Asia Health Policy Program, Walter H, Shorenstein Asia-Pacific Research Center, Stanford University, 616 Serra St,, Encina Hall E311, Stanford, CA, 94305-6055, USA.
Health Econ Rev. 2013 Jan 17;3(1):1. doi: 10.1186/2191-1991-3-1.
Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China's recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance.We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services.
争议围绕着私营部门在医疗服务提供中的作用，包括初级保健和人口健康服务。中国最近的卫生改革呼吁对私营提供者不歧视，并强调加强初级保健，但正式的外包举措仍然很少，相关的实证证据也非常有限。本文介绍了中国山东省将私营提供者纳入城市初级和预防保健服务的合同案例研究。该案例研究借鉴了三个主要的数据来源：行政记录；对潍坊和城市 Y 的 1600 多名社区居民进行的家庭调查；以及对潍坊和城市 Y 的 1000 多名社区卫生站（CHS）工作人员进行的提供者调查。我们用对关键信息提供者的一对一深入访谈补充了定量数据，包括负责公共卫生和政府财政的地方官员。我们发现患者构成存在显著差异：由私营社区卫生站服务的社区的居民社会经济地位较低（更有可能没有保险，健康状况较差），而由政府拥有的 CHS 服务的社区的居民社会经济地位较高。对 1013 名居民的家庭调查分析表明，如果他们的社会经济地位较低（以教育或收入衡量），他们更愿意在附近的 CHS 进行常规健康检查。在控制了规模和其他 CHS 特征后，潍坊的政府和私营社区卫生站在合同维度上的表现没有统计学差异。相比之下，对比城市 Y 的表现较低，并且公共和私营提供者之间存在很大差距。我们讨论了这些模式出现的原因，以及政策制定者和居民认为初级保健服务的主要问题和关注点是什么。
