Yang Li, Sun Li, Wen Liankui, Zhang Huyang, Li Chenyang, Hanson Kara, Fang Hai
School of Public Health, Peking University Health Science Center, Beijing, China.
China Center for Health Development Studies, Peking University, No 38 Xueyuan Road, Haidian District, Beijing, China.
Int J Equity Health. 2016 Dec 1;15(1):194. doi: 10.1186/s12939-016-0482-x.
In 2009, China launched a health reform to promote the equalization of national essential public health services package (NEPHSP). The present study aimed to describe the financing strategies and mechanisms to improve access to public health for all, identify the strengths and weaknesses of the different approaches, and showed evidence on equity improvement among different regions.
We reviewed the relevant literatures and identified 208 articles after screening and quality assessment and conducted six key informants' interviews. Secondary data on national and local government health expenditures, NEPHSP coverage and health indicators in 2003-2014 were collected, descriptive and equity analyses were used.
Before 2009, the government subsidy to primary care institutions (PCIs) were mainly used for basic construction and a small part of personnel expenses. Since 2009, the new funds for NEPHSP have significantly expanded service coverage and population coverage. These funds have been allocated by central, provincial, municipal and county governments at different proportions in China's tax distribution system. Due to the fiscal transfer payment, the Central Government allocated more subsides to less-developed western regions and all the funds were managed in a specific account. Several types of payment methods have been adopted including capitation, pay for performance (P4P), pay for service items, global budget and public health voucher, to address issues from both the supply and demand sides. The equalization of NEPHSP did well through the establishment of health records, systematic care of children and maternal women, etc. Our data showed that the gap between the eastern, central and western regions narrowed. However the coverage for migrants was still low and performance was needed improving in effectiveness of managing patients with chronic diseases.
The delivery of essential public health services was highly influenced by public fiscal policy, and the implementation of health reform since 2009 has led the public health development towards the right direction. However China still needs to increase the fiscal investments to expand service coverage as well as promote the quality of public health services and equality among regions. Independent scientific monitoring and evaluation are also needed.
2009年，中国启动了一项卫生改革，以促进国家基本公共卫生服务包（NEPHSP）的均等化。本研究旨在描述改善全民公共卫生服务可及性的筹资策略和机制，识别不同方法的优缺点，并展示不同地区在公平性改善方面的证据。
我们查阅了相关文献，经过筛选和质量评估后确定了208篇文章，并进行了6次关键信息提供者访谈。收集了2003 - 2014年国家和地方政府卫生支出、NEPHSP覆盖情况及卫生指标的二手数据，采用描述性分析和公平性分析方法。
2009年之前，政府对基层医疗卫生机构（PCIs）的补贴主要用于基本建设和一小部分人员费用。自2009年以来，NEPHSP的新增资金显著扩大了服务覆盖范围和人群覆盖范围。这些资金在中国的税收分配体系中由中央、省、市、县政府按不同比例分配。由于财政转移支付，中央政府向欠发达的西部地区分配了更多补贴，且所有资金都在一个特定账户中管理。采用了几种支付方式，包括按人头付费、绩效付费（P4P）、按服务项目付费、总额预算和公共卫生券，以从供需双方解决问题。通过建立健康档案、对儿童和孕产妇进行系统保健等措施，NEPHSP的均等化取得了良好成效。我们的数据显示，东部、中部和西部地区之间的差距缩小了。然而，流动人口的覆盖率仍然较低，慢性病患者管理的有效性方面仍需提高。
基本公共卫生服务的提供受到公共财政政策的高度影响，2009年以来卫生改革的实施引领了公共卫生朝着正确方向发展。然而，中国仍需增加财政投入以扩大服务覆盖范围，提高公共卫生服务质量并促进地区间公平。还需要独立的科学监测和评估。
