SE scores were 0.5483, 0.6081 and 0.9329, respectively. The hospitals with TE and PTE scores less than 0.7 accounted for more than 60%, and no hospital was observed to operate effectively. Truncated regressions suggested that the proportion of health professionals, including doctors, nurses, pharmacists, inspection technician and image technician (district level: β = 0.57, 95% CI = 0.30-0.85; county level: β = 0.33, 95% CI = 0.15-0.52), and the number of health workers who received job training (district level: β = 0.67, 95% CI = 0.26-1.08; county level: β = 0.34, 95% CI = 0.14-0.54) had a positive association with efficiency scores. The amount of financial subsidy (β = 0.07, 95% CI = 0.05-0.09) was found to be directly proportional to the productive efficiency of the county-level MCHHs.(Continued on next page)