School of Public Policy and Management, Tsinghua University, Beijing 100084, PR China.
Health Policy. 2011 May;100(2-3):181-8. doi: 10.1016/j.healthpol.2010.10.003. Epub 2010 Oct 30.
To track and evaluate the effectiveness since 2007 of urban health reform policies in Beijing that provided universal health insurance and strengthened local government-owned community health centers (CHCs).
Pre- and post-reform data on outpatient visits, staff, and financial statements among all CHCs in a district in Beijing were analyzed by the nonparametric Kruskal-Wallis method. Field surveys were also conducted to supplement the statistical analysis.
The post-reform data showed a substantial increase in outpatient visits at the district level, but the number of outpatient visits was flat at the CHC level. In addition, short-term CHC responses to reform policies, such as employment growth, and operating expense-to-revenue ratio, have not been cost effective.
The overall increase in outpatient visits at the district level, including at large hospitals, conceals the fact that CHCs within the district were unable to attract a greater number of patients. The lack of operational efficiency in the process of establishing and transforming CHCs may put the primary care system at financial risk in the long run. Well-synchronized policy measures should be considered in future reforms, especially in shaping the behaviors of patients, CHCs, and physicians.
自 2007 年以来，追踪和评估北京市城市卫生改革政策的效果，这些政策提供了全民健康保险，并加强了地方政府所有的社区卫生服务中心（CHC）。
通过非参数 Kruskal-Wallis 方法分析了北京市一个区所有 CHC 的门诊量、人员和财务报表的改革前后数据。还进行了实地调查，以补充统计分析。
改革后的区级门诊量数据显示出大幅增加，但 CHC 层面的门诊量持平。此外，CHC 对改革政策的短期反应，如就业增长和运营费用与收入比，并没有带来成本效益。
区级，包括大医院，门诊量的整体增加掩盖了一个事实，即区内的 CHC 无法吸引更多的患者。在建立和改革 CHC 的过程中缺乏运营效率，从长远来看，可能会使初级保健系统面临财务风险。在未来的改革中，应考虑采取协调一致的政策措施，特别是在塑造患者、CHC 和医生的行为方面。
