What should the government do regarding health policy-making to develop community health care in Shanghai?

• Published in: The International journal of health planning and management 2011-10, Vol.26 (4), p.379-435
• Main Authors: Yu, Yun, Sun, Xiaoming, Zhuang, Yuehong, Dong, Xuefen, Liu, Hongwei, Jiang, Ping, Yu, Zhoudong, Zhang, Yin
• Format: Article
• Language: English
• Subjects: China; China (People's Republic); Community health care; community health service; Community Health Services; Delivery of Health Care - organization & administration; Delphi Technique; Female; government controlled payment system; Health administration; Health care expenditures; Health care policy; Health Care Reform; Health needs; Health Policy; Health Services Needs and Demand; Humans; Male; Medical services; Medical technology; Medical treatment; Policy Making; Profits; Public health; Reforms; Shanghai, China; Socioeconomic factors; State Medicine - organization & administration; Surveys and Questionnaires
• ISSN: 0749-6753; 1099-1751
• DOI: 10.1002/hpm.1117

SUMMARY Background The traditional three‐stratum healthcare system, within which municipal, district and community hospitals all paid great attention to improving medical treatment service by developing medical technology, is no longer able to meet the current health needs in Shanghai. In 1997, the Chinese government called for the development of community health services to serve as a basic platform to provide public health service and basic medical cure. However, because the market‐oriented economic reform was based on a fee‐for‐service mechanism (without a strict monitoring system), most community health centers (CHCs) still put great effort into developing medical services geared to profit, rather than to provide proper medical service for all and a “quality” public health service. To try to solve the problem, some government‐controlled payment (GCP) system has been implemented in CHCs gradually in districts of Shanghai. The study intended to evaluate the impact of GCP solutions already implemented, as well as the impact of the standardized GCP system with supplementary solutions, in enabling CHCs to focus on providing quality public health services and appropriate medical treatment, rather than focusing on profit and loss, in order to meet the health needs aroused by major socioeconomic transition in Shanghai. Method In order to make a systematic assessment, a standardized form of GCP was piloted for 6 months in Changning, Zhabei, and Songjiang districts, representing rich urban, poor urban and rich rural districts, respectively. We employed an evaluation index system with 26 indicators, based on a systematic review of literature and two rounds of Delphi consultation. The evaluation index system investigates four main themes of the reform: the government's role, the reform measures, the performance of CHC services and satisfaction with CHC services. We conducted an evaluation of the impact of both various types of GCP implemented in recent years and the standardized GCP system used during the more recent pilot project conducted across districts with different socioeconomic profiles. Cross‐sectional comparisons between the pilot districts and control districts with similar socioeconomic context were also carried out to observe further the impact of the GCP system. Result Various GCP systems were implemented in 2006 in Changning and Songjiang district and in 2007 in Zhabei district. These GCP systems were standardized in April 2009 and piloted for 6 mon