Evaluation of the effects of comprehensive reform on primary healthcare institutions in Anhui Province

Abstract

BackgroundIn 2009, the Chinese Central Communist Party and the China State Council started to implement comprehensive healthcare reforms. The first round of reforms, involving Anhui province, was from 2009 to 2011, and focused on primary healthcare institutions. This study conducts an initial assessment of the effects of specific parts of the reforms in Anhui.MethodsMixed quantitative and qualitative methods were adopted for data collection. Seven hundred and three health institutions from 15 counties were randomly chosen. The practices, development, effects, problems, and other relevant information related to the reform were classified into four aspects: medicine management; personnel systems and income distribution mechanisms; compensation mechanisms for primary healthcare institutions; and strengthening the primary healthcare system. The effects of reform were analyzed by evaluating changes in compensation channels, visit costs, diagnosis and treatment structure, hardware, structures, efficiency, and behavior.ResultsA new system for authorizing drugs resulted in a total of 857 new drugs being accessible at agreed prices through primary healthcare institutions in Anhui. The cost of the average outpatient visit decreased from 35.29 RMB to 31.64 RMB, although for inpatients, the average cost increased from 799.05 RMB to 992.60 RMB. The number of healthcare personnel decreased, but their workloads increased. The total revenue from government sources increased by 41.09%, and the proportion of revenue from drugs decreased by 25.19%. The rate of diagnosis and treatment visits and outpatient visits to primary healthcare institutions increased. Finally, between 2008 and 2010, 1,195 standardized township hospitals, 14,134 village clinics, and 1,234 community health service institutions were constructed.ConclusionThe reform of primary healthcare institutions in Anhui has improved the personnel structures surrounding frontline healthcare workers, increased their incomes, improved work efficiency, and changed the compensation patterns of primary healthcare institutions, improved hardware, reduced drug prices, and, to some extent, improved the diagnosis and treatment structure. However, the reforms have not radically changed the behavior of medical workers or the visit patterns of patients. Approaches such as strengthening performance evaluation, and carrying out initiatives to further mobilize frontline healthcare workers, enhance rational drug use through improved training and educate patients, should be undertaken in the future.

Enhanced Performance of Community Health Service Centers during Medical Reforms in Pudong New District of Shanghai, China: A Longitudinal Survey

“…In China, the state-owned health institutions obtain their funding from a variety of sources, and CHSCs rely mainly on the local governmental support plus running-profit, while other public hospitals are more likely to be self-sufficient, gaining their profits from prescription drugs [ 18 ]. Therefore, the configuration for a CHSC is in accordance with the local economy, size of the area and local population.…”

Availability, cost, and prescription patterns of antihypertensive medications in primary health care in China: a nationwide cross-sectional survey

“…The pharmaceutical policy has also evolved quickly in recent years, such as allowance for primary health care sites to procure non-essential medicines in 2014 and abolishment on the government price ceiling in (Appendix 1). While availability of medications may have increased after the National Essential Medicine Policy was launched, [12][13][14] little is known about current patterns of access to antihypertensive medications across Chinese PHC settings, where higher financial burdens and limited medication choices may result in lower treatment and control rates. This information is essential for developing targets for interventions that are designed to improve national hypertension treatment and control.…”

Motivating factors on performance of primary care workers in China: a systematic review and meta-analysis

“…As for the risk of bias, more than half of the included studies presented a low risk of bias, with the total score ranging from 6 points to 10 points (in online supplementary appendix 3). Included studies analysed the motivation of PCWs from different perspectives: some measured job satisfaction15–30; some explored the motivating factors’ influence on attrition and retention18 22 31–35; some studied the impact of some policies or interventions on the motivating factors for health workers 31 36–46…”

“…Another line of inquiry explored the impact of different health system reform policies on motivating factors. For example, in a qualitative study, administrators and front line healthcare workers in PHC institutions mentioned that the increased income after the 2009 health system reforms did not fully reflect the increased workload, and those who worked the most were not necessarily rewarded the most, constituting a demotivating factor for some health workers 37…”