School of Health Service Management, Anhui Medical University, Hefei, China.
The First Affiliated Hospital, University of Science and Technology of China, Hefei, China.
JMIR Public Health Surveill. 2022 Jul 22;8(7):e31289. doi: 10.2196/31289.
Public health service is an important component and pathway to achieve universal health coverage (UHC), a major direction goal of many countries. China's National Basic Public Health Service Program (the Program) is highly consistent with this direction.
The aim of this study was to analyze the key experience and challenges of the Program so as to present China's approach to UHC, help other countries understand and learn from China's experience, and promote UHC across the world.
A literature review was performed across five main electronic databases and other sources. Some data were obtained from the Department of Primary Health, National Health Commission, China. Data obtained included the financing share of the national/provincial/prefectural government among the total investment of the program in 32 provinces in 2016, their respective per capita funding levels, and some indicators related to program implementation from 2009 to 2016. The Joinpoint regression model was adopted to test the time trend of changes in program implementation indicators. Face-to-face individual interviews and group discussions were conducted with 48 key insiders.
The program provided full life cycle service to the whole population with an equitable and affordable financing system, enhanced the capability and quality of the health workforce, and facilitated integration of the public health service delivery system. Meanwhile, there were also some shortcomings, including lack of selection and an exit mechanism of service items, inadequate system integration, shortage of qualified professionals, limited role played by actors outside the health sector, and a large gap between the subsidy standard and the actual service cost. The Joinpoint regression analysis demonstrated that 13 indicators related to program implementation showed a significant upward trend (P<.05) from 2009 to 2016, with average annual percent change values above 10% for 6 indicators and below 6% for 7 indicators. Three indicators (coverage of health records, electronic health records, and health management among the elderly) rose rapidly with annual percent change values above 30% between 2009 and 2011, but rose slowly or remained stable between 2011 and 2016. In 2016, the subsidy standard per capita in the eastern, central, and western regions was equivalent to US $7.43, $7.15, and $6.57, respectively, of which the national-level subsidy accounted for 25.50%, 60.57%, and 79.52%, respectively.
The Program has made a significant contribution to China's efforts in achieving UHC. The Program focuses on a key population and provides full life cycle services for the whole population. The financing system completely supported by the government makes the services more equitable and affordable. However, there are a few challenges to implementing the Program in China, especially to increase the public investment, optimize service items, enhance quality of the services, and evaluate the health outcomes.
公共卫生服务是实现全民健康覆盖（UHC）的重要组成部分和途径，是许多国家的主要方向目标。中国的国家基本公共卫生服务项目（项目）与这一方向高度一致。
本研究旨在分析该项目的关键经验和挑战，以展示中国实现 UHC 的方法，帮助其他国家了解和借鉴中国的经验，并促进全球 UHC。
在五个主要电子数据库和其他来源进行了文献回顾。一些数据来自中国国家卫生健康委员会基层卫生司。获取的数据包括 2016 年全国 32 个省项目总投资中中央、省、地（市）政府的筹资份额、各自的人均筹资水平以及 2009 年至 2016 年与项目实施相关的一些指标。采用 Joinpoint 回归模型检验项目实施指标的时间变化趋势。对 48 名关键内部人士进行了面对面的个人访谈和小组讨论。
该项目以公平和负担得起的融资系统为全人群提供全生命周期服务，增强了卫生人力的能力和素质，促进了公共卫生服务提供系统的整合。同时，也存在一些不足，包括服务项目缺乏选择和退出机制、系统整合不足、合格专业人员短缺、卫生部门以外的行为者作用有限以及补贴标准与实际服务成本之间存在较大差距。Joinpoint 回归分析表明，2009 年至 2016 年，与项目实施相关的 13 项指标呈显著上升趋势（P<.05），其中 6 项指标的年均变化率超过 10%，7 项指标的年均变化率低于 6%。2009 年至 2011 年，有 3 项指标（健康记录覆盖率、电子健康记录和老年人健康管理）的年变化率超过 30%，但 2011 年至 2016 年，这些指标的年变化率增长缓慢或保持稳定。2016 年，东部、中部和西部地区的人均补贴标准分别相当于 7.43 美元、7.15 美元和 6.57 美元，其中中央财政补贴分别占 25.50%、60.57%和 79.52%。
该项目为中国实现 UHC 做出了重要贡献。该项目以重点人群为重点，为全体人口提供全生命周期服务。政府完全支持的融资系统使服务更加公平和负担得起。然而，在中国实施该项目仍存在一些挑战，特别是需要增加公共投资、优化服务项目、提高服务质量和评估健康结果。
