School of Medicine and Health Management, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, HuBei Province, China.
BMC Health Serv Res. 2013 Mar 25;13:114. doi: 10.1186/1472-6963-13-114.
The World Health Report 2000 stated that increased public financing for healthcare was an integral part of the efforts to achieve equity of access. In 2009, the Chinese government launched a three-year health reform program to achieve equity of access. Through this reform program, the government intended to increase its investment in primary healthcare institutions (PHIs). However, reports about the outcome and the improvement of the equity of access have yet to be presented.
Stratified sampling was employed in this research. The samples used for the study comprised 34 community health service centers (CHSCs) and 92 township hospitals (THs) from six provinces of China. Collected data, which were publicly available, consisted of the total revenue, financial revenue, and the number of people for the periods covering January 2010 to September 2010 and January 2011 to September 2011. Revenue information for 2009 and 2010 was obtained from China's Health Statistics Yearbook.By using indicators such as government investment, government finance proportion and per capita revenue, t-tests for paired and independent samples were used to analyze the changes in government investment.
Government invest large amount of money to the primary healthcare institutions. Government finance proportion in 2008 was 18.2%. This percentage increased to 38.84% in 2011, indicating statistical significance (p = 0.000) between 2010 and 2011. The per capita financial input was 20.92 yuan in 2010 and 31.10 yuan in 2011. Compared with the figures from 2008 to 2010, the gap in different health sectors narrowed in 2011, and differences emerged. The government finance proportion in CHSCs revenue was 6.9% higher than that of THs, while the per capita revenue of CHSCs was higher. In 2011, the highest and lowest government finance proportions were 48.80% (Shaanxi) and 19.36% (Shandong), respectively. In that same year, the per capita revenue of Shaanxi (40.69 Yuan) was higher than that of Liaoning (28.79 Yuan). Comparing the 2011 figures with those from 2008 to 2010, the gap in 2011 clearly narrowed.
In the three-year health reform program, the Chinese government increased its investment to PHIs gradually and significantly. Thus promote equity to access and universal coverage. However, the increase in government investment stemmed from political desire and from the lack of institutionalization of practice and experience. Hence, a mode of financial allocation must be formulated to promote consistency in government input after the three-year health reform program.
《世界卫生报告 2000》指出，增加公共卫生投入是实现公平可及的重要组成部分。2009 年，中国政府启动了为期三年的卫生改革计划，以实现公平可及。通过这项改革计划，政府打算增加对基层医疗机构的投资。然而，有关结果和公平可及性改善的报告尚未公布。
本研究采用分层抽样。研究使用的样本包括中国六个省份的 34 个社区卫生服务中心（CHSCs）和 92 个乡镇卫生院（THs）。收集的数据是公开的，包括 2010 年 1 月至 9 月和 2011 年 1 月至 9 月期间的总收入、财政收入和人数。2009 年和 2010 年的收入信息来自《中国卫生统计年鉴》。使用政府投资、政府财政比例和人均收入等指标，对 2010 年和 2011 年的政府投资变化进行配对和独立样本 t 检验。
政府向基层医疗机构投入了大量资金。2008 年政府财政比例为 18.2%，2011 年增至 38.84%，具有统计学意义（p=0.000）。2010 年人均财政投入为 20.92 元，2011 年为 31.10 元。与 2008 年至 2010 年的数据相比，2011 年不同卫生部门之间的差距缩小，差异显现。CHSCs 收入中政府财政比例比 THs 高 6.9%，而 CHSCs 的人均收入较高。2011 年，政府财政比例最高和最低的分别为 48.80%（陕西）和 19.36%（山东）。同年，陕西人均收入（40.69 元）高于辽宁（28.79 元）。与 2008 年至 2010 年的数据相比，2011 年的差距明显缩小。
在三年卫生改革计划中，中国政府逐渐显著增加了对基层医疗机构的投资。从而促进公平可及和全民覆盖。然而，政府投资的增加源于政治意愿，缺乏制度化的实践和经验。因此，在三年卫生改革计划之后，必须制定一种财政分配模式，以促进政府投入的一致性。
